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Monitoring of patients receiving HMG therapy is essential for dosage adjustment and prevention of side effects. Each woman's response is different and the dose given needs to be adjusted carefully. The two most commonly used techniques are serum estrogen levels and ultrasound. Estrogen levels in the blood help the doctor to determine how well the ovaries are responding to HMG and when the dose needs to be adjusted. In addition, monitoring estrogen levels helps to prevent hyperstimulation. Ultrasound allows doctors to actually see the ovaries and determine the number of follicles which are developing and their size. Ultrasound is also used to determine when and if the ovulatory HCG injection should be given. If there are too many follicles developing, there is a greater chance of multiple births and the decision may be made to avoid the ovulatory injection of HCG.
Studies show that about 75% of women taking HMG will ovulate. It is estimated that 20% to 42% of patients receiving HMG will become pregnant, as long as the fallopian tubes are open and the sperm count is adequate.
Intercourse is advised daily or every other day beginning on the day prior to the administration of HCG. Your doctor may want to advise you further on this point. Some doctors will perform an intrauterine insemination on the day of ovulation to increase the chances of a pregnancy.
HMG has to be imported into India, and is very expensive. It is therefore best used by infertility specialists only. The commonest use of HMG today is in IVF and GIFT programmes where it is used to stimulate several eggs to grow (superovulation).
This represents a more purified form of HMG which contains mostly FSH and negligible amounts of LH. The indications for use, administration and ovarian response are almost identical to HMG. However, as FSH contains almost no LH, it has a theoretical advantage for women with PCO (polycystic ovarian syndrome) who characteristically have an elevated LH level. However, it is also more expensive than HMG.
HCG is produced by the placenta during pregnancy. Because it is very similar biologically to LH it is used to trigger ovulation by mimicking the natural LH surge at midcycle. It can be used in combination with Clomid and also HMG/FSH to induce ovulation. It is isolated and purified from the urine of pregnant women. It is available in ampoules as a sterile white powder containing 5000 IU or 10000 IU. This powder is dissolved in a diluent and administered by IM injection.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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