Ovarian Stimulation

What are the commonly used medications for ovarian stimulation?

Medications are needed to stimulate multiple egg development in the ovaries. Clomiphene Citrate is usually the first drug to be used in OI and IUI. Some of the well known side effects include vaginal dryness, thinning of the endometrial lining. Due to the lower efficacy of this drug, some other medications can be used.

The most commonly used medications are the conventional type of human menopausal gonadotropin (hMG), highly-purified hMG（hp-hMG, MENOPUR®), highly-purified human FSH (HP-hFSH) and recombinant FSH (rFSH).

hMG and HP-hMG contain both FSH and LH activity. LH is a hormone present in all healthy woman. LH is important for follicular development. LH is also needed to support the development and maturation of large follicle.5 Due to the importance of LH, recombinant LH is also available in the market to supplement rFSH. However, two injections will be needed if additional LH is injected separately and so the treatment cost will also increase. The use of hMG or HP-hMG can supply LH activity in a single injection which is both time and cost saving.

Comparison between commonly used medications in ovarian stimulation

• 1. Coomarasamy A et al., Human Reproduction 2008; 23(2): p 310-315
• 2. Al-Inany et al., Reproductive Biomedicine Online 2007; 16(1): 81-88
• 3. European and Israeli Study Group on Highly Purified Menotropin versus Recombinant Follicle-Stimulating Hormone, Fertility & Steriity 2002; 78(3): p. 520-8
• 4. Smitz J et al., Human Reproduction 2007; 22(3): p. 676-687
• 5. Weghofer A et al., Human Reproduction 2008; 23(3): p.499-503
• 6. Ziebe S et al., Human Reproduction 2007; p. 2404-13
• 7. William R Keye et al., Reproductive Biology and Endocrinology 2005; 3:62
• 8. Freedman MF et al., Fertility & Sterility 2007; 87(4) Supp. 2: p. S14-S15
• 9. Wolfenson C et al., Reprod Biomed Online 2005;10(4): 442-54
• 10. Filicori M et al., Fertility & Sterility 2005; 84(2): p. 275-84
• 11. http://www.drugs.com/pro/gonal-f.html
• 12. Karen L et al., BioDrugs 1998; 9(3): p. 235-250

Calendar for Gonadotropin Development

How to inject?

All infertility medications are administered by intramuscular (in the muscle) or subcutaneous (under the skin) injection. Due to the high purity of the newly developed product, most of the medications can be injected under the skin, which is a convenient procedure with minimal painfulness. The idea of giving yourself injection may not be as scary as it seems.

All required are appropriate teaching by staff from the IVF team and a bit of practice. By learning how to give the daily injections, not only that you and your partner will have greater flexibility and control over your treatment, but it also reduces the amount of time and money from travelling to the clinics on a daily basis, and gives your partner an opportunity to get involve in the process.

Most of you will find it difficult to give the first injection, however, it will become easier with practice. Here are some tips that may help to elevate the discomfort from the injection:

• Relax, take a deep breath and quickly slide the needle into the skin
• Choose a different injection site each day
• Do not spend too much time on thinking before the injection
• Always follow your doctor’s instructions about when and how to give the injections
• If you are really afraid, it may help to visualise the reason of why you are going through this IVF treatment

Possible side effects of injecting infertility medications include:

• Redness, pain or irritation from the shot (which is eliminated by the development of highly-purified medications)
• Breast tenderness
• Fatigue
• Increased risk for multiple births, which may increase the risks of miscarriage and premature delivery.
• Enlarged ovaries, which can cause abdominal pain.
• Dehydration, which may increase risk of a blood clot.
• Ovarian hyperstimulation syndrome (OHSS), which is a rare but serious condition when too many follicles develop in response to the medication. Symptoms may include severe pain in the pelvis, abdomen, and chest, nausea, vomiting, bloating, weight gain, and difficulty breathing. Call your doctor immediately if you have any of these symptoms.