Anovulation, failure of follicular maturation: Absence of adequate hormonal stimulation; ovarian follicles do not ripen, and ovulation will not occur. Unfavorable cervical mucus: Normally the cervical glands secrete large volumes of thin, watery mucus, but if the mucus is unfavorable (scant, thick, or sticky), sperm is unable to pass through to the uterus. Hyperprolactinemia: Excessive prolactin secretion may cause amenorrhea, galactorrhea, and infertility. Luteal phase defect: Progesterone secretion by the corpus luteum is insufficient to maintain endometrial integrity. Endometriosis: Endometrial tissue is implanted in abnormal locations (e.g., uterine wall, ovary, extragenital sites). Androgen excess: May decrease fertility (most common condition is polycystic ovary). Medications to induce ovulation
F
Name
Category
Availability
Uses
Side Effects
Cetrorelix (Cetrotide)
GnRH antagonist
I: 0.25 mg, 3 mg
Inhibition of premature LH surges in women undergoing ovarian hyperstimulation
OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, dyspnea, peripheral/dependent edema; headaches, pain/redness at injection site, mood swings, hot flashes, insomnia, vaginal dryness
Chorionic gonadotropin (Novarel, Ovidrel, Pregnyl)
Gonadotropin
I: 5,000 units, 10,000 units, 20,000 units
Ovidrel: 250 mcg/0.5 ml
In conjunction with clomiphene, human menotropins or urofolitropin to stimulate ovulation
OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, dyspnea, peripheral/dependent edema; ovarian enlargement, ovarian cyst formation, headache, pain at injection site
Clomiphene (Clomid, Milophene, Serophene)
Antiestrogen
T: 50 mg
Anovulation, oligo-ovulation with intact pituitary/ovarian response and endogenous estrogen
Ovarian cyst formation, ovarian enlargement, visual disturbances, premenstrual syndrome, hot flashes, headaches, blurred vision, nausea, breast tenderness
Follitropin alpha (Gonal-F)
Gonadotropin
Injection, powder: 75 units, 450 units, 1,050 units
Injection, solution: 300 units/0.5 ml, 450 units/0.75 ml, 900 units/15 ml
In conjunction with human chorionic gonadotropin to stimulate ovarian follicular development in pts with ovulatory dysfunction not due to primary ovarian failure (e.g., anovulation, oligo-ovulation)
OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, dyspnea, peripheral/dependent edema; flu-like symptoms, upper respiratory tract infections, bleeding between menstrual periods, nausea, ovarian enlargement, ovarian cysts, acne, breast pain/tenderness, mood swings
Follitropin beta (Follistim AQ)
Gonadotropin
I: 75, 350, 650, 975 international units FSH
In conjunction with human chorionic gonadotropin to stimulate ovarian follicular development in patients with ovulatory dysfunction not due to primary ovarian failure (e.g., anovulation, oligo-ovulation)
OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, shortness of breath, peripheral/dependent edema; flu-like symptoms, breast tenderness, dry skin, rash, dizziness, fever, headaches, nausea, fatigue, mood swings
Goserelin (p. 558) (Zoladex)
GnRH agonist
Implant: 3.6 mg, 10.8 mg
Endometriosis, adjunct to menotropins for ovulation induction
Hot flashes, amenorrhea, blurred vision, edema, headaches, nausea, vomiting, breast tenderness, weight gain, mood swings, insomnia, vaginal dryness
Leuprolide (p. 684) (Eligard, Lupron)
GnRH agonist
Injection, Solution: 5 mg/ml for subcutaneous injection
Injection, powder: 3.75 mg, 7.5 mg, 11.25 mg, 15 mg, 22.5 mg, 30 mg
Endometriosis, adjunct to menotropins/human chorionic gonadotropin for ovulation induction
Hot flashes, amenorrhea, blurred vision, edema, headaches, nausea, vomiting, breast tenderness, weight gain, mood swings, insomnia, vaginal dryness
Menotropins (Menopur, Repronex)
Gonadotropin
75 units FSH, 75 units LH activity
In conjunction with chorionic gonadotropin for ovulation stimulation in pts with ovulatory dysfunction due to primary ovarian failure
OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, dyspnea, edema of lower extremities; ovarian enlargement, ovarian cyst formation, breast tenderness, mood swings
Nafarelin (Synarel)
GnRH
2 mg/ml nasal spray (200 mcg/spray)
Endometriosis, adjunct to menotropins/human chorionic gonadotropin for ovulation induction
Loss of bone mineral density, breast enlargement, bleeding between regular menstrual periods, acne, mood swings, seborrhea, hot flashes, headache, insomnia, vaginal dryness
Urofollitropin (Bravelle)
Gonadotropin
75 units FSH activity
In conjunction with human chorionic gonadotropin for ovulation stimulation in pts with polycystic ovary syndrome who have elevated LH:FSH ratio and have failed clomiphene therapy
OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, shortness of breath, edema of lower extremities; ovarian enlargement, ovarian cyst formation, pain/redness at injection site, breast tenderness, nausea, vomiting, diarrhea, mood swings 
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