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FSH is produced by the pituitary gland
and it directly stimulates the development of eggs
contained within the ovarian follicles. When FSH levels
are increased by external injection, numerous follicles
are recruited. The dosage  of
FSH is adjusted based upon ultrasound
measurements of the follicles and the levels of
estrogen to insure proper development and avoid side
effects.
FSH is used in assisted
reproductive technology cycles (IVF) because numerous
eggs must be produced for successful retrieval,
culture,
and transfer. FSH is also used for ovarian stimulation
when products, such as Clomid,
fail.
Controlled dosages of FSH are also
used to stimulate ovulation in intrauterine
insemination (IUI) cycles. Dr. Kustin closely
monitors these patients to guard against ovarian hyperstimulation
syndrome (painful swollen ovaries) and reduce the
chance of high order multiple births. Most cases of
quadruplets (or more) result from IUI cycles administered
by non-specialists.
Serono Laboratories first introduced an FSH/LH menotropin in the United States under the trade name, Pergonal. Pergonal was a "natural product" derived from the urine of postmenopausal women and it contained impurities and luteinizing hormone. Pergonal is no longer available in the United States and other urinary products such as Repronex, Humegon, and Menopur have taken its place.
Metrodin was introduced in the 1990's. It was a highly purified form of Pergonal containing only trace amounts of LH. Many physicians administered Pergonal and Metrodin together because of the belief that LH was necessary. Bravelle is an FSH preparation currently distributed by Ferring Laboratories and it is similar to Metrodin.
 More
recently highly purified forms of FSH have been created
using genetic recombinant technology. The products
include Gonal-F and Follistim, which are "pure"
with no trace of LH. Organon and Serono have released
a "pen injection mechanism" which is very
convenient to use.
A controversy continues to rage among
reproductive specialists as to the necessity of LH
for good follicular and endometrial development.
Some feel that in some patients, the pure FSH products
do not provide for adequate stimulation. Some
patients respond well with FSH alone whereas others
stimulate in a more physiological way by the addition
of very low doses of
hCG (because of its LH effect) or the addition
of Repronex. FSH is sometimes used in combination
with LH (Luveris).
In all cases, patients administer fertility drugs
according to their specific protocol.
Serono Laboratories recently released Luveris, which is a genetically derived pure LH product. LH can now be precisely administered in FSH stimulation cycles when the physician believes LH is necessary. Luveris can also be used to induce ovulation.
One serious side effect of FSH, which can occur, is ovarian hyperstimulation syndrome (OHSS). This is a condition where the ovaries become painfully enlarged and there is a collection of fluid within the abdominal cavity. The patient may experience discomfort including difficulty breathing and abnormal lab test values.
The condition always improves and may be associated with pregnancy conceived with gonadotropin therapy. Careful monitoring and expert use of these medications reduces the incidence of OHSS significantly. The treatment usually includes pain control and appropriate fluid therapy. Rarely, more aggressive treatment is indicated.
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