Infertility In Women - Medications

Many of the drugs used in superovulation are either taken from natural sources (menotropins) or are genetically developed:

The standard agents are menotropins, which are hormones extracted from urine of postmenopausal or pregnant women. Menotropins contain high concentrations of FSH or LH. The specific agents that are administered either in combination or as FSH.
Genetically developed hormones (called recombinant drugs) are proving to be very effective. These are pure hormonal agents and they are allowing the doctor to better tailor the regimen to the unique needs of the patient.

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Human Menopausal Gonadotropins (hMG). HMG (Pergonal, Repronal, Metrodin) is a menotropin that contains both FSH and LH and is obtained from the urine of postmenopausal women. HMG must be self-administered as an injection. It is one of the potent ovulation drugs now in use and is often used in assisted reproductive techniques. It may be effective in stimulating fertility in women with ovarian dysfunction, endometriosis, and unexplained infertility. HMG is administered as a series of injections two or three days after the period starts. Injections are usually given for seven to 12 days, but the time may be extended if ovulation does not occur. In such cases, an injection of human chorionic gonadotropin (hCG) may trigger ovulation.

FSH. FSH stimulates the follicles directly and may be used with hCG to produce the LH and FSH surges that trigger ovulation. FSH is typically used alone for women who have taken clomiphene and failed. Such women often have polycystic ovaries, which is characterized by high LH and low FSH levels.

Urofollitropin (Metrodin, Fertinex, Bravelle) is a menotropin extracted from the urine of postmenopausal women and has been the standard FSH agent. Recombinant follicle-stimulating hormone (Puregon, Gonal-F, Follistim) is genetically developed form of the natural FSH. Therefore it has no risk for contaminants, such as urinary proteins or traces of LH, which can occur with menotropins. (Bravelle is a highly-purified menotropin and may be as effective as recombinant FSH.)

Human Chorionic Gonadotropin (hCG). Human chorionic gonadotropin or hCG is similar to luteinizing hormone and mimics the LH surge, which is to stimulate the follicle to release the egg. Standard hCG agents (APL, Follutein, Pregnyl, Profasi, Humegon) are derived from the urine of pregnant women. The recombinant (genetically developed) form of hCG (Ovridel) has fewer side effects at the injection site and its quality can be better controlled than the natural agents. It is generally used after hMG or FSH to stimulate the final maturation stages of the follicles. Ovulation, if it occurs, does so about 36 to 72 hours after administration.