Advanced Hormonal Therapy

Ovulation Testing

Subtle or obvious abnormalities in hormonal production areas (brain, adrenal, ovarian, or thyroid) can interfere with the normal development, ovulation, and fertilization of an egg.

Clomiphene Challenge Test

This is one of the best ways to determine the ability of the ovary to ovulate. Clomiphene is administered on cycle days 5 to 9. An FSH level is taken on cycle day 3 and another on cycle day 10. If the total FSH of the two determinations is 25 or greater, the likelihood of achieving ovulation/pregnancy using your own eggs is very unlikely. This test is particularly important if you are older.

FSH

Follicle stimulating hormone is produced from the brain's pituitary gland. When this hormone is elevated beyond a certain limit, it is telling us that the ovary cannot produce or release eggs.

LH

Luteinizing hormone is produced from the brain's pituitary gland. This hormone must rise to very high levels for the brain to sense an egg-bearing follicle has produced the critical level of estrogen that indicates it is mature. The egg will be released from the follicle just about 36 hours after the first surge of LH hits the bloodstream.

Prolactin

Another hormone produced from the brain's pituitary gland. This hormone is necessary in average amounts to promote follicle maturation and is also critical in stimulating milk production for breastfeeding. At inappropriately high levels, it interferes with LH and inhibits the process of ovulation.

TSH

Thyroid stimulating hormone is produced from the brain's pituitary gland. TSH stimulates the thyroid gland to produce thyroid hormone. Thyroid hormone is the "thermostat" for the rate that the body cells "burn" nutrients. If it is set too high or too low, it is counterproductive to the ovulation process.

17 hydroxy-steroids

Major production of these hormones is in the adrenal gland. If they are too high, they signify that adrenal androgen production is feeding back to the brain and to the ovary to disrupt the normal surging of LH and the normal maturation of follicles.

Testosterone

The most significant amount of this male hormone comes from the ovary itself. You cannot make estrogen without first producing testosterone and testosterone-like molecules. There is an acceptable range of testosterone and if exceeded, it has the same effect as the androgen problem as 17 hydroxysteroid (above).

Ovulation Induction Therapy & Hormones

About 25% of infertile women have problems with ovulation. These problems can include the inability to produce a fully matured egg or failure to release an egg from the ovary. Many fertility drugs can be used to correct ovulation problems and increase the chance for pregnancy.

  1. Clomiphene Citrate (also known as Clomid, Serophene): This medication is taken orally for five days each cycle, usually days 3-7. Clomiphene is similar to the estrogen molecule and works by blocking estrogen receptors in the brain. This essentially “tricks” the brain into thinking that your ovaries aren’t working very hard and drives them to work harder by enlarging the follicles and producing more estrogen.  When the brain sees a high enough “trigger level” of estrogen from the ovary, it will finally send out enough of the ovulation signaling hormone, LH, to rupture the most promising follicle(s) and release the egg. The lowest dose of clomiphene to induce ovulation is used for at least 4-6 cycles to provide an adequate trial. About 40-45% of couples receiving clomiphene will become pregnant within 6 cycles.
  2. Letrozole: When used early in the menstrual cycle, letrozole inhibits the production of estrogen. This results in normal or enhanced follicular recruitment without the risk of ovarian hyperstimulation. Letrozole has a very short half-life (~45 hours) and, therefore, is quickly cleared from the body. For this reason, it is less likely to adversely affect the endometrial lining and cervical mucus. Studies show that pregnancy rates are comparable to clomiphene.
  3. Metformin/Avandia: commonly used in true Polycystic Ovarian Syndrome, these agents are thought to increase the sensitivity and number of insulin receptors throughout the body (especially the ovary) to allow cells to make glucose more available and promote better cellular metabolism & function. This medication may help you to ovulate more regularly.
  4. HCG (Human Chorionic Gonadotropin – also known as Pregnyl, Novarel): this medication is naturally harvested and purified from the urine of pregnant mothers. This hormone is produced by the embryo and its placental tissues to give a signal to the ovary to continue to produce progesterone long after the ovary should have stopped producing it in a routine cycle. It is a hormone whose structure barely differs from LH. Because of this, we frequently will use this injectable hormone to mimic the work of LH to promote ovulation. This helps improve the timing for successful fertilization after intercourse.
  5. HMG (Human Menopausal Gonadotropins, ie. FSH &LH): Injectable agents used to originate or to amplify production of eggs and ovulation.
  6. FSH recombinants (Metrodin, Fertinex, Follistim): thanks to genetic drug manufacturing techniques, pure FSH is available to provoke or to enhance follicle development and ovulation. These medications stimulate the ovary to produce more mature eggs.
  7. FSH/LH combination (Pergonal, Repronex): prior to availability of recombinant FSH, this was the only gonadotropin medication we had. The hormones were present in a 50/50 ratio.  The compounds were harvested and purified from the urine of menopausal women. While we occasionally use this for an additional LH effect, it is not the most common regimen for advanced ovulation effect.
  8. GNRH Agonist (leuprolide acetate, Lupron): this essential fertility tool is used to deplete the brain of FSH & LH so that the ovary will cease production of estrogen. It is used in long acting form in patients to help control endometriosis and relieve their associated pain. It is used in short acting form to stop the brain’s own production of FSH & LH in order to have the ovulation process under the complete control of drug administration. This prevents the unwanted, unpredictable surge of the ovulatory hormone, LH, before follicle development is truly ready for ovulation. It is occasionally used to enhance the brief surge of FSH & LH that occurs within the first two days of using the medication to add to the effects of the FSH and LH we are injecting to stimulate the ovary.
  9. GNRH Antagonist (Antagon, Ganarelix, Cetrotide): used to partially limit the LH surge so that premature ovulation will not occur and the egg(s) can reach the appropriate state of development before being harvested at an IVF procedure.
  10. Progesterone: Given as an injection, suppository, or cream, progesterone can aid and enhance the effect of progesterone production from the ovary. Progesterone helps the uterine lining maintain its rich vascular structure, slow the natural rhythmic contractions of the uterine muscle, and assist in the production of blocking antibodies so mother’s immune system will not reject the genetically foreign infant developing inside her.
  11. Hyperstimulation: An unfortunate complication of hormone stimulation to the ovary whereby the ovary responds independently and vigorously to cause pelvic discomfort, weight gain, shortness of breath, and a higher risk of blood clots.

We often monitor ovulatory function with BBT (basal body temperature charts) and OPKs (ovulation predictor kits), both of which are easy and inexpensive for you to do at home.

Contact Women's Health Care Waukesha 262-549-2229 for advanced hormomonal therapy infertility treatement for couples in SE Wisconsin