Stimulating Follicular Development
IUI is a procedure where many factors must be taken into account. But for anovulatory women undergoing IUI, triggering ovulation is a prime concern. When the first line of treatment for ovulatory disorders, Clomid, fails to bring the desired result, injectable medication may be added or used instead. Urofollitropin or recombinant follicle-stimulating hormone (FSH) is an injectable form of a single hormone that assists in ovulation. Human menopausal gonadotropins (hMG) are a combination of this same follicle-stimulating hormone (FSH) with the addition of luteinizing hormone (LH).
While a normal cycle produces one egg per month, treatment with injectable hormones can produce several eggs at a time. After treatment with Urofollitropin or hMG is complete, another injection is necessary, this time with the substance known as human chorionic gonadotropin (hCG). This final injection signals your ovaries that it is time to release the mature eggs into the fallopian tubes.
Treatment with hMG or single hormone FSH shots begins three days into your menstrual cycle. The length of treatment depends on how long it takes for your eggs to reach maturation, but in general, a course of treatment with these injectable drugs lasts from a week to 12 days. Your doctor will need to teach you or your partner how to give the shots.
At this point, you will be monitored with care to see how you respond to the medication. This is done with blood tests to evaluate hormone levels and with trans-vaginal ultrasounds which afford your doctor a clear view of both your ovaries and eggs. Once the eggs have matured, you will receive an hCG injection, which should bring on ovulation within 24-36 hours. The IUI procedure will be scheduled to take place a day or two later.
You can expect to have some side effects from treatment with hMG, for instance, bloating, tenderness, weight gain, and fluid retention. You may also find the injections difficult to administer. Gonal F and Follistim are two forms of this treatment which are known to cause fewer side effects, and can be administered as subcutaneous (under the skin) injections with smaller needles. Repronex is another type of hMG which can be given under the skin instead of through the muscle. Subcutaneous injections are far less painful than those given intramuscularly.
As with most of the drugs used in treating infertility, hMG increases the chances of a multiple pregnancy, some 10-40% of the time. Multiple pregnancies increase your chances of having a miscarriage or other complications of pregnancy.
One drawback to treatment with hMG is the cost. You can expect to spend anywhere from $2000 to $5000 for each cycle of treatment with gonadotropins. These figures include the drugs, office visits, and monitoring tests. Not all insurance policies cover this treatment and you may have to pay out of pocket, up front.