Women have two ovaries located in the pelvis alongside the uterus. Their main functions are to release eggs and produce hormones. At birth, the ovaries contain thousands of eggs, each surrounded by cells that develop into small fluid-filled blisters known as follicles. When a woman is ovulating normally, each month one of these follicles will grow to about 20 millimeters in diameter and release an egg (ovulation). The egg then passes down the fallopian tubes, where fertilization occurs. The fertilized egg (embryo) travels to the uterus to implant itself in the lining (endometrium) and develop as a pregnancy. If the egg is not fertilized in the fallopian tubes, the endometrium is shed as a menstrual period about 14 days after ovulation.
The normal female reproductive cycle is principally controlled by hormones released from several organs in the body. At the base of the brain, the hypothalamus gland produces gonadotropin-releasing hormone (GnRH). This hormone, in turn, stimulates the pituitary gland to release two important reproductive hormones: follicle stimulating hormone (FSH) and luteinizing hormone (LH). Both of these hormones have a direct and important effect on the ovaries during the menstrual cycle.
The amounts of FSH and LH released and their specific functions change as the cycle progresses. FSH stimulates the growth of follicles in the ovaries. Each follicle contains an egg and produces additional hormones. LH helps FSH to stimulate the production of these hormones, both before and after ovulation. Roughly half way through the menstrual cycle, a sudden surge of LH and FSH causes a small rupture of the dominant follicle, releasing the egg. At this stage of the cycle, LH is the most important hormone because it enables the egg to become mature and ready for fertilization.
Female hormones are also produced in the ovaries. The most important are estrogens, which promote the growth of the follicles and development of the endometrium, and progesterones, which are released after ovulation to prepare the endometrium for pregnancy.
Reproductive medicines, known as gonadotropins, are hormones that are normally produced by glands in the brain. Usually a gonadotropin releasing hormone antagonist or agonist (GnRH-a) is administered before any assisted reproductive technology procedures begin – this halts the patient’s natural hormone cycle. Gonadotropins stimulate the development of the follicles in the ovaries. This stimulation, known as controlled ovarian hyperstimulation (COH), is an essential step in the IVF procedure. Using this technique, doctors can usually collect multiple egg cells to make ready for fertilization.
For many years, human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) have been extracted from human urine – specifically the urine of post-menopausal or pregnant women. hMG represents both FSH and LH activity, while hCG represents only LH activity.
More recently, these products have been manufactured using recombinant DNA technologies. This method of production has led to preparations with a very high purity while also eliminating the need to collect urine for manufacturing.
Following is a list and description of the most commonly used medications in assisted reproductive technologies.
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FSH (follicle stimulation hormone)
• Follistim® AQ (follitropin beta injection) is a pure FSH preparation manufactured by recombinant DNA technology. It is prescribed by a reproductive endocrinologist for ovulation induction in anovulatory patients, and for the development of multiple follicles in ovulatory patients undergoing assisted reproductive technologies such as IVF. Follistim AQ is available in a “cartridge-and-pen” formulation that offers multiple doses and requires no mixing. Follistim AQ comes in 300IU, 600IU, and 900IU cartridge sizes, as well as a 75ml vial.
(follitropin alfa injection) is a prescription medication containing FSH, manufactured by recombinant DNA technology. Gonal-F RFF is prescribed for the induction of ovulation and pregnancy in the anovulatory infertile patient and for the development of multiple follicles in ovulatory patients participating in an assisted reproductive technology program. Gonal-F RFF is available in a 75IU vial and can be administered subcutaneously (just under the skin). It is also available in a “pen,” a drug delivery system that comes in 300IU, 450IU and 900IU sizes.
hMG (Human Menopausal Gonadotropin)
Menopur® (menotropins for injection, purified) is a purified preparation of human menopausal gonadotropin (hMG) containing hormones necessary for human reproduction. Menopur is a preparation of naturally derived gonadotropins that has undergone an exacting purification process. The hMG in Menopur is extracted from the urine of postmenopausal women and is purified using state-of-the-art technology.
hCG (Human Chorionic Gonadotropin)
Pregnyl® (chorionic gonadotropin), a highly-purified preparation derived from the urine of pregnant women, was introduced in Europe in 1932 as the first hCG preparation drug and still continues to be one of the leading hCG therapies manufactured and sold today. Pregnyl acts like luteinizing hormone (LH) – it induces ovulation and releases the mature egg from the follicle. It is typically used after ovarian stimulation with follicle stimulating hormones to help follicles mature in the ovaries of women undergoing assisted reproductive technologies (ART), such as in vitro fertilization. It is also used to trigger ovulation in infertile women with ovarian dysfunction. Pregnyl is supplied in 10,000 USP unit vials and must be mixed with an accompanying sterile diluent. It must be administered by intramuscular injection.
Ovidrel® Gonadotropin-Releasing Hormone (GnRH)
Antagonist (choriogonadotropin alfa for injection) is the first and only recombinant human chorionic gonadotropin (hCG) and the only hCG approved for administration by subcutaneous injection in the US. Ovidrel® is used after ovarian stimulation to help follicles mature in the ovaries of women undergoing assisted reproductive technologies (ART), such as in vitro fertilization. It is also used to trigger ovulation in infertile women with ovarian dysfunction. Ovidrel is available as a 250 mcg prefilled syringe.
Novarel 5,000 USP units
s an hCG used to induce ovulation in women who have not ovulated but the cause of infertility is not due to primary ovulation failure. It is also used to induce ovulation and pregnancy in anovulatory, infertile women, in whom the cause of anovulation is secondary and not primary ovarian failure. These women have already been treated with an FSH therapy, MENOPUR, or similar therapies.
Ganirelix Acetate Injection
(formerly called Antagon™)is a synthetic gonadotropin-releasing hormone (GnRH) antagonist that is used to suppress premature luteinizing hormone (LH) surges in women during assisted reproductive technology (ART) treatment. This prevents eggs from being released prematurely. It is typically administered for 4 or 5 days in the middle of the FSH cycle. Ganirelix Acetate is available as a 250 mcg prefilled syringe. It is administered subcutaneously, can be stored at room temperature, and requires no mixing on the part of the patient.
Cetrotide® Gonadotropin-Releasing Hormone
(GnRH)Agonist (cetrorelix acetate for injection), is a synthetic gonadotropin releasing hormone (GnRH) antagonist used to suppress premature luteinizing hormone (LH) surges in women during assisted reproductive technology (ART) treatment. This prevents eggs from being released prematurely. Cetrotide may be administered as a single 3 mg dose or daily 0.25 mg doses over 5-7 days, as your physician instructs. Both doses must be mixed with an accompanying sterile diluent and administered subcutaneously with the syringe provided.
is a gonadotropin releasing hormone agonist (GnRH-a) and is structurally very similar to GnRH. GnRH is a hormone released from the hypothalamus that controls the release of the LH and FSH from the pituitary gland. These hormones in turn are responsible for stimulating the production of hormones and the development of eggs in the ovary. Administering Lupron temporarily inhibits the release of LH and FSH from the pituitary, and thereby inhibits ovarian function. Lupron is available as a 2-week kit.
works by initiating the release of gonadotropin releasing hormone (GnRH) from the hypothalamus. This causes the pituitary gland to release more FSH and LH, stimulating follicle development and ovulation. Clomiphene citrate is usually prescribed by an obstetrician / gynecologist (OB/GYN) or reproductive endocrinologist for the treatment of ovulatory failure in patients desiring pregnancy and whose husbands are fertile and potent. Clomiphene is typically considered first-line therapy for patients experiencing ovulatory difficulties. Clomiphene is available as a 50 mg tablet.
(progesterone gel) is a bio-adhesive vaginal gel that offers a sustained release of progesterone, with low levels of absorption into the blood stream. Progesterone, the active ingredient in Crinone, is required to prepare the lining of the uterus or endometrium to receive and nourish an embryo. Crinone 8% is supplied as a single-use vaginal applicator, and may be administered daily or twice daily, as your physician instructs. If you become pregnant, your physician may decide to continue treatment for up to 10 to 12 weeks.
(progesterone) Vaginal Insert 100 mg Progesterone is a natural hormone often prescribed for infertile women during the luteal phase of an Assisted Reproductive Technology (ART) treatment. The first new product for luteal phase support to be approved by the FDA in a decade, Endometrin is indicated to support embryo implantation and early pregnancy by supplementation of corpus luteal function.
Progesterone In OiI
is of the reproductive hormones, is needed to increase the receptivity of your endometrium for implantation of an embryo and is used as part of an assisted reproductive technology (ART).
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