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The Muasher Center
for Fertility and IVF
8501 Arlington Boulevard, Suite 500
Fairfax, Virginia 22031
Ph. 703.542.3610
Fx. 703.876.6317
Fertility Drugs: FSH, Follistim®, Gonal-F®
FSH is the hormone responsible for stimulating the development of the eggs, which are contained within the follicles located on the ovaries. FSH is naturally produced by the pituitary gland, which is regulated by gonadotropin releasing hormone (GnRH) released by the hypothalamus (located at the base of the brain).
In assisted reproductive technology cycles, numerous eggs are required for retrieval, culturing, and transfer. Injectable FSH is administered to stimulate the development of multiple follicles. Cycles are monitored with ultrasound, estradiol measurements and clinical evaluations.
The first commercially available FSH product was Pergonal, manufactured by Serono laboratories. Pergonal is derived from the urine of post menopausal women and contains impurities, notably luteinizing hormone (LH). There is debate as to the effect of LH on egg development and the "quality" of the stimulation. Some clinicians use recombinant FSH combined with products containing a fraction of LH.
One major disadvantage of Pergonal is that it must be administered intramuscularly. Repronex is a "human derived" gonadotropin that can be administered subcutaneously. Pergonal is no longer sold in the United States. Menopur is a newer “human derived” gonadotropin that is now available and can be used instead of Repronex.
Gonal-F® and Follistim® are pure FSH products derived from recombinant genetic technology. They contain no LH which some clinicians believe leads to improved egg quality. Both products are administered subcutaneously. In fact, FSH can now be easily administered with a "pen" apparatus.
Newer human derived products such as Bravelle® have increased purity and can be administered subcutaneously. The major advantage of these medications is that they are less expensive than the recombinant products.
FSH should only be administered by a reproductive endocrinologist who is thoroughly trained in its use. Dosages of FSH must be adjusted based upon each patient’s individual response. The physician must also be alert to potentially serious side effects such as ovarian hyperstimulation syndrome.
Most cases of high order multiple births result from IUI cycles utilizing FSH administered by non specialists, not IVF. The fertility specialist must carefully monitor the FSH induction to limit the potential for triplets and above.