My patient asked me today if it was absolutely necessary to use injectable medications for her IVF cycle. Unfortunately, I had to tell her that the shots were unavoidable. Using injectable medications to stimulate follicular growth has evolved over the last 100 years. I would like to discuss the evolution and potential future of gonadotropins (injectable medications used to help grow eggs).
I have been prescribing injectable medications for in vitro fertilization (IVF) for over a decade. Every time I write a prescription for gonadotropins, I am reminded about the humble beginnings and amazing development of what we now know as the modern gonadotropin injectable medication. The Practice Committee of the American Society of Reproductive Medicine states, Use of gonadotropin therapy is so central to infertility treatment that it is easy to overlook the considerable discovery and research that preceded production of the effective and safe products available today. The history underpinning this development spans close to 100 years and provides a splendid example of how basic animal experimentation and technological advances have progressed to clinical application.
From animal research sprouted human research in gonadotropin development, usage, and safety. The Practice Committee also states, Research underlying production of the current gonadotropin preparations has spanned at least five decades. Gonadotropin manufacture has evolved from extraction of urine to application of recombinant techniques to yield a variety of FSH preparations for ovarian stimulation.
Today, women daily inject these medications to recruit and mature eggs in the ovary. Most women undergoing IVF require around 7 to 10 days of gonadotropin therapy. That means 7 to 10 shots – just to mature the eggs. Wouldn’t it be great if we could get similar growth of follicles but with fewer injections?
Current research trials are underway exploring the possibility of decreasing the number of injections taken during controlled ovarian hyperstimulation and IVF. A new, longer acting gonadotropin being developed may decrease the number of shots a patient takes during the IVF process. The Practice Committee states that this new preparation of gonadotropin hold[s] promise for improving patient satisfaction while maintaining efficacy.
This longer acting preparation could replace up to seven injections! A single subcutaneous injection of the recommended dose could last as long as a week. This new medication is currently being studied in numerous trials to evaluate safety and efficacy. As of right now, it is too soon to know if and when this medication will be approved for mainstream IVF usage in the USA. However, a lot of patients would be happy with fewer injections during an IVF cycle!
Source: Gonadotropin preparations: past, present, and future; Volume 90, Issue 5, Supplement, November 2008, Pages S13“S2
Dr. Lowell T. Ku, M.D. is an award winning and leading Reproductive Endocrinology and Infertility specialist at Dallas IVF, one the nation’s premiere infertility centers. Dr. Ku clarifies the many confusing terms used in the world of Infertility using straightforward explanations.