Different substances are used to mimic the natural cycle depending on the cause of infertility and the stage of follicular maturation.
Hormonal stimulation – medication overview
Did you know…?
Gonadotropins differ in their means of production:
Urinary gonadotropins
The urine of women after menopause is collected and processed accordingly. LH and FSH are present in the urine as a mixture. If this combination is left in the preparation process, it is called human menopausal gonadotropin (hMG).
Recombinant gonadotropins
Gonadotropins produced using state-of-the-art biotechnological techniques with a protein purity of over 99%.
How does the medication work?
In the natural hormonal cycle, clomifene inhibits negative feedback from the body’s own oestrogens and thus stimulates the release of GnRH in the hypothalamus. This triggers the pituitary gland to release more LH and FSH. → Maturation of follicles and induction of ovulation
Dosage
Form of administration
Tablets
Type of medication
Chemically synthesised selective oestrogen receptor modulator (SERM)
Start of treatment
Once a day from the 5th day of the cycle
Duration of treatment
5 days
Treatment carried out for
Max. 3 months
When is clomifene used?
Stimulation with clomifene is seen as a simple, more conservative method and is therefore often used as a first step in women who wish to have children but do not ovulate. → for OI/IUI
How does the medication work?
FSH treatment is intended to replace the body’s own FSH. FSH is administered to either compensate for a deficiency in the body or to perform a medically assisted reproductive technique (IVF, ICSI).
Dosage
Form of administration
Pre-filled syringes (pens) or dry substance
Type of medication
Gonadotropin
Start of treatment
The solution is injected under the skin (subcutaneously) once a day.
Duration of treatment
Dosage and duration depend on the treatment goal and are determined by the doctor on a case-by-case basis. Depending on the treatment regimen and treatment goal, FSH may be administered in combination with other hormones.
When is FSH used?
- In women, it is used to stimulate follicular growth.
- In men, it is used to stimulate sperm production.
How does the medication work?
Administering LH alongside FSH is intended to replace the body’s own LH. LH is administered to either compensate for a deficiency in the body or to perform a medically assisted reproductive technique (IVF, ICSI).
Dosage
Form of administration
Pre-filled syringes (pens) or dry substance
Type of medication
Gonadotropin
Start of treatment
The solution is injected under the skin (subcutaneously) once a day.
Duration of treatment
Dosage and duration depend on the treatment goal and are determined by the doctor on a case-by-case basis. The combined preparation (LH, FSH) is available as a ready-to-use solution.
When is LH used?
Used to stimulate follicular maturation in women with a severe LH and FSH deficiency
- LH is usually given in combination with FSH
How does the medication work?
HCG is usually formed by the placenta and supports pregnancy. It also promotes the formation and function of the corpus luteum (progesterone production) and the uterine lining.
Dosage
Form of administration
Solution for injection in a pre-filled syringe
Type of medication
Gonadotropin
Start of treatment
After completion of hormonal stimulation
Duration of treatment
Single injection to induce ovulation
When is hCG used?
Women
During hormonal stimulation, it is administered to complete egg maturation and induce ovulation.
Men
In men, it is used to treat undescended testicles and delayed puberty, as well as fertility disorders due to disruptions in the hormonal cycle (lack of FSH and LH) and insufficient formation of testosterone in the testicles.How does the medication work?
GnRH agonists or antagonists prevent premature ovulation. Otherwise, the egg would be unable to be retrieved.
Dosage
Form of administration
Solution for injection after preparation of a dry substance
Start of treatment
Before and during hormonal stimulation
Agonist or antagonist
Depends on the findings (patient) and the treatment regimen
When are GnRH agonists/antagonists used?
Component of the stimulation protocol for hormonal stimulation
How does the medication work?
Progesterone is used to stimulate the development of the uterine lining so that the fertilised egg cell can implant itself optimally. It also prevents further follicles from maturing and generally supports pregnancy.
Dosage
Type of medication
Progestogens (corpus luteum hormones)
Form of administration
Tablets, vaginal gel, syringes
Start of treatment
Around day 13, after induction of ovulation
Duration of treatment
Daily application up to day 28
When is progesterone used?
- Used in the second phase of the menstrual cycle (luteal phase)
- Used in spontaneous and induced cycles in the context of assisted reproduction
What is a stimulation protocol?
As the individual dosages, drug compositions and time frames vary depending on the patient, the attending physician prepares a document known as a stimulation protocol. This shows the medications to be taken and the corresponding timings and makes planning easier. It will also help you to understand the entire course of treatment.
