Medication

Understanding Hormone Therapy

Sometimes, hormone therapy is needed to help a woman's ability to conceive.

The type of medicine used depends upon which phases of the infertility treatment cycle you are in. It's a relatively common treatment.

A woman usually receives hormone therapy while she undergoes either ovulation induction (OI) or assisted reproductive technologies (ART) treatments.

Follicular phase

During the first 13 days of a woman's cycle, follicles in her ovaries begin to produce a single mature egg. During this phase, Gonal-f® (follitropin alfa for injection), a follicle stimulating hormone (FSH), may be prescribed to help stimulate the development of the follicles. If a woman has been diagnosed with profound luteinizing hormone (LH) deficiency (less than 1.2 IU/liter), Luveris® (lutropin alfa for injection), an LH, may also be prescribed to aid in stimulating follicular development in profoundly LH-deficient hypogonadotropic hypogonadal (HH) women (LH< 1.2 IU/L).

Throughout the cycle, timing is very important. During this phase, a woman's body releases a hormone called estradiol. If the level of estradiol gets too high too early, it can trigger a premature surge of LH that leads to early ovulation. So Cetrotide® (cetrorelix acetate for injection) may be used in controlled ovarian stimulation to delay this surge until the developing follicles are ready. Around the 11th day, treatment with Gonal-f® is stopped and the woman may receive a single injection of Ovidrel® PreFilled Syringe (choriogonadotropin alfa injection). Ovidrel® PreFilled Syringe mimics the surge of LH, which triggers the final step in the follicular phase. The hormone in Ovidrel® PreFilled Syringe causes the final maturation of the eggs and their release from the ovaries. This is called ovulation.

If the woman is undergoing OI, this is the time for intrauterine insemination (IUI). The sperm is inserted into the reproductive tract in an attempt to fertilize the egg.

In ART, if the woman is undergoing in vitro fertilization (IVF), the eggs are instead retrieved and brought together with the male's sperm in a laboratory in order to create an embryo.

Luteal phase

Once ovulation occurs, the body naturally begins releasing progesterone to prepare the endometrium (lining of the uterus) to receive the embryo.

Some women's bodies, however, don't produce enough progesterone on their own. Because of low progesterone, the endometrium may not develop the thick, nourishing lining required for pregnancy. As a result, an embryo cannot attach and get the nourishment it needs to develop. A woman may need a medication to supplement her own progesterone. This medication helps prepare and later maintain the uterine lining for the embryo.

During this phase, embryos created in the laboratory using IVF will be implanted into a woman's uterus. Medication such as progesterone will often continue after pregnancy is detected and until progesterone naturally produced by the placenta takes control of nurturing the pregnancy.

Important Considerations
As with all prescription medications, side effects may occasionally occur with use of fertility drugs. Doctors specializing in fertility or reproductive health should only prescribe these products. Patients prescribed gonadotropins and GnRH analogs should be monitored carefully by a trained fertility specialist. Risks include the following events which can be serious: hypersensitivity reactions; ovarian hyperstimulation syndrome (OHSS); pulmonary and vascular complications, and multiple births. For complete product details about a specific fertility drug, please refer to the Full Prescribing Information offered below.

RFF: Revised Formulation Female

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Important Considerations:
Gonal-f® RFF Pen (follitropin alfa injection) is indicated for the induction of ovulation and pregnancy in the oligo-anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® RFF Pen is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program. Gonal-f® RFF Pen (follitropin alfa injection) should only be prescribed by physicians specializing in fertility or reproductive health. Gonal-f® is a potent gonadotropic substance capable of causing mild to severe adverse reactions, including Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications, and multiple births. Gonal-f® is contraindicated in women who exhibit prior hypersensitivity to FSH preparations, primary gonadal failure, uncontrolled thyroid or adrenal dysfunction and pregnancy. Nursing women should not use Gonal-f®. Common side effects include headache, abdominal pain, enlarged abdomen, and injection site disorders. For complete product details, see full prescribing information.

Important Considerations:
Women: Gonal-f® (follitropin alfa for injection) is indicated for the induction of ovulation and pregnancy in the anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program.
Men: Gonal-f® (follitropin alfa for injection) is indicated for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure. Gonal-f® (follitropin alfa for injection) should only be prescribed by physicians who are thoroughly familiar with infertility problems and their management. Gonal-f® is a potent gonadotropic substance capable of causing Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications. Gonal-f® is contraindicated in women and men who exhibit prior hypersensitivity to recombinant FSH preparations or one of their excipients, high levels of FSH indicating primary gonadal failure, uncontrolled thyroid or adrenal dysfunction, sex hormone dependent tumors of the reproductive tract and accessory organs, and an organic intracranial lesion such as a pituitary tumor; and in women who exhibit abnormal uterine bleeding of undetermined origin, ovarian cyst or enlargement of undetermined origin and pregnancy. Women who are pregnant or nursing should not use Gonal-f®. The most common side effects in patients using Gonal-f® include headache, ovarian cysts, nausea and upper respiratory infections in women and in men, acne, breast pain and growth, and fatigue. Injection site reactions were also reported. Reports of multiple births have been associated with Gonal-f® treatment. For complete product details, see the full prescribing information.

For complete product details, please read the Prescribing Information offered below.


© EMD Serono, Inc. CIM Last Update 2008-09-16
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