Fertility Medications: FSH & HMG (Subcutaneous Injections)
What are Injectable Drugs?
FSH (Gonal F or Follistim) and HMG (Menopur) are medications which are given by injection to stimulate the ovaries to develop multiple follicles (which contain eggs). These medications are given for fertility therapy to mature multiple eggs. Women typically produce only mature one egg in a natural cycle. These meds can also be used in women who do ovulate to increase their chances of pregnancy by making more eggs available for fertilization through ovulation (this is called COH: controlled ovarian hyperstimulation) or by retrieving them for IVF.
Monitoring Your Safe Response
Women respond to these fertility medications at different rates, so careful monitoring with vaginal ultrasound and blood estrogen testing is critical to achieve proper, individualized response. The purpose of this monitoring is to make sure that an appropriate number of eggs are maturing thereby allowing us to optimize chances of conception. Monitoring also helps with determining trigger ovulation day or retrieval day in IVF, when the eggs reach a certain maturity level.
A baseline ultrasound scan is done at the beginning of your cycle (day 1, 2, or 3) prior to beginning the medications to ensure that the ovaries appear normal, without cysts, especially if the drugs were used in the previous cycle. After several days of injections, additional ultrasound and estrogen testing is performed, until the follicles are measured to be a precise size and the corresponding level of estrogen in your blood reaches a particular level. At this point, the eggs are felt to be mature, or ready, and we then instruct that you take the HCG shot (Ovidrel). Ovulation then begins approximately 36 to 40 hours later, and intercourse or IUI or IVF is timed accordingly.
Some side effects which may be observed during a medication cycle are breast tenderness, mood swings, bloating, tiredness, and pelvic discomfort. Many women form temporary cysts on their ovaries after ovulation. These cysts do not usually cause any problems other than some pelvic fullness, and they always eventually go away. Sometimes, however, these cysts will grow to considerable size and may cause significant abdominal bloating or pain. The resulting condition is referred to as hyperstimulation and varies from mild to severe. Please call us if you have any problems during this time and particularly if you experience dizziness, decreased urination, shortness of breath, or a weight gain of more than 5 pounds.
These drugs are associated with an increased risk of multiple births in superovulation. This incidence of multiple pregnancies is approximately 25%, usually twins. Less than 5% of the total pregnancies result in triplets, and less than 1 % are higher-order (quadruplets or more). There is no evidence that miscarriages or birth defects are more common with these drugs. There is also no evidence that these medications cause the development of an earlier menopause or any other maternal complication such as the later development of ovarian cancer. Ovarian Hyperstimulation Syndrome (OHSS) is a potentially serious complication. OHSS will be described to you in detail in your injection class, videotape, and consent forms, which we require you to view before you get started.