Injectables to conceive? Usually they will do some labs to see what may be causing the problems to conceive and go from there. Either they will put you on FSH or LH or FSH/LH combo, some will do Lupron, others will have you do birth control pills to get you regular before they put you on injectables. Normally the injectables are used with IUI or other procedures like IVF or GIFT and ultrasounds, so be prepared for them. You will also have labs done throughout your cycle to see how you are responding to the injectables. And last but not least, you will most likely get a trigger shot to induce ovulation. This also may be followed by progestereone injections if you are deficient in progesterone.
Here is some information about Repronex:
Repronex is used for the treatment of certain types of infertility in women. Menotropins are a mixture of naturally occurring hormones that include follicle stimulating hormone (FSH) and luteinizing hormone (LH).
In females, FSH is largely responsible for stimulating the growth of the ovarian follicle, which includes the developing egg and the cells surrounding the egg that produce hormones needed to sustain pregnancy, such as estrogen. The most important role of LH is to cause ovulation. After ovulation, a group of follicle cells form to make the corpus luteum and produce progesterone, which causes the endometrium to thicken so that it can support implantation of the fertilized egg. Menotropins are usually given with human chorionic gonadotropin (hCG). This hormone works similarly to LH and helps to ensure that ovulation occurs at the expected time.
Menotropins are also used to stimulate the ovary to produce several follicles which can be used for in vitro fertilization or gamete intrafallopian transfer.
Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
How should I use this medication?
Menotropins will be given under the supervision of your doctor. The dose of menotropins will depend on your circumstances and will be decided by the doctor. It is recommended that the starting dose of menotropins for causing ovulation in the hopes of becoming pregnant is 150 IU of FSH/LH, injected into a muscle or under the skin once a day for five days. The dose should not exceed 450 IU, and dosing for more than 12 days is not recommended. Usually hCG will be used the day after the last dose of menotropins.
It is very important that the dosing schedule be followed closely and that all doctor's appointments be kept so that progress can be monitored. If you miss a dose, your doctor will help to establish a new dosing schedule.
It is very important to understand how this treatment works. For treatment of infertility in women, it is recommended to have intercourse daily beginning on the last day of therapy until ovulation occurs. Your doctor may recommend that you record your basal body temperatures daily to identify when you are ovulating. Be sure to ask the doctor any questions you may have.
What form(s) does this medication come in?
Repronex® (menotropins for injection) is available as vials, each containing 75 IU FSH and 75 IU LH plus 20 mg lactose in a sterile powder form. Diluent (0.9% sodium chloride) is provided for mixing the powder.
Who should NOT take this medication?
Menotropins for injection should not be used by women who:
already have high levels of FSH (indicating another reason for infertility)
have uncontrolled thyroid and adrenal gland dysfunction
have any lesion inside the head such as a pituitary tumour
have undiagnosed abnormal vaginal bleeding
have ovarian cysts or enlargement
are pregnant
are allergic to any ingredients in this medication (e.g., lactose)
Here is some information from SIRM -
www.haveababy.com
GONADOTROPINS: HOW THEY WORK AND THE RISKS AND SIDE EFFECTS ASSOCIATED WITH THEIR ADMINISTRATION
Gonadotropins are hormones produced by the pituitary gland and which stimulate sex hormone production as well as gamete (sperm and egg) production in the man /woman. They are also responsible for the expression of secondary sexual characteristics such as hair growth, muscular development, and voice changes and breast development. There are two gonadotropins, Follicle stimulating Hormone (FSH) and Luteinizing hormone (LH). The gonadotropins are excreted in the urine. Two types are available pharmaceutically. The first, Human Menopausal Gonadotropins (hMG ;Repronex) is derived from the urine of menopausal women, and the second, Recombinant FSH (FSHr), is genetically engineered.
Human Menopausal Gonadotropins (hMG) –Repronex (Ferring): hMG is a good source of both FSH and LH. This is because a menopausal woman's pituitary gland, in response to a feedback message that her ovaries are no longer producing enough estrogen, increases the output of FSH and LH in an effort to re-stimulate the failing ovaries. The excess FSH and LH is excreted in the urine. Urine used for hMG is distilled, filtered, and purified by an expensive process. At the time this book is being written, one ampule of hMG (75 units) costs about $60 in the United States, and the average woman might require 25 or more ampules per treatment cycle.
It has been postulated that the LH component of hMG directly stimulates the tissue surrounding the ovarian follicles (ovarian storm), which propagates precursors that in turn produce male hormones (androgens). Some of these androgens may filter into the surrounding follicles and adversely affect egg development. It is also possible that some of the androgens could inhibit the proper development of the endometrial lining. In this way, ovarian androgen production induced by LH could have a deleterious effect on egg and embryo quality as well as on the potential for healthy implantation in the endometrium.
Recombinant FSH ( Follistim-Organon & Gonal F- Serono); Human menopausal gonadotropin, has in recent times largely been supplanted by purified FSH, derived by way of genetic engineering that makes it possible to induce bacteria to produce the product. Known as Recombinant FSH (FSHr), it appears to be more bioactive than urinary derived FSH products such as hMG. FSHr also has advantages in treating selected infertility problems such as ovaries with multiple small cysts (polycystic ovarian disease), but this situation rarely applies to the IVF setting. Instead of influencing the hypothalamus and pituitary gland to produce more hormones to stimulate follicular development (as is the case with clomiphene), gonadotropins act directly on the ovaries and do not inhibit the function of estrogen or the enzymes of the cells lining the follicles. If administered in sufficient amounts beginning early enough in the menstrual cycle, gonadotropins will prompt the maturation of multiple follicles. Although the average number of eggs usually retrieved from a woman younger than 40 after gonadotropin stimulation-provided she has two ovaries-is usually between six and 15, retrievals of more than 50 eggs have been reported
Because gonadotropins cannot be absorbed through the stomach into the bloodstream, they must be administered by injection rather than in pill form. While hMg must be injected intramuscularly, FSHr can be administered subcutaneously, thereby rendering the injections easier to administer and far less painful .The usual injection schedule is from day 2 or 3 through day 8 to 12 of the menstrual cycle.
One of the most significant attributes of gonadotropins is the safety-valve effect on ovulation. No matter how well stimulated a woman becomes when she takes gonadotropins, she will be unlikely to ovulate until she receives an injection of the hormone, Human Chorionic Gonadotropin (hCG). Thus, if for any reason it is determined that the woman should not progress to ovulation, the hCG is simply not administered.
Purified Urinary-Derived FSH (Bravelle –Ferring Pharmaceuticals)
This amounts to Repronex that has been processed further to extract almost all LH to the point that there is virtually no LH (<2%) remaining. It has equivalent efficacy to the Recombinant FSH (FSHr)
Risks and Side Effects of Gonadotropins
Many women taking gonadotropins report breast tenderness, backaches, headaches, insomnia, bloating, and increased vaginal discharge, which are directly due to increased mucus production by the cervix.
Luteal-phase defects (inadequate production of progesterone by the corpus luteum to sustain the endometrium) are also known to occur in association with gonadotropin therapy. However, endometrial biopsies have shown that the development of the uterine lining of patients stimulated with gonadotropins is usually a few days ahead of that which could be expected in unstimulated cycles. Thus, gonadotropins help to synchronize development of the endometrium with growth of the follicles and eggs. This synchronization is a critical prerequisite for successful implantation because IVF embryos are usually transferred to the uterus a few days earlier than they would reach it under natural circumstances. Therefore, accelerated endometrial development enhances the chances that the young embryos will implant after their transfer to the uterus.
Possible side effects of gonadotropin administration include over stimulation that can threaten the woman's well-being include enlargement and "weeping" of the ovaries, a condition in which a large amount of fluid is exuded into the abdominal cavity. In severe cases this can cause the abdomen to distend severely and may even compromise breathing. In rare cases the kidneys or liver may fail and the woman may stop producing urine, which can be life-threatening. In very severe cases her blood may lose its ability to clot properly. These situations, however, are extremely rare and are sometimes caused by inappropriate use of gonadotropins. They are highly unlikely to occur in the properly managed cycle.
It is significant that gonadotropins are unlikely to produce any serious persistent side effects until the woman receives the injection of hCG to stimulate ovulation. Thus, the physician has ample time to assess her status and withhold the hCG if it appears that she might develop major side effects. (Such an assessment is made on the basis of blood estradiol values or ultrasound examinations immediately prior to administration of hCG.) This built-in protective advantage shields almost all women being treated with gonadotropins (administered either alone or in combination with clomiphene) from the serious hazards of over stimulation
Variations in Response to Gonadotropins:
Some women stimulate well after relatively small doses of gonadotropins. Others require two, three, or even four times that dosage to achieve the same effect. In the past, selecting the proper dosage was a trial-and-error process. There was simply no way to predict how a particular woman might respond. Each woman is unique, and each can be expected to react differently to gonadotropins. However, about 80% of women respond appropriately to an average injection.
We measure FSH (follicle-stimulating hormone) and estradiol (E2) in the woman's blood on the second or third day of a natural menstrual cycle preceding the IVF cycle. We use the levels of these hormones to predict the probable way she will respond to a variety of stimulation methods. We believe these tests are also valuable in selecting the most appropriate dosage and regimen of fertility drugs to be administered. In selected cases we can perform a “clomiphene challenge test “ which provides additional information as to how a woman might respond to a given dosage of gonadotropins.
Despite these refinements, however, stimulation for IVF is still somewhat of a hit-or-miss procedure. For example, when a woman has used up most of her lifetime egg budget and is left with less than a critical number of eggs, she begins to enter a phase of hormonal change known as the climacteric. The climacteric is associated with a loss of fertility, the onset of hot flashes, and mood changes. It ultimately culminates with the total cessation of menstruation between the ages of 40 to 55, a process called the menopause. The ovaries still produce hormones after menopause, but they are released in a constant rather than cyclical manner.
Ovarian Hyperstimulation Syndrome and “prolonged coasting”:
In certain circumstances inadvertent ovarian hyperstimulation might occur. It has been demonstrated that if more than 30 follicles develop following stimulation with fertility drugs and the woman's plasma estradiol at its highest level exceeds 6,000 picograms per milliliter, there could be as much as an 80% risk of the life-endangering complications described above. Until recently, the only way to prevent these complications from occurring was by withholding hCG in those cases where inadvertent over stimulation appeared to be taking place.
In 1993 Sher et al, reported on an approach that permits the cycle of treatment to continue while eliminating any significant risk of severe ovarian hyperstimulation. This new method can only be applied in cases where patients are being concurrently treated with GnRHa (the gonadotropin-releasing hormone agonist). In cases where the advent of severe hyperstimulation is suspected, the gonadotropin therapy is withheld while the GnRH agonist treatment is continued, and the woman undergoes daily blood estradiol measurements until the concentration drops to a safe level. At that time hCG is administered, regardless of the number of developed follicles or the number of eggs retrieved; thus, these women do not develop Life-endangering complications. Although the fertilization rate of the eggs appears to be reduced using this method, the pregnancy rate does not appear to be compromised. We have termed this method prolonged coasting. Prolonged coasting prevents canceled cycles and with them, canceled dreams.
Finally, the entire contents of the follicles are removed during egg retrieval, thus reducing the likelihood that the ovary will "weep." For this reason, serious side effects from gonadotropins are much less likely to occur in women who undergo egg retrieval than in those who do not.
When a woman fails to become stimulated on the first try, hormone tests are indicated to ensure that she is not in the climacteric as well as to determine if hormonal abnormalities or other conditions might be inhibiting her sensitivity to gonadotropins. If she is not in the climacteric and no other abnormalities are detected, then it can be anticipated that she will eventually respond to an adjusted dosage of gonadotropins. She can begin another round of gonadotropin therapy with an adjusted dosage after she lets her body recover for a month or two
.
Follicle growth and development, egg maturation, the number of eggs that can be retrieved, and the risk of side effects are directly related to the patient's response as evaluated by blood-estrogen levels and/or ultrasound, not to the dosage of gonadotropins. Therefore, it is illogical to fear administering an escalating dose of gonadotropins after a poor response to a standard dosage. What is important is to monitor the individual's response to the drug.
Combination of Clomiphene and Gonadotropins:
A few IVF programs today still administer a mixture of clomiphene and gonadotropins for controlled ovarian hyperstimulation. While the vast majority of IVF programs in the United States with good reason, no longer use this combination, a significant number of pregnancies have been reported by the few programs that still cling to this method. One of the reasons for using this combination is because clomiphene increases the ovaries' sensitivity to gonadotropins, thereby reducing the dosage of gonadotropins that must be administered.
Thus, the overall cost of the fertility drugs is significantly decreased by reducing the required amount of expensive gonadotropins. A second reason for administering these drugs in combination is to simplify their administration (clomiphene can be taken in pill form although gonadotropins must be injected).
However, we believe that the administration of this combination has several drawbacks. First, because clomiphene has the ability to induce ovulation, a combination of clomiphene and gonadotropins may cause spontaneous ovulation even without the administration of hCG. In such a case, egg retrieval might inadvertently take place after ovulation has occurred, resulting in fewer eggs being retrieved. In addition, some physicians feel that the combination of the two drugs makes it difficult to pinpoint the amounts of each that should be changed when the overall dosage must be adjusted in subsequent treatment cycles.
Side effects associated with the use of gonadotropins and related to the degree of stimulation as measured by estrogen levels also apply to the use of clomiphene plus gonadotropins. Accordingly, proper management of the treatment cycle should limit the risks of side effects from the clomiphene- gonadotropin combination.
Hope all this confusing mess helps!
laural
Injectable Medicines - need some info... 
