Gonadatropin Injections

Battling Infertility from PCOS? Gonadatropin Injections for Infertility: What You Should Know

Have you been diagnosed with infertility caused by PCOS?Perhaps you suspect, but are unsure, if your infertility is caused by PCOS ? You should know you aren’t alone! PCOS is the most prevalent endocrine disorder among women today, affecting one woman out of twenty. That’s 7 million women in the US alone! PCOS is so widespread that it is the leading cause of female infertility. So you are in good company if you are one of the millions of women dealing with this heartbreaking condition.

You may have already tried several strategies to address your infertility, or you may be just beginning your search for a solution. There are a few pharmaceutical treatments that are used in the management of PCOS and infertility. Injections of human gonadotropins are an example. More than 90% of women are able to restore ovulation by means of this medication. Between 20% and 60% of women treated with injections of gonadotropins are able to conceive. But how do you know if this treatment is right for you? Are you curious to know just how PCOS causes infertility in the first place? Are there symptoms that predict infertility? If you’re struggling to conceive, what are your options? What are gonadotropins anyway, and when are they usually recommended? Is this treatment right for you? If not, what alternative treatments might you consider instead?

You can find the answers to these questions and more in the tabs above. But we know how busy you are! In a nutshell, the underlying cause of infertility due to PCOS is an imbalance of hormones, including an elevated level of male sex hormones, known as androgens. The normal process of ovulation and menstruation is disrupted by high androgen levels, which, in turn, impairs fertility. Often, women with PCOS -related infertility have coped with irregular or infrequent periods for years before discovering they were infertile. Gonadotropins are hormones secreted by the pituitary gland that impact your reproductive system. Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) are the two gonadotropins useful in the treatment of infertility.

Your doctor may try Clomiphene Citrate first, but may recommend injection with human gonadotropins if you fail to conceive using Clomiphene Citrate. Gonadotropin injections do produce a number of side effects. The most dangerous side effect is Ovarian Hyperstimulation Syndrome (OHSS). In severe cases, this is potentially life threatening, so care must be taken when choosing this treatment for infertility.

Regardless of whether you choose to take gonadotropin injections or not, you can greatly improve your chances of overcoming infertility related to PCOS by making positive changes in your lifestyle. Changes in diet and exercise can lessen all your PCOS symptoms, even infertility, and has no risk of dangerous side effects. Insulite Laboratories can assist you with dietary advice and exercise tips, as well as providing you the emotional support to be successful in beating your food cravings and making these lifestyle changes really stick. This, along with Insulite Laboratories’ specially targeted natural herbal supplements for PCOS , can help you transform your health and reverse your PCOS .

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Causes

Infertility is a frustrating and unfortunate problem, especially if you’ve been anticipating motherhood with excitement. PCOS is currently the leading cause of female infertility, and has interrupted the plans of millions of women to become mothers. What causes this difficult condition in the first place?

The underlying cause is disordered hormones. PCOS causes your body to produce too much of certain hormones, which can prevent ovulation. Your ovaries contain tiny follicles (fluid-filled sacs). When an egg matures, the follicle bursts and an egg is released. The egg moves through the fallopian tube into the womb, where fertilization can occur. This process is called ovulation. In women with PCOS , not enough hormones are produced for an egg to fully mature. If the egg isn’t released, a small cyst forms in the ovary. Over time, if ovulation continues to fail, multiple ovarian cysts can develop, which interfere with proper ovarian function. Without ovulation, the egg cannot be fertilized, and thus pregnancy cannot occur.

If you have had trouble conceiving, your doctor will first want to get a precise diagnosis. Diagnosing PCOS involves the following tests: medical history (especially about menstrual periods, weight changes, etc.), physical exam (measuring blood pressure, waist size, body mass index), pelvic exam, blood tests and vaginal ultrasound (sonogram), for examining ovaries for cysts and measuring the endometrium (lining of the womb). 1 Tracking your other symptoms beyond infertility can assist your doctor in making a correct diagnosis of your condition.

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Symptoms

Even if you aren’t presently trying to become pregnant, you may be worried about the future. Will you be able to conceive when you’re ready? Are there any warning signs of possible infertility problems in the future? Women with PCOS often struggle with a variety of menstrual problems for years before learning they are infertile. Menstrual irregularities can begin in adolescence, and continue throughout adulthood. These symptoms may include absent periods, infrequent periods, irregular menstrual flows, as well as extremely painful and/or prolonged periods.

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Treatment Options

No doubt about it! If you have PCOS -induced infertility, you are in a veritable battle to reclaim your good health and restore your fertility. There are several treatment approaches for infertility, including injections with human gonadotropins. What exactly are gonadotropins? Gonadotropins are hormones secreted by the pituitary gland. These include several hormones that impact your reproductive system. Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) are two such gonadotropins, and are the most commonly utilized in the treatment of infertility.

Doctors often prescribe Clomiphene Citrate first to try to stimulate ovulation. Clomiphene Citrate is prescribed along with Metformin as a rule. Clomiphene Citrate, when compared to gonadotropins, has a lower risk of multiple pregnancies. Therefore, gonadotropins are generally used only when Clomiphene therapy fails. Gonadotropins may be the next therapy your doctor suggests. Gonadotropins are typically administered via self injection. Medical preparations of human gonadotropins typically contain the hormones LH (Luteinizing hormone) and/or FSH (follicle-stimulating hormone).LH and FSH are naturally secreted by your pituitary gland. LH and FSH stimulate the reproductive system both in males and in females. In fact, these hormones are indispensable for reproduction and menstruation. In women, these hormones stimulate the ovaries to produce a follicle containing an egg, and to release the egg, making pregnancy possible. Lacking normal amounts of LH and FSH, women with PCOS may fail to ovulate, preventing even a possibility of pregnancy.

Gonadotropins, when used for treating infertility, are prepared in a laboratory in the form of intramuscular injections or subcutaneous injections. For some women, FSH injections only are enough to induce ovulation. However, for patients with more chaotic menstrual periods or especially low levels of LH and FSH, a preparation containing both LH and FSH may be necessary to achieve ovulation. Moreover, gonadotropins effectively encourage your body to produce multiple egg follicles. This is useful for assisted reproductive techniques, such as in vitro fertilization (IVF) and intrauterine insemination. This is yet another reason why gonadotropin injections may be prescribed to a woman with PCOS , if she is attempting such techniques.

If you choose this treatment, you will give yourself daily injections from the beginning of your menstrual cycle for 8-14 days. You will need to continue until an ultrasound examination reveals that at least one mature follicle has formed. Treatment with gonadotropins should only be conducted by highly qualified doctors. During the treatment course, close monitoring of the ovaries is necessary. Ultrasound and blood tests are undergone 3 times a week throughout the entire span of treatment with the injectable medications. This monitoring is indispensable, as treatment with gonadotropins carries a risk of serious side effects.

The results of treatment with gonadotropin injections can be favorable. More than 90% of anovulatory women are able to restore ovulation by means of this medication. Additionally, 20% to 60% of women treated with injections of gonadotropins become pregnant. Of these women, 70% – 85% will carry their child to term and give birth to a normal child. 3 While these numbers are encouraging, it is important to note the percentage of women who will not be successful in reversing their infertility with gonadotropin injections. 40% – 80% of women will still not become pregnant. And those who do still face a risk of miscarriage or stillbirth.

It is critical that you weigh the serious side effects of this treatment, especially given the low probability of success with gonadotropin injections. The Side Effects tab above contains more information about this. If you’ve already tried Clomiphene Citrate unsuccessfully, you may be feeling a bit anxious about whether you can achieve fertility. Don’t let this anxiety cause you to make a rash decision. Discuss all aspects of any treatment you’re considering with your medical professional.

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Side Effects

The most dangerous side effect of gonadotropin therapy is Ovarian Hyperstimulation Syndrome (OHSS), which develops as a result of overstimulation of the ovaries. In severe cases, this is potentially life threatening. OHSS occurs when ovarian enlargement and multiple fluid-filled follicles develop on the ovaries. It causes weight gain, accumulation of abdominal fluid, and low blood pressure. In extremely severe cases patients may suffer from severe abdominal pain, vomiting, and blood clots in the legs or lungs. In this case, urgent hospitalization, followed by intravenous fluid therapy, is obligatory, and in some cases draining fluid from the abdomen is necessary.

Fortunately, the most severe side effects occur only in approximately 1% of patients. But in about 6% of patients, a less severe form of OHSS occurs. To prevent OHSS, injections of gonadotropins are discontinued if blood estrogen levels become too high, or if an ultrasound examination shows too many follicles on the ovaries. After the ovaries have returned to a normal size, a gonadotropins therapy course can be renewed. Severe overstimulation can be avoided by carefully monitoring use of injectable gonadotropins and reducing dosage as needed.

Another complication after gonadotropin treatment is multiple pregnancies. In approximately 20% of cases, twins are born; in 5% of cases, triplets are the result; and in 1% of cases, quadruplets or more may be born! The risk of multiple pregnancies increases due to the large number of mature follicles that grow after stimulating the ovaries. This is noticeable on ultrasound examination. In certain cases, if the treatment does not yield results, an even higher dose of gonadotropins is then prescribed.

One more side effect of this therapy is that as the ovaries are stimulated to produce more than one follicle, regular menstrual period symptoms can be exaggerated. You may experience unusual fatigue, headaches, breast tenderness, abdominal pain, and pelvic twinges. If patients are overweight or underweight, they may have to delay the treatment, as the risk of side effects increases if body weight isn’t under control. Additionally, smoking women have a higher rate of miscarriage and are encouraged to stop smoking before initiating treatment.

There are other treatment approaches for PCOS and infertility. Most pharmaceutical treatments, including this one, are targeted at a specific symptom or two. To really address the underlying cause of PCOS , which is insulin resistance, a more broad treatment approach is needed.

Want to learn more about natural PCOS treatment options?

Supplementation Options

If you are struggling with infertility and PCOS , you should know it is impossible to cure this condition completely. But it is possible to get the symptoms of PCOS under control, and to minimize the damage of PCOS causes to your health and wellbeing. Drug therapies, such as gonadotropin injections, can help with some PCOS symptoms, but the risk of side effects may be too great for this to be a viable option for you.

Herbal supplements are all-natural and have been used for centuries. Here are some of the possible herbs that can help with PCOS and infertility:

Saw Palmetto (berries) – a 5-alpha reductase inhibitor impedes testosterone conversion and reduces circulating testosterone (androgens).
Vitex Agnus Castus (Chaste tree berry) – Improves menstrual regularity, supports luteal phase of menstrual cycle and addresses hyperprolactinemia.
Stinging Nettle (root) – Increases sex hormone-binding globulin.
Flax Seed – Supports estrogen metabolism, which increases the production of protective estrogen metabolites and increases sex hormone-binding globulin.
Milk Thistle extract (seed) – Supports liver function.
Vanadyl Sulfate – Restores blood glucose, lowers cholesterol, increases insulin sensitivity, improves glucose tolerance and metabolism, decreases body fat and reduces appetite naturally.
Chromium (Citrate) – Supports insulin binding to cells and decreases cholesterol and insulin levels. Boosts insulin response to glucose.
Alpha Lipoic Acid – Increases insulin sensitivity and lowers glucose levels. Provides antioxidant activity, scavenges free radicals, supports glucose transport and extends the functional capacity of Vitamin C, Vitamin E and CoQ10.
Magnesium (Citrate) – Positively affects insulin secretion/action and improves cholesterol profile. (Lower than normal levels of magnesium are associated with Insulin Resistance, glucose intolerance and hyperinsulinemia.)
Zinc Citrate – Lowers insulin concentration and improves insulin sensitivity.
L-Carnitine (Tartrate) – Improves insulin sensitivity.
Copper (Citrate) – Balances zinc and supports its ability to lower insulin concentration.
Calcium (Citrate) – Reduces fasting insulin levels, increases insulin sensitivity and regulates fat tissue.
Biotin – Involved in the manufacture and release of insulin; a cofactor required for the synthesis and oxidation of fatty acids.
Manganese (Citrate) – Reverses glucose intolerance, a deficiency associated with Diabetes.
Pancreatic Tissue (procine) – Contains specific amino acids in the correct proportions to supply growth, balance and repair factors of the pancreas.
Adrenal Tissue (bovine) – Contains specific amino acids to supply growth, balance and repair factors of the adrenals.
Vegetarian Enzyme Blend – Improve absorption and digestion of proteins and nutrients.
Vitamin C from calcium ascorbate – Prevent Vitamin C deficiency that induces disordered glucose regulation, improves glucose tolerance and scavenges free radicals. Reduces damage to arteries and arterioles and reduces glycosylation.
CoQ10 (Ubiquinone) – Lowers glucose and insulin levels and plays a major role in carbohydrate metabolism. Aids peripheral glucose utilization while lowering fasting blood sugar.
Vitamin B12 (Cyanocobalamin) – Reduces neuropathy, sorbitol accumulation, muscle weakness and tingling.
Folic Acid – Ensures sufficient folate status to aid in the prevention of many chronic diseases (e.g. atherosclerosis, anemia, heart disease) and reverses homocysteine levels.
Quercetin – Antioxidant to inhibit free radical production. Reduces intracellular accumulation of sorbitol that is implicated in the pathogenesis of cataracts, retinopathies, neuropathies and other disorders.
Bilberry Extract – Improves microcirculation and protects the vessels of the eyes, in particular.
Grape Seed Extract – Reduces free radicals and supports healthy blood vessels. Lowers cholesterol levels and prevents damage to the artery from elevated glucose and insulin levels.
Thiamin – Thiamin (Vitamin B1) (as thiamin HCL) May help convert carbohydrates into energy. Thiamin is important for several body functions of the heart, muscles, and the nervous system.
Vitamin D – Vitamin D (as cholecalciferol) Vitamin D plays an important role in bone health, immunity and wound healing. Vitamin D may also affect insulin secretion and glucose tolerance.
Cinnamon Extract (CinSulin ®) – helps maintain healthy blood sugar levels.
Guar Gum – Helps maintain healthy cholesterol, triglycerides, systolic blood pressure and supports insulin sensitivity which regulates appetite.
Apple Pectin & Beet Powder – Slow the absorption of glucose into the blood stream, which reduces insulin response.
Fenugreek – Reduces the effect of carbohydrates following a meal, maintains healthy cholesterol levels and improves insulin response and glucose tolerance.
Milk Thistle – Helps maintain healthy blood sugar and insulin levels. Supports the liver.

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END NOTES
Shriver, E.K.(2010) Beyond Infertility. Polycystic Ovary Syndrome (PCOS ). National Institute of Child Health and Human Development.
“Infertility FAQ’s,” Centers for Disease Control and Prevention, 28 June 2011,
http://www.cdc.gov/reproductivehealth/Infertility.
Fauser, B. (2012) Patient information: Infertility treatment with gonadotropins (Beyond the Basics).
http://www.uptodate.com/contents/patient-information-infertility-treatment-with-gonadotropins-beyond-the-basics.

Trivax, B., & Azziz, R.(2007). Diagnosis of polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50(1), 168-177.

 

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