What Role Do Gonadotropins Play in Fertility?

A doctor's hands palms up with an illustration of the uterus projecting above them.

If you’ve tried other fertility medications or treatments without success, it’s understandable that you may feel discouraged and frustrated. Your Reproductive Endocrinologist (RE) may recommend gonadotropin injections as the next course of action in your fertility treatment plan.

With the following guide on everything you need to know about gonadotropins, you can begin the next steps in your infertility journey with more confidence.

What are Gonadotropins?

Gonadotropins are hormone injections used in fertility treatments to stimulate ovulation, as they contain follicle-stimulating hormone (FSH), luteinizing hormone (LH), or both FSH and LH hormones, depending on the unique fertility medication. These two hormones are essential to ovulation. In most cases, these gonadotropin injections are self-injections that you’d perform at home.

How Do Gonadotropins Help with Fertility?

Your body naturally produces gonadotropin hormones (i.e. FSH and LH) from the pituitary gland during different phases of the menstrual cycle. FSH hormone is naturally released from your pituitary gland during the follicular phase of your menstrual cycle to begin follicle development. Your LH hormone isn’t released until later, however. Your pituitary gland releases an LH-hormone surge at the onset of the ovulation phase in the menstrual cycle to release mature eggs.

Gonadotropin injections essentially offer hormone support to those struggling with ovulation by providing excess of these vital fertility hormones. If your body is struggling with ovulation, you may be experiencing a decrease in gonadotropins, and your RE may suggest gonadotropin injections to emulate the production of these hormones to stimulate follicular development and egg production. Many gonadotropin fertility treatments involve two different stages of injections, where the first stage involves injections containing FSH to stimulate egg development and the second stage involves human chorionic gonadotropin (HCG) injections to stimulate ovulation, as HCG is often used to emulate LH in gonadotropin treatments.

There are several different types—and brands—of gonadotropin injections, and each varies on what type of hormones it contains and how it was derived. Some gonadotropin medications are manufactured using recombinant DNA technology and others are human derived and purified. Here are some common gonadotropin injections used in fertility treatments:

  • Gonal-F—a recombinant human follicle stimulating hormone (rFSH) injection
  • Follistim—a rFSH injection
  • Menopur—a purified human menopausal gonadotropin (hMG) injection

Your RE and fertility team may recommend specific gonadotropin medications based on your unique fertility treatment plan.

What Does the Gonadotropin Treatment Process Look Like?

While individual gonadotropin treatment plans can vary from patient to patient, most treatments will involve a similar process to the one that follows:

  • Early in your next menstruation cycle, you’ll meet with your RE who’ll determine if you’re ready to begin a gonadotropin cycle. If you’re ready, your RE will educate you on how to administer the at-home injections and address any of your questions, or direct you to a MedTeach program.
  • After beginning your daily gonadotropin injections, your RE will monitor your egg production closely using frequent ultrasound imaging, bloodwork, etc. You can expect frequent appointments, so your RE can determine if you need any adjustments to your gonadotropin dosage.
  • If your lab work shows signs of overstimulation of egg production or any other potential complications, your RE may cancel the current gonadotropin cycle, and allow your body to “reset” before beginning another cycle.
  • If your RE determines that the lab work and imaging show evidence of appropriate mature egg development, she/he will likely use an HCG injection to stimulate ovulation (i.e. egg release). Typically, ovulation usually occurs about 38 to 44 hours after the hCG injection.

What’s the Success Rate with Gonadotropin Treatments?

There are many potential factors that can determine the success rate of gonadotropin treatments, and you should discuss expectations for your unique treatment plan with your RE and fertility team. Declining egg quality after the age of 35 may become a factor, so it is wise to seek an expert opinion and begin diagnostic testing to ascertain your individual circumstances.  To ensure you receive the best chance at a successful gonadotropin treatment, be sure to follow the advice and instructions from your RE and fertility team.  Egg freezing has also become a viable option for patients who for many reasons wish to have children later.  We recommend that you discuss the possibility of freezing your eggs with your RE if this is a reasonable option for you. 

Are There Any Risks with Gonadotropin Treatments?

While gonadotropin injections have proven to be successful in helping women increase the likelihood of becoming pregnant, there are two unique risks or complications of which you should be aware:

Ovarian hyperstimulation syndrome (OHSS): In some cases, gonadotropin injections can cause excess hormones to overstimulate the ovaries. This hyperstimulation can cause various complications including blood clots, kidney failure, ovarian torsion, rupture of ovarian cyst, pregnancy loss, etc. To reduce risk of OHSS, your Reproductive Endocrinologist performs frequent assessments using ultrasound imaging and bloodwork to monitor appropriate levels of hormones and stimulation, and your RE may abruptly stop or cancel a gonadotropin cycle if she/he sees evidence of hyperstimulation.

Multiple pregnancies: Stimulation from gonadotropins can increase the chances of releasing multiple eggs that result in multiple gestation (i.e. twins, triplets, etc.).  Multiple pregnancies often put the mother and babies at risk. Your RE and fertility team will monitor you closely to reduce your risk of multiple pregnancies.  More commonly, many physicians now recommend a single embryo transfer in order to reduce the chances of a multiple pregnancy.

Are Gonadotropin Injections Right for You?

You should consult your RE to discuss what fertility treatment options are best for you and whether you are a good candidate for gonadotropin injections.

If you’re considering gonadotropins in your fertility treatment plan, consider consulting our highly-trained pharmacists and staff at Mandell’s Clinical Pharmacy, an independently-owned specialty pharmacy supporting infertility patients and treatment centers. Available 24/7 every single day, our knowledgeable staff is always here to offer our unconditional support, address your questions and concerns, and provide quality services and educational resources to help you at every step of your journey, including information on fertility options, injection instruction and guidance, and financing and discount programs that may be available to you.

For more information on gonadotropin injections and other fertility pharmaceutical products, contact us today, or get started by registering online as a new patient or requesting a quote to determine what your medication costs may be. We know how difficult this process can be, and we would be honored to support you through your infertility journey.