Ovidrel, Pregnyl, Novarel
These products mimic the activity of
luteinizing (LH) hormone during the menstrual cycle.
Once the follicles are mature, the hypothalamus signals
the pituitary gland to release a surge of LH which
then causes ovulation.
Patients undergoing ART/IVF
stimulation with FSH
to down regulate the production of endogenous (produced
in the body) FSH and LH. This prevents
spontaneous ovulation prior to the time of egg retrieval.
Early ovulation can cause the loss of the IVF
cycle with its associated costs. These compounds
are also used in conjunction with FSH stimulated IUI
cycles to facilitate ovulation and timing of intercourse.
Novarel and Pregnyl are human derived chorionic gonadotropin (hCG) preparation while Ovidrel is “pure” hCG manufactured using genetic recombinant mammalian technology. hCG has the same effect of inducing ovulation as LH. Since Lupron or Ganirelix block the internal production on LH, hCG must be given 36 hours prior to inducing ovulation and rupture of the follicles.
Luveris is pure LH manufactured using genetic recombinant mammalian technology. It is indicated for use in women with profound LH and FSH deficiencies. Reproductive endocrinologists customize their protocols for each patient and sometimes additional LH may be necessary to produce a good stimulation. Luveris can also be used to stimulate ovulation.
Progesterone is necessary to stimulate the thickening, and increase in vascularity, of the endometrium in preparation to support a developing embryo. Progesterone is initially produced by the corpus luteum which is a structure located on the ovary formed by the follicle after ovulation. Once the embryo implants in the endometrium, the placenta begins to produce progesterone.
Progesterone is routinely administered after ART cycles to insure adequate endometrial development and support the pregnancy since Lupron/Ganirelix interferes with natural progesterone production. Progesterone is also used to treat the luteal phase defect where there is inadequate production of progesterone during the luteal phase of the ovulatory cycle.
Progesterone is administered by injection, vaginal suppositories, oral troches, gels, or oral micronized capsules.
Sometimes a woman may develop a condition
known as hyperprolactinemia (elevated prolactin hormone
levels). Prolactin is the hormone responsible for
breast milk production in pregnancy and elevated levels
can cause anovulation (lack of ovulation). Abnormally
elevated levels of prolactin in the absence of pregnancy
are sometimes caused by a nonmalignant tumor located
on the pituitary gland.
Parlodel lowers prolactin levels and establishes normal ovulation. Sometimes surgery by a neurosurgeon is necessary to remove the tumor.