FSH Products- Gonal-F, Follistim, Repronex, Menopur

FSH causes the recruitment, and supports the development, of the ovarian follicles, each of which contains an egg. The pituitary gland produces FSH after it is stimulated with gonadotropin releasing hormone (GnRH), which is released by the hypothalamus.

Injectable FSH is used in assisted reproductive technology cycles, usually for 7-10 days, to stimulate the recruitment and development of multiple eggs, which are needed for procedures such as IVF and IVF/ICSI.

Patients undergoing ovulation induction with FSH are carefully monitored using vaginal probe ultrasound and E2 hormone measurements to insure follicular development and avoid serious side effects.  The ultrasound determines follicle size and count. It is also used to assess the thickness of the endometrium (lining of the uterus), and monitor follicular development. If the lining is thin, it may indicate a hormonal problem.

Dosages of FSH are adjusted based upon the information from estradiol levels and ultrasound evaluation.

The first “FSH containing product” was Pergonal, which consisted of 75 IU of FSH and 75 IU of LH. Newer products include Gonal-F and Follistim which are pure FSH products (no LH or other impurities) derived using genetic recombinant technology.  Repronex is a natural product extracted from the urine of postmenopausal women, which contains both FSH and luteinizing hormone (LH). The major advantage of Repronex is that it is less expensive. These medications can be administered subcutaneously.

The most severe adverse effect associated with FSH is ovarian hyperstimulation syndrome (OHSS) which occurs in approximately 1% if cases. These drugs must always be administered by a specialist (reproductive endocrinologist) thoroughly trained in their use.

Symptoms of OHSS usually occur one week pos hCG injection and an include:

• Ovarian enlargement
• Pelvic pain
• Weight gain
• Abdominal swelling

The risk for ovarian hyperstimulation is increased in-patients diagnosed with polycystic ovarian syndrome (PCOS)

• Clomid
• Lupron, Ganirelex
• hCG, Ovidrel, Luveris
• Metformin
• Progesterone
• Other Medications