FSH, Follicle Stimulating Hormone
Pergonal was the first “FSH” containing product released for ovulation induction (stimulation of egg development within the ovarian follicles). Pergonal was a “natural” product being derived from the urine of postmenopausal women. After menopause, the level of FSH rises because there are no viable eggs. Pergonal had equal amounts of FSH and luteinizing hormone (LH). Urinary derived products today that are similar to Pergonal include Repronex, and Menopur. Bravelle is also a urinary derived product that has been highly purified to remove most of the LH. These products contain varying ratios of FSH to LH activity that can be mimicked by chorionic gonadotropin [hCG]).
Newer FSH products include Gonal-F and Follistim which are derived from genetic recombinant technology using mammalian cells. Essentially the gene responsible for human FSH is cloned and placed in mammalian cell cultures which then begin to manufacture FSH. Large quantities of these cells are produced to provide the commercially available products.
For many years there has been an ongoing debate about the need for small quantities of LH in the FSH stimulation cycle. Many physicians use pure FSH alone in IVF and stimulated IUI protocols whereas others add one of the urinary derived products. Clinically there appears to be little difference between these two protocols except in certain patient types like the polycystic ovarian syndrome patient or when patients are using products to suppress the pituitary (in order to prevent premature release of the egg) such as leuprolide acetate (Lupron) or a GnRH antagonist (Ganirelix or Cetrotide).
Other infertility specialists prefer to use the natural urinary derived products because they are often less expensive than the genetically produced products. Ovulation induction drugs are a major contributor to total treatment cost.
Clinically all of these products stimulate follicular development and have varying effects on endometrial development. Whereas Pergonal was administered intramuscularly using a large, long needle, all of these products can now also be given subcutaneously (small short needle). Injection administration will be taught during the IVF class we offer at RCC's Utah IVF clinic.
FSH is administered by injection. Different protocols and dosages must be individualized during treatment. Dosage adjustments are made based upon the results of follicular ultrasound scans and estradiol hormone measurements. Lupron and Ganirelix or Cetrotide enable control over the length of the follicular phase and when ovulation will occur. Patients must come to our office for regular monitoring during the ovarian stimulation phase of the treatment cycle.
FSH should be administered by a reproductive endocrinologist/infertility specialist thoroughly trained in its use. These products can cause serious side effects if not administered and monitored properly. This applies to IVF patients as well as those undergoing stimulated intrauterine insemination cycles (IUI).
Once the follicles mature, an injection of human chorionic gonadotropin (hCG) is given to stimulate ovulation and release of the mature eggs. In a natural cycle, ovulation is stimulated by a spike in the LH level. The body responds to the hCG surge in the same manner as LH.
Ovidrel is a genetically produced product that is identical to the body’s hCG . Pregnyl, Novarel and Profasi are natural urinary derived hCG products that produce the same effect at about half the cost. Ovidrel does have the advantage that it is prepackaged in a ready to use syringe with a needle and has less skin reaction than the natural product.
Luveris is a new recombinant pure LH that some fertility specialists use to trigger ovulation.
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