Gonadotropins: Injectable Fertility Medications (FSH and hMG)

What are gonadotropins?

Gonadotropins are hormones that signal the ovaries. The two natural ones are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Medication versions, made by recombinant technology or purified from urine, are injected to help several follicles grow at once.

When they are used

• IVF and egg freezing to retrieve multiple eggs in one cycle
• IUI and ovulation induction when pills have not worked, usually in low doses
• Rarely, in people with hormone deficiencies that stop ovulation

Males with certain hormone problems can also use gonadotropins to stimulate sperm production, under a specialist’s care.

How treatment works

1. A baseline ultrasound and blood tests early in the cycle.
2. Daily injections, typically for about 8 to 14 days. In IVF, a second medicine such as an antagonist prevents premature ovulation.
3. Monitoring every few days to track follicles and hormones and adjust dosing.
4. A trigger shot once follicles are mature.
5. Retrieval or insemination, then progesterone support if embryos are transferred.

Side effects

• Bloating, pelvic heaviness, mood swings and tiredness
• Bruising or soreness at injection sites
• Headaches and breast tenderness
• Ovarian hyperstimulation syndrome (OHSS): rapid weight gain, a swollen belly, nausea, vomiting and reduced urination. Contact your clinic right away or seek emergency care.
• Multiple pregnancy if more than one embryo is transferred or if several follicles ovulate in an IUI cycle

Practical tips

• Ask your clinic or pharmacy how to store each medication and how to mix and inject it.
• Rotate injection sites and keep a schedule or reminder.
• Keep your after-hours clinic number handy.
• Ask about costs and specialty pharmacy options early, because medication can be a major expense. See fertility costs and insurance.

Questions to ask your prescriber

Which medication and dose and why? How will you monitor me? How do you reduce OHSS and multiple pregnancy risk? What happens if I respond too much or too little? Use the appointment questions planner.

Understanding the different products

Gonadotropin products differ. Pure FSH products, produced by recombinant technology, contain only FSH. Menotropins (hMG) contain both FSH and LH activity. Some clinics use only FSH, while others combine them, often based on age, reserve or prior response. Pens and vials differ in how they are prepared and dosed. Evidence that any one brand is better for all patients is limited, so cost and availability often drive choices. Ask which product you are prescribed, and why.

Antagonist and agonist protocols

IVF protocols differ in how they prevent early ovulation. In an antagonist protocol, a second medicine is added partway through stimulation. It is shorter and common, particularly because it lowers OHSS risk. In a long agonist protocol, another medicine suppresses the pituitary starting in the previous cycle, followed by stimulation. Some patients, such as those with endometriosis, may be offered a version of this. Your clinic selects a protocol based on your history.

Monitoring visits

Expect several visits during stimulation, typically every two to three days at first, then more often. Each visit includes a vaginal ultrasound and blood tests. These are quick, but they require flexibility with work, so plan ahead. Results guide your dose. Do not worry about changes in dose, which are normal.

Injection technique and comfort

Many people find injections less daunting than expected. Practical tips include rotating sites, allowing alcohol to dry before injecting, using a fresh needle, and applying ice or pressure beforehand. If you bruise, a little pressure after helps. Partners can learn to inject if you prefer. If you are anxious, ask your nurse to watch your first injection.

Storage, travel and disposal

Some medications need refrigeration, and some can be kept at room temperature for a limited period. Ask for written storage instructions. If you travel, use a cooler and carry a letter from your clinic. Dispose of needles in a sharps container, and ask the pharmacy about local disposal.

Cost and ways to manage it

Medication can be a significant cost. Options include specialty pharmacies, manufacturer savings programs, clinic partner pharmacies and, where eligible, insurance. Ask your clinic for a written medication list with doses and approximate quantities so you can compare prices. See fertility costs and insurance.

When to call the clinic

Call for severe abdominal pain, rapid weight gain, shortness of breath, vomiting that will not stop, or if you miss a dose or are unsure what to do. See urgent symptoms.

Questions people often ask

Will the injections change my body permanently? No. The effects, such as bloating and mood changes, ease after the cycle ends. Will stimulation use up my eggs faster? Stimulation rescues follicles that would have been lost in that cycle anyway, and current evidence does not show it brings menopause forward. Can I keep working? Most people do, with time off for monitoring visits and the retrieval day. Tell your employer only what you are comfortable sharing, and ask your clinic for a letter if needed.

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