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Fertility Drugs- hCG, Progesterone, Bromocriptine
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hCG (human chorionic gonadotropin)-Pregnyl, Novarel; r-hCG Ovidrel, Luveris (r-LH)
Once the ovarian follicles mature, the hypothalamus signals the pituitary gland to release a surge of luteinizing hormone (LH). This surge of LH is responsible for initiating ovulation of the mature eggs. The ovary responds to a spike in human chorionic gonadotropin (hCG) in the same manner as LH, thus ovulation will occur after an injection, or spike, of hCG.
hCG is available as Pregnyl and Novarel, which are natural products, derived from placental tissue. hCG is also available as Ovidrel, which is pure r-hCG, manufactured using genetic recombinant technology. The major advantage of Pregnyl and Novarel is that they are less expensive than Ovidrel.
Luveris is recombinant LH (r-LH) and is indicated for the treatment of patients with severe hypothalamic hypogonadism (extremely low levels of LH). Luveris may offer an advantage in “sweetening” FSH protocols or inducing ovulation but this remains to be demonstrated.
Progesterone
Progesterone is a hormone that supports the development of the endometrium, which is the lining of the uterus. The endometrium must thicken and become more vascular to support the growth of a developing embryo. When the endometrium does not develop properly it is sometimes due to inadequate progesterone during the luteal phase, known as a luteal phase defect.
Once the follicles mature and are ovulated, the remaining follicular structure on the ovary is known as the “corpus luteum”. The corpus luteum begins production of progesterone to support initial embryonic development. Once the placenta forms it begins progesterone production to support the growth of the fetus. IVF patients receive progesterone because medications such as Lupron or Ganirelex interfere with its natural production.
Progesterone can be given in many forms including injection, vaginal troche, vaginal suppositories and oral micronized capsules.
Parlodel (bromocriptine)
Once a woman becomes pregnant, the pituitary gland increases the production of prolactin, which is known as the "breast milk" hormone. As the name implies, prolactin is responsible for stimulating the production of breast milk in pregnant women.
When the prolactin level is elevated in women who are not pregnant, the condition is known as hyperprolactinemia, which can lead to irregular, or no ovulation. In some cases, hyperprolactinemia is caused by a small non-malignant tumor within the pituitary gland. When a tumor is present, surgical removal is usually the "first line" treatment. In other cases, bromocriptine is administered to medically lower prolactin levels.
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