Human chorionic gonadotropin
Progesterone is a hormone that stimulates and supports the development of the endometrium. It is initially produced by the ovary at the corpus luteum which is formed from the follicle after the egg is ovulated. Elevated progesterone levels are one indication that ovulation has occurred.
The endometrium must thicken and become more vascular during the luteal phase of the menstrual cycle in order to accept and support the developing embryo. Both estrogen and progesterone stimulate the development of the endometrium.
After conception, progesterone is secreted by the placenta and is necessary to maintaining an ongoing pregnancy. Progesterone is sometimes administered to women with recurrent miscarriage and it is usually given to women after assisted reproductive technology cycles.
Progesterone is available in several forms including intramuscular injection, gel, vaginal suppository, oral troche, and as micronized oral capsules.
hCG (Pregnyl, Profasi, Ovidrel)
Pregnyl and Profasi are human chorionic gonadotropin (hCG) hormone products derived and purified from the urine of pregnant women. Ovidrel is produced by genetic recombinant cell technology (non-human derived) and is a pure form of recombinant hCG (r-hCG).
hCG is produced by the placenta and its role is to signal the corpus luteum to secrete progesterone. However, the body reacts to hCG in the same manner as it does to leutinizing hormone (LH). The LH surge is responsible for triggering ovulation once the follicles are mature.
Antagon is used during stimulated ART cycles to block the action of LH, thereby preventing premature release of the eggs. Lupron can also be used during stimulated ART cycles and it suppresses LH production; therefore, the LH surge cannot occur. However, an injection of hCG is interpreted by the body as the LH surge and will trigger ovulation. hCG is administered 36-38 hours prior to egg retrieval and mimics the action of LH.
Parlodel (bromocriptine) is used to treat a condition known as hyperprolactenemia, or elevated prolactin levels. Prolactin is the hormone responsible for breast milk production which normally rises during and after pregnancy.
Elevated levels in the absence of pregnancy can cause irregular ovulation and are often due to a benign tumor of the pituitary gland. The tumor is sometimes surgically removed depending upon its size and location or prolactin levels can be lowered using bromocriptine.
We often use one cycle of birth control pills to prevent cyst formation and control the start of an ART cycle. Birth control pills contain both estrogen and progesterone and diminish the production of FSH and LH.
Many other types of medications are used to treat the various conditions causing infertility. Antibiotics are used to treat reproductive tract infections including Chlamydia, gonorrhea, and others. The choice of antibiotic depends upon the seriousness of the infection and the suspected bacteria.
Corticosteroids are used in many different types of autoimmune disorders including Lupus. They may also be used in cases where the adrenal glands cause overproduction of male hormones (androgens). We often use low dose corticosteroid therapy prior to embryo transfer to increase the chances of a successful implantation.