Gonadotrophins types and sources

 

A)        Kinds of  Gonadotropins(Brands)

Gonadotropins can be used where clomiphene fails or where indicated.

Gonadotropin Preparations

A)        Human     pituitary gonadotropin. Not used nowadays

B)         Human menopausal gonadotropins (75 i.u. of FSH 75 i.u. LH).with urinary proteins as impurity

C)         Highly   purified HMG (75 i.u. of FSH and 75 i.u. of LH with <5% of urinary protein).

D)        Very minimal LH:  Purified   urinary FSH (75 i.u. of FSH and < 0.7 i.u. of LH).

E)           Very minimal LH, also very minimal Urinary proteins: Highly purified urinary FSH (75 i.u. of FSH and <0.001 i.u. of LH and <5% urinary protein).

F)Recombinant FSH (i.u. of FSH and no LH).

G)        Recombinant LH.

 

B) Pre requisites for Patients to be started on Gonadotropins for IUI or say IVF

1.       Counseling should be done regarding need for treatment, monitoring required, its success rates, alternative therapy, cost and risk of multifoetal gestation and hyperstimulation.

2.       Screening to rule out other factors responsible for infertility.

3.       Baseline transvaginal ultrasonography.

4.       Day 2 LH, FSH and estradiol

5.       Rule out other endocrinopathies like hyperprolactinemia and thyroid dysfunction.

6.       Ovarian tumours or cysts must be ruled out.