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Gonadotropin Treatment for Infertility

Examples

Generic Name Brand Name
human chorionic gonadotropin (hCG) Ovidrel, Pregnyl
human menopausal gonadotropin (hMG) Bravelle, Menopur, Repronex
recombinant human follicle-stimulating hormone (rFSH) Follistim, Gonal-F

How It Works

Gonadotropin fertility medicines contain follicle-stimulating hormone (FSH), luteinizing hormone (LH), or both. These hormones play a central role in egg production.

In women. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are needed for egg production (ovulation). Early in the menstrual cycle, a woman with low hormone levels who is not ovulating can have daily human menopausal gonadotropin (hMG) or recombinant human FSH (rFSH) injections for an average of 12 days. If this helps develop mature follicles, the ovary is ready to ovulate. One dose of human chorionic gonadotropin (hCG) is then used to stimulate ovulation.

In men with low testosterone and FSH. LH stimulates the production of testosterone, and FSH promotes the formation of sperm. If a semen analysis, LH testing, and FSH testing suggest that abnormal hormone levels are preventing sperm production, these gonadotropins may be prescribed together to promote sperm formation. The man gets an hCG injection 3 times weekly until blood testosterone level is within the normal range (this may take 4 to 6 months). Treatment continues with injections of hCG 2 times a week and hMG or FSH 3 times a week until the sperm count rises to normal levels.

Why It Is Used

Gonadotropins are given by injection to help the body make the hormones needed for egg or sperm production.

In women. Gonadotropins may be used:

  • To stimulate ovulation related to low natural gonadotropin or estrogen levels. (This is most commonly seen in women with excessive exercise or eating disorders.)
  • When clomiphene alone or clomiphene combined with another medicine has been ineffective for correcting irregular or no ovulation caused by polycystic ovary syndrome (PCOS).
  • For developing multiple egg follicles on the ovaries. Multiple eggs are harvested and used in assisted reproductive techniques such as in vitro fertilization or gamete intrafallopian transfer.
  • In combination with intrauterine insemination for couples with unexplained infertility when clomiphene has not worked.

In men. Gonadotropin therapy can treat low sperm counts caused by low levels of natural gonadotropins.

How Well It Works

The combination human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) or recombinant human follicle-stimulating hormone (rFSH)/hCG treatment can consistently stimulate ovulation. It results in pregnancy in 30 to 60 out of 100 women who fail to ovulate. But of those pregnancies, up to 35% end in miscarriage.1

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

For women

Call your doctor if you have:

  • Hives.
  • Bloating.
  • Pain, swelling or irritation at the injection site.
  • Rash at the injection site or on your body.
  • Stomach or pelvic pain.

Common side effects of this medicine include:

  • Coughing.
  • Headache.
  • Mild nausea.
  • Sneezing.
  • Sore throat.
  • Stuffy or runny nose.

For men

Call your doctor if you have:

  • Hives.
  • Shortness of breath.
  • Dizziness.
  • Fainting.
  • Headache.
  • Loss of appetite.
  • Frequent nosebleeds.

Common side effects of this medicine include:

  • Breast enlargement (temporary).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

During gonadotropin treatment, frequent monitoring of egg follicle development is needed. This may be done with ultrasound and blood tests. Without careful monitoring, the ovaries may become hyperstimulated. Ovarian hyperstimulation syndrome (OHSS) can be a very serious condition. It usually goes away by itself in 2 to 4 weeks. But a woman may need bed rest or hospitalization and intravenous fluid therapy. Or she may need a procedure to remove fluid from the abdomen.

Gonadotropins should only be used by doctors who are specially trained in infertility and who are familiar with the management of possible complications.

Ovarian stimulation increases the likelihood of multiple pregnancy (twins, triplets, or more).

Up to 35% of women who become pregnant after hMG/hCG or rFSH/hCG therapy have a miscarriage.1 This is higher than the risk of miscarriage in the general population.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

After you know you are pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant or trying to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Lobo RA (2012). Infertility: Etiology, diagnostic evaluation, management, prognosis. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 869–895. Philadelphia: Mosby.

Credits

By Healthwise Staff
Kathleen Romito, MD - Family Medicine
Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Last Revised November 14, 2013

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