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FSH is the hormone that stimulates the development
of follicles during a normal ovulatory cycle. FSH is produced
by the pituitary gland, which is under the influence of
gonadotropin releasing hormone released by the hypothalamus.
Injectable FSH mimics the bodies FSH and may be used after
Clomid failure and as a first line drug in conjunction with
IVF or GIFT. Dependent upon numerous patient specific variables,
it may also be used as a "primary" ovulation induction
agent.
 FSH
is now available for subcutaneous injection as Gonal-F,
Follistim, or Bravelle. Most patients, or their partners,
self-administer these products. Gonal-F and Follistim are
pure products derived from recombinant genetic engineering.
Some physicians feel there is an advantage to 100% pure
products. Bravelle is primarily FSH but is has trace amounts
of LH.
Patients receiving FSH undergo monitoring in
order to achieve better success rates and to reduce potential
medication side effects. This monitoring consists of serum
estradiol levels to help assess the "health" of
the follicle(s) and transvaginal ultrasound evaluations.
FSH dosage is adjusted based upon the results of these tests.
The FSH cycle usually begins on day 3 of the
menstrual cycle. Ultrasound and estradiol levels are obtained
before initiation of stimulation. After the stimulation
cycle begins, patients must check with our office regularly
to receive optimized dosage adjustments.
Major complications from FSH are infrequent,
but do occasionally occur, especially if patients do not
follow their individualized monitoring and stimulation protocols.
Hyperstimulation syndrome may occur because of "over-stimulation"
of the ovaries, or for no definable reason. Risks of blood
clots and ovarian enlargement with potential for injury,
or even loss of an ovary, may be associated with this condition.
 Most
of these side effects occur after the stimulation cycle
and administration of hCG. Therefore, patients' activities
are limited after the stimulation. Severe ovarian hyperstimulation
syndrome is rare, but must be considered in cycle management.
After HCG has been given, daily weights should be taken
and recorded. Dr. Cooper should be notified if there is
a weight gain of three pounds in one day, or five pounds
in three days, also if there is no urinary output in a six-hour
waking period contact our office.
If symptoms of ovarian hyperstimulation are
mild, conservative management will be used. However, if
there is evidence of severe ovarian hyperstimulation, hospitalization
may become necessary. Again, this is a rare occurrence.
The second major concern is multiple pregnancies,
which may occur in up to 30% of cases, but usually much
less. Triplets, or more, are possible in approximately 3%
of cases. High order multiple births are less common in
IVF because the number of embryos placed into the uterus
is limited. It is impossible to precisely control the number
of follicles ovulated in an IUI cycle thus there is a higher
chance of multiples.
The economic risks, as well as medical and
emotional risks, associated with multiple births are significant.
Therefore, it is sometimes necessary to cancel a stimulation
cycle when data indicate that the risk of multiple births
is too high.
The FSH cycle can incur a considerable expense.
It is therefore, important to follow the cycle plan as it
has been set up at the onset of the cycle. The cycle plan
will include the medication dosage and times of administration
as well as the monitoring schedules.
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