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Thursday, 27 March 2014

Demystifying ovarian stimulation

While undergoing treatment of infertility, you are 'bombarded' with a lot of complicated information. It is of course difficult to understand and assimilate the information that is relevant so that informed decisions can be taken. I will therefore attempt to present before you the different aspects in a simplified manner. Let me begin with ovarian stimulation drugs.

The two hormones which 'drive' the growth of the follicles in ovary are Follicle Stimulating Hormone (or FSH) and Luteinising Hormone (or LH). Both these hormones work in tandem leading to the follicle growth that culminates in the release of egg (ovulation) from the ovary. 

In order to induce ovulation artificially, there are two ways: tablets and injections. The tablets (commonest being Clomiphene) do not directly stimulate the ovary, these cause the brain to release FSH and LH at exaggerated levels. The injections on the other hand directly stimulate the ovaries. In the vast majority of women, FSH injections suffice for stimulation. 

Injections that are given for ovarian stimulation are of two types:

  • human Menopausal Gonadotrophins (hMG)purified from natural sources (urine of menopausal women
  • Recombinant FSH (r-FSH): synthesized using technology (Recombinant DNA technology)

rFSH can be given subcutaneously (like insulin injections) and are very expensive. hMG is much cheaper but as effective as r-FSH. However hMG injections can only be given into muscle. Highly purified versions of hMG are also available that are a little more expensive (but not as much as r-FSH) and can be given subcutaneously.

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