1. How do injectable fertility agents work?
2. What should I expect during treatment?
3. What is an IUI?
4. What is "washed" sperm?
5. How successful is this therapy?
6. Are there side effects from gonadotropin therapy?
7. Are there risks from this therapy?
8. What is the cost for this therapy?

How do injectable fertility agents work?
During a natural menstrual cycle, hormones from the pituitary gland (LH & FSH) cause the growth of a fluid-filled cavity, or follicle, within the ovary. Although several follicles start to grow each month, in a natural cycle only one will become mature enough to ovulate its egg.

Pergonal, Puregon, and Gonal-F are commercially available, natural forms of LH and/or FSH. Together, they are known as gonadotropins. Gonadotropins have been used for approximately 35 years to induce or augment ovulation when all other simpler forms of treatment have been unsuccessful.

Gonadotropins are not absorbed by mouth, so they must be given by injection. However, when injected (rather than secreted naturally from the pituitary gland), gonadotropins tend to stimulate the growth of more than one follicle. Close monitoring (by blood tests and ultrasounds) is therefore necessary to minimize complications such as ovarian overstimulation and multiple pregnancies.

A second medication (hCG) is given to trigger ovulation when blood tests and ultrasounds indicate one to four mature follicles. Ovulation usually occurs 36-48 hours after this final injection.

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What should I expect during treatment?
The treatment usually starts on day 3 or 4 of a menstrual cycle and lasts approximately 8-12 days. We will teach you or your partner to give your daily injections at home.

You will have clinic appointments every one to four days for blood tests and/or vaginal ultrasound scans in order to monitor your response and possibly adjust your dose. These visits will occur between 8:00 and 9:00 a.m. and will become more frequent toward the time of ovulation. Although each woman and each cycle is different this is an example of a treatment cycle schedule:

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What is an IUI?
Sometimes, we offer an intrauterine insemination (IUI) with your partner's sperm instead of, or in addition to intercourse. This usually occurs approximately 36 hours after the hCG injection. A speculum is placed in your vagina and a small tubing (catheter) is passed through your cervix into your uterus. The sperm is slowly injected directly into the uterine cavity and the catheter withdrawn. The procedure takes only a few minutes and should be relatively painless.

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What is "washed" sperm?
In nature, sperm are deposited in the vagina and then they have to swim through the cervical mucus (which traps lots of sperm). By doing an IUI, there may be more sperm available at the site of fertilization, since the cervix is bypassed. Because the sperm are placed directly into the uterus in an IUI, they have to be washed first, to get rid of any dead cells, bacteria, and the seminal fluid. The sperm wash procedure takes about 1 hour, so the IUI procedure is scheduled 1 ½ hours after the sperm collection procedure to allow the laboratory staff enough time to prepare the sperm for insemination.

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How successful is this therapy?
In the general population, about 20 to 25% of healthy fertile couples become pregnant each month they try. In contrast, the pregnancy rate among couples with infertility is usually about 2 to 5% per month. Gonadotropins usually produce pregnancy rates of about 10 to 15% per cycle, depending on the woman’s age, diagnosis and duration of infertility. Among women with certain ovulatory disorders, gonadotropins may even restore normal fertility rates of 20 to 25% per month. If you do not become pregnant within the first three treatment cycles, we will discuss other options with you.

Approximately 10-20% of pregnancies will miscarry, which is not substantially different than the general population. There is no increase in the risk of congenital abnormalities, ectopic pregnancies or birth defects as compared to other women your age.

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Are there side effects from gonadotropin therapy?
Because your ovaries will be stimulated to produce more than one follicle at a time, you may find that your usual menstrual cycle symptoms are exaggerated. You may experience bloating, breast tenderness, cramping, pelvic "twinges", fatigue or headaches.

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Are there risks from this therapy?
Most women will produce 1-4 mature follicles during treatment. Although not every follicle contains an egg, the ovaries may occasionally overstimulate and produce too many mature follicles. We try to minimize this by frequent monitoring and dose adjustments.

Although ovulating more than one egg may increase your chances of conceiving, it will also increase your chance of having a multiple pregnancy. Between 15-25% of all gonadotropin pregnancies are twins (depending on the woman's age and the cause of her infertility) while 1-3% of pregnancies result in triplets or more. In such cases, a reduction procedure could be considered to reduce a higher multiple pregnancy down to twins if this is considered desirable by the patient or couple.

In about 1% of cases, ovarian hyperstimulation syndrome (OHSS) may develop. In such cases the ovaries become extremely enlarged and extra fluid accumulates in the abdomen. This is a serious complication, which requires bed-rest, intravenous fluids or even drainage of the abdominal fluid. Rarely hospitalization may become necessary.

If we think you are at high risk for a multiple pregnancy or OHSS, we may withhold the ovulating injection of hCG and "cancel" the cycle. Alternately, we may suggest converting the cycle to an IVF cycle as a safety measure. By retrieving the eggs from the ovaries and transferring a limited number of embryos back to the uterus, we can decompress the ovaries and potentially lower the risk of multiple pregnancy and OHSS. There is an additional fee for an IVF conversion.

Fertility drugs have not been proven to increase the risk of breast, ovarian or uterine cancer. Women who have never been pregnant have a higher risk of breast or ovarian cancer. Several large follow up studies provide reassurance that this risk is not increased following the use of fertility drugs. Past or future use of the birth control pill can lower your risk of ovarian cancer. A yearly physical exam is important for the prevention and early detection of all diseases.

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What is the cost of ovulation induction?
Please refer to our fee guide for specific costs.

Although no two cycles are the same, medication costs usually range between $700 and $1500 for each cycle. There is an additional cost for injection supplies. You should check with your extended benefits carrier to see if any of the drugs are covered, to what extent, and for how many treatment cycles.