Ovarian stimulation is an infertility treatment in which medicines, called fertility drugs, are used to boost ovulation among women who do not ovulate or to stimulate the development of multiple eggs among women who have trouble getting pregnant. Learn about the most common medications used to treat infertility by stimulating ovulation.
Fallopian Tube and Ovary: Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans
Image by TheVisualMD
What Is Ovarian Stimulation?
Fallopian Tube and Ovary: Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans
Image by TheVisualMD
Fallopian Tube and Ovary: Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans
Fallopian Tube and Ovary: Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans.
Image by TheVisualMD
Superovulation
In this process, also known as ovarian stimulation, ovulation induction, or stimulation of egg maturation, a woman takes medication to stimulate the ovaries to make many mature eggs at one time.
These medications are given by injection for 8 to 14 days. A health care provider closely monitors the development of the eggs using transvaginal ultrasound and blood tests to assess follicle growth and estrogen production by the ovaries. When the eggs are mature—as determined by the size of the ovarian follicles and the level of estrogen—an injection of the hormone hCG initiates the ovulation process. A health care provider takes out (egg retrieval) the eggs 34 to 36 hours after the hCG injection.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Additional Materials (5)
IVF Ovarian Stimulation Short Protocol
Video by Life Invitro/YouTube
In Vitro Fertilization Ovarian Stimulation
Video by University of Iowa Health Care/YouTube
IVF PROCESS STEP BY STEP (In Vitro Fertilisation): Ovarian stimulation
Video by Instituto Bernabeu/YouTube
3A IVF CONTROLLED OVARIAN STIMULATION THE PROCESS
Video by Ton Yen/YouTube
Infertility Ovarian Stimulation • West Coast Women’s Reproductive Center
Video by West Coast Women's Reproductive Center/YouTube
1:29
IVF Ovarian Stimulation Short Protocol
Life Invitro/YouTube
1:23
In Vitro Fertilization Ovarian Stimulation
University of Iowa Health Care/YouTube
1:02
IVF PROCESS STEP BY STEP (In Vitro Fertilisation): Ovarian stimulation
Instituto Bernabeu/YouTube
6:00
3A IVF CONTROLLED OVARIAN STIMULATION THE PROCESS
Ton Yen/YouTube
1:08
Infertility Ovarian Stimulation • West Coast Women’s Reproductive Center
The Ovarian Reserve Profile comprises several tests that are performed to assess a woman’s ovarian reserve (egg supply). This indicates the woman’s fertility potential, and it’s usually ordered as part of an in vitro fertilization work-up.
The Ovarian Reserve Profile comprises several tests that are performed to assess a woman’s ovarian reserve (egg supply). This indicates the woman’s fertility potential, and it’s usually ordered as part of an in vitro fertilization work-up.
Every female is born with a lifetime supply of ovules (eggs) in her ovaries; since puberty and through the woman’s reproductive years, these ovules are released on a monthly basis. When a woman reaches menopause, her egg supply is used up, which means that her potential fertility is exhausted.
The Ovarian Reserve Profile comprises several tests, including but not limited to:
Anti-Müllerian Hormone (AMH)
Follicle Stimulating Hormone (FSH)
Estradiol (E2)
Inhibin B
Clomiphene citrate challenge test (CCCT)
Antral Follicle Count (AFC)
These tests provide information about the woman’s remaining egg supply (ovarian reserve), which is indicative of her fertility potential.
The Ovarian Reserve Profile test, along with other factors such as the woman’s age, are used as indicators for estimating her ovarian reserve. This can indicate the woman’s chances for a successful pregnancy with in vitro fertilization (IVF).
Your doctor may want to order this test in the following situations:
As part of the work-up for infertility and assisted reproduction techniques
To help predict the onset of menopause
To evaluate ovulatory dysfunction
To assess the chances of successful pregnancy following IVF
To help decide the appropriate dosage of fertility drugs, thus decreasing the chances of either poor ovarian response or exaggerated response (hyperstimulation)
For the hormone tests, a needle will be used to take a blood sample from a vein in your arm.
If your doctor also included an Antral Follicle Count test, then a transvaginal ultrasound must be performed. In this case, you will be asked to remove your underwear and lie on your back. Then, a healthcare practitioner will apply a water-based gel on a probe that has been previously covered with a condom, and the probe will be carefully inserted on your vagina to visualize your ovaries.
No special preparations are necessary. These tests must be done on day 3 of the menstrual cycle; however, day 2 and 4 may also be acceptable.
For the blood tests, you may feel a little sting when the needle is inserted and extracted but otherwise is a quick procedure. You may also experience bruising and a little bleeding, as well as mild soreness for a short amount of time after the extraction.
There are no risks related to a transvaginal ultrasound test. You may feel slight discomfort during the procedure.
It is normal for a woman’s ovarian reserve to go down with age. Therefore, in normal conditions, a 20-year-old will not have the same ovarian reserve as a 35-year-old woman.
None of these tests should be used as a stand-alone test. Your doctor will take into consideration the results of these tests, along with your age, your clinical findings, and your family medical history to make an appropriate evaluation of your ovarian reserve.
504295: ReproSURE™ (Ovarian Reserve Profile) | LabCorp [accessed on Oct 02, 2018]
An Update on Ovarian Aging and Ovarian Reserve Tests [accessed on Dec 09, 2018]
What is Ovarian Reserve, and How is it Tested? - Dominion Fertility [accessed on Dec 09, 2018]
AMH Fertility Test | Everything You Need To Kow about Ovarian Reserve [accessed on Dec 12, 2018]
Also called: FSH, FSH Levels, Follicle-Stimulating Hormone, Follitropin, Pituitary Gonadotropin
This test measures the level of follicle-stimulating hormone (FSH) in the blood. FSH plays an important role in sexual development and function. FSH levels that are too high or too low can cause health problems for men and women and delayed or early puberty in children.
Follicle-Stimulating Hormone (FSH) Test
Also called: FSH, FSH Levels, Follicle-Stimulating Hormone, Follitropin, Pituitary Gonadotropin
This test measures the level of follicle-stimulating hormone (FSH) in the blood. FSH plays an important role in sexual development and function. FSH levels that are too high or too low can cause health problems for men and women and delayed or early puberty in children.
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Use the slider below to see how your results affect your
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(mi.U.)/mL
4.7
21.5
Your result is Normal.
FSH levels increase temporarily each month to stimulate your ovaries to produce eggs.
Related conditions
This test measures the level of follicle-stimulating hormone (FSH) in a sample of your blood. A hormone is a chemical messenger in your bloodstream that controls the actions of certain cells or organs. FSH plays an important role in sexual development in children and fertility in adults.
In women who menstruate (have periods), FSH helps control the menstrual cycle. It triggers the growth of eggs in the ovaries and gets the eggs ready for ovulation. Ovulation is when an ovary releases an egg so it can travel down a fallopian tube where it can be fertilized by sperm.
In men, FSH helps control the amount of sperm that the testicles (testes) make. It also affects how healthy the sperm are.
In children, FSH levels are normally low until puberty starts. Then FSH levels begin to rise along with the levels of other hormones. The increase in all these hormones triggers the physical changes of puberty:
In girls, FSH tells the ovaries to start making the hormone estrogen. Estrogen is involved in the growth of breasts, body hair, and menstruation.
In boys, FSH tells the testicles to start making the hormone testosterone. Testosterone is involved in the growth of facial and body hair, changes in a boy's voice, and sperm production.
FSH levels are controlled by a complex system of hormones made in different parts of your body. Abnormal levels of FSH may be a sign of a problem with any of these parts. They include your:
Pituitary gland, a small gland at the base of your brain. It makes FSH.
Hypothalamus, a part of your brain. It makes hormones that tell your pituitary gland how much FSH to make.
Reproductive glands, your ovaries or testicles. The amount of sex hormones they make let your hypothalamus and pituitary gland know when to start and stop making FSH.
Other names: follitropin, FSH, follicle-stimulating hormone: serum, pituitary gonadotropins
FSH testing is used to help diagnose conditions that cause too much or too little FSH. The specific way the test is used depends on your sex and age.
In women, an FSH test may be used to:
Help find the cause of infertility
Check for medical conditions that affect how the ovaries work
Find the reason for irregular or stopped menstrual periods in women of childbearing age
Find out when a woman is most likely to get pregnant
Find out if menopause or perimenopause may have begun:
Menopause happens when the ovaries stop making certain hormones, and menstrual periods have stopped for 12 months in a row. This usually happens around age 50.
Perimenopause is the time leading up to menopause when hormones and periods begin to change. It usually starts around age 45.
In men, an FSH test may be used to:
Help find the cause of infertility
Find the reason for a low sperm count
Check for medical conditions that affect the testicles
In women and men, FSH testing may be used to help diagnose disorders of the:
Pituitary gland
Hypothalamus
In children and teens, FSH testing is most often used to find out if a medical disorder is causing early or delayed (late) puberty.
An FSH test is often used with a blood test for another hormone made in the pituitary gland called luteinizing hormone (LH). These two hormones work together to control sexual development and reproduction. Blood tests to check estrogen, testosterone, and progesterone levels are also commonly used with FSH testing.
For women: You may need this test if:
You've been unable to get pregnant after 12 months of trying.
Your menstrual periods aren't regular or have stopped. If you're age 45 or older, testing usually isn't needed. That's because high levels of FSH are a normal sign of perimenopause and menopause. As your ovaries release fewer eggs, your body makes more hormones to try to trigger ovulation. But you may need an FSH test along with other hormone tests if there is a medical reason, including:
Premature menopause (age 40 or younger)
Early menopause (before age 45)
Having symptoms that may be related to menopause, but the cause isn't clear
You have a less interest in sex than usual.
For men: You may need this test if:
You've been unable to get your partner pregnant after 12 months of trying.
You have less interest in sex than usual.
You have a low sperm count.
You have a loss of muscle and/or body hair.
For women and men: You may need an FSH test if your health care provider thinks you could have a pituitary disorder. Pituitary problems can affect fertility and decrease your interest in sex. They may also cause symptoms, such as:
Fatigue
Weakness
Decreased appetite and/or weight loss
Children and teens may need FSH testing if puberty seems to be starting too early or too late:
Early puberty means showing signs of sexual development before age 8 in girls and age 9 in boys.
Delayed puberty means not showing signs of sexual development by age 13 in girls and age 14 in boys.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Women who have menstrual periods may need to be tested at a specific time during their menstrual cycle. That's because FSH levels change throughout the month.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
To understand the results of your FSH test, your provider will consider your sex, age, symptoms, medical history, and the results of other hormone tests, especially your level of luteinizing hormone (LH). Your provider can explain what the results of your FSH test mean.
Generally, in women and men:
Higher levels of FSH are often a sign of a condition in the reproductive glands (ovaries or testicles) that prevents them from making normal levels of sex hormones. The pituitary responds by making more FSH to try to get them to work properly. High FSH may also be a sign of a condition outside of the reproductive glands that affects how the glands work.
Conditions linked to high FSH levels include:
In women:
Ovaries that never developed normally
Primary ovarian insufficiency (POI)
Polycystic ovary syndrome (PCOS)
Menopause or perimenopause
An ovarian tumor
Thyroid diseases or adrenal gland disorders
A chromosomal disorder, such as Turner syndrome
In men:
A germ cell tumor (a tumor that starts in the cells that become sperm)
Mumps
A physical injury to the testicles
A chromosomal disorder, such as Klinefelter syndrome
In women and men, damage to the ovaries or testicles, which may be caused by:
Autoimmune disease
Radiation therapy and/or chemotherapy
Lower than normal levels of FSH in women and men are often a sign of a problem with the pituitary gland or hypothalamus. These problems may make it hard for your body to make FSH and LH.
In women, low FSH levels may also be linked to rapid weight loss, being very underweight, or extreme exercise.
Generally, in children with signs of early sexual development (before age 8 in girls or age 9 in boys):
High levels of FSH and LH mean the child has early puberty, also called precocious puberty. In most cases, the cause is unknown. But in certain cases, the cause is a problem in the brain, such as:
A brain tumor
A past brain injury
A past brain infection, such as meningitis or encephalitis
Normal levels of FSH and LH mean the child has a type of early puberty called peripheral precocious puberty. This often means that a disorder in the testicles, ovaries, or adrenal glands is causing higher than normal levels of estrogen or testosterone. Severe hypothyroidism and exposure to medicines that contain sex hormones may also cause this type of early puberty.
Generally, in teens with no signs of sexual development by age 13 for girls or age 14 for boys, low or normal levels of FSH and LH usually mean delayed puberty. Many teens with delayed puberty are healthy and go through normal puberty at a later age. But delayed puberty may be caused by certain medical conditions, such as:
Poor nutrition from a long-term illness or eating disorder
Hypogonadism, which is when the ovaries or testicles make little or no hormone. It may be caused by:
Certain genetic disorders, including Kallmann syndrome
Tumors in the brain or pituitary gland
Turner syndrome in girls
Klinefelter syndrome in boys
Certain autoimmune disorders
Radiation therapy or chemotherapy
If you have questions about test results, talk with your or your child's provider.
At-home test kits that measure FSH levels in urine (pee) may help women find out if menopause or perimenopause is causing symptoms, such as irregular periods, vaginal dryness, or hot flashes.
Home tests can only find higher than normal FSH levels. They shouldn't be used to check whether you can become pregnant because they can't accurately tell whether your ovaries are making eggs. If you use a home FSH test, discuss your symptoms and test results with your provider.
Follicle-Stimulating Hormone (FSH) Levels Test: MedlinePlus Medical Test [accessed on Jan 20, 2024]
Follicle-stimulating hormone (FSH) blood test: MedlinePlus Medical Encyclopedia [accessed on Jan 20, 2024]
Follicle-stimulating Hormone (FSH) Test - Testing.com. Jan 5, 2023 [accessed on Jan 20, 2024]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (16)
Hormonal Control of the Menstrual Cycle, Animation.
Video by Alila Medical Media/YouTube
How the Body Works : The Menstrual Cycle
Video by Daniel Izzo/YouTube
What Is High FSH?
Video by fertilityauthority/YouTube
What is FSH?
Video by fertilityauthority/YouTube
Human Physiology - Hormonal Regulation of Male Reproduction
Video by Janux/YouTube
Follicle-stimulating hormone
Follicle-stimulating hormone
Image by MartaFF
Follicle-stimulating Hormone
Follicle-stimulating hormone is a hormone found in humans and other animals. It is synthesized and secreted by gonadotrophs of the anterior pituitary gland. FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body. FSH and luteinizing hormone (LH) act synergistically in reproduction. Specifically, an increase in FSH secretion by the anterior pituitary causes ovulation.
Image by TheVisualMD
Follicle-stimulating hormone
The time scale starts with the (LMP), given as day number. Day number 1 corresponds to 0 to 0.99 days from LMP, and Day number 2 corresponds to 1.00 to 1.99 days from LMP and so forth. The time scale ends at whatever is the actual next menstruation, which marks the beginning of the next cycle, which is equivalent to starting all over again from the beginning of the time scale.
Image by Mikael Haggstrom
Inhibin
Inhibins are a family of gonadal hormones, so named because they inhibit the secretion of follicle-stimulating hormone (FSH). In females, inhibin A is predominantly produced from the ovarian follicle and inhibin B predominantly from small developing follicles. Levels of both fluctuate during the menstrual cycle, and decrease to very low levels at menopause with the depletion of ovarian follicles. However, total inhibin levels may be elevated in women with ovarian cancer that has begun in stromal tumors. Also known as stromal sex cord tumors or arrhenoblastoma, these tumors begin in the hormone-producing cells of ovarian tissue.
Image by TheVisualMD
Ovarian Cycle Showing Oocyte and Matured Follicle
Visualization of the ovarian cycle. The ovarian cycle is a process by which an oocyte matures, erupts from the follicle and travels down the fallopian tube to the uterus. What is left of the follicle becomes a structure known as the corpus luteum. At the top of this image are oocytes and below them are primary follicles containing oocytes. As the follicle matures, the surrounding cells proliferate forming a multi-layered coat of granulosa cells. The granulosa cells are surrounded by thecal cells. The antrum, a cresent-shaped cavity filled with follicular fluid, develops within the maturing follicle. Once the follicle becomes fully mature, the ovum is discharged from the ovary, enters the fallopian tube and travels toward the uterus to awaits fertilization. The remaining follicle transforms into the corpus luteum which secretes hormones estrogen and progeterone. If fertilization does not occur, the corpus luteum degenerates. If fertilized, however, the egg secretes the human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby allowing the development and maintainance of the thick uterine lining of the womb.
Image by TheVisualMD
Thyroid-stimulating Hormone: Pituitary Gland
The pituitary gland is often referred to as the 'master gland' because it regulates the activities of other endocrine glands. The pituitary gland, however, takes its orders from the hypothalamus, which decides which particular hormones the pituitary should release and when.
Image by TheVisualMD
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Ooctye Erupting from Ovary
Visualization of an oocyte erupting from the surface of the ovary. The ovary, which is suspended by the ovarian ligament, is seen in cross section. Revealed are the ovarian follicles which are oocytes in various stages of maturation. Each month, one of the mature follicles ejects it's oocyte through the surface of the ovary. This event is called ovulation. The finger-like projections of the fallopian tube sweep up the oocyte into the duct where it awaits fertilization. Meanwhile, the remains of the ruptured follicle in the ovary are transformed into a structure called the corpus luteum which eventually degenerates if fertilization does not occur. If fertilized, however, the egg secretes the a hormone called human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick uterine lining of the womb.
Image by TheVisualMD
Fallopian Tube and Ovary
Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans. The ovaries are the site of egg production and maturation within the human female. Each month, an oocyte is ejected from a mature follicle to the surface of one of the two ovaries. This event is called ovulation. The finger-like projections of the fallopian tube (fimbriae) sweep up the oocyte into the duct where it awaits fertilization. The remains of the ruptured follicle in the ovary are transformed into a structure called the corpus luteum. Upon fertilization, the egg secretes a hormone called human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick uterine lining of the womb. If fertilization does not occur, the corpus luteum degenerates into a corpus albicans, which is essentially scar tissue and is mostly comprised of collagen.
Image by TheVisualMD
Hormonal Regulation of Growth
Image by OpenStax College
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Luteinizing Hormone
Luteinizing hormone is a hormone produced by gonadotroph cells in the anterior pituitary gland. In females, an acute rise of LH (\"LH surge\") triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone (ICSH), it stimulates Leydig cell production of testosterone. It acts synergistically with FSH.
Estradiol (E2) is a hormone that belongs to a group of steroids called estrogens. E2 is produced in the ovaries of women and in the testicles of men. This test is useful to assess hormonal unbalances that affect the development of sexual characteristics in both males and females.
Estradiol Test
Estradiol (E2) is a hormone that belongs to a group of steroids called estrogens. E2 is produced in the ovaries of women and in the testicles of men. This test is useful to assess hormonal unbalances that affect the development of sexual characteristics in both males and females.
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Use the slider below to see how your results affect your
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pg/mL
12.5
166
Your result is Normal.
Normal results vary based on the person's age, sex, and the method used for testing by the laboratory.
Related conditions
Estradiol is a hormone that belongs to a group of steroids called estrogens.
Estrogens are implicated in the development and function of female reproductive organs and secondary sexual characteristics (such as breasts enlargement), while also playing a role in menstrual cycle regulation and pregnancy maintenance.
Even though these hormones have been considered to be exclusively female hormones, they are also involved in bone metabolism and growth in both males and females.
There are three main types of estrogens, which are estrone (E1), estradiol (E2), and estriol (E3).
Estradiol is mostly produced in the ovaries of women in reproductive age and in the testicles of men. E2 is considered to be the most potent estrogen and the one with the higher concentration in non-pregnant, pre-menopausal women.
An estradiol test measures the amount of this hormone in a sample of your blood.
In women, the assessment of estradiol levels is an essential part of the reproductive function evaluation. Estradiol testing can be used to:
Help determine the cause of abnormalities in the menstrual cycle, such as oligomenorrhea (menstrual irregularities) or amenorrhea (lack of menstruation).
Evaluate hypogonadism (decreased functional activity of the ovaries).
Investigate abnormal vaginal bleeding.
Assess the health and function of the ovaries for assisted reproduction protocols, such as in-vitro fertilization.
To establish the time of ovulation and optimal time for conception.
Help diagnose the cause of precocious or delayed puberty.
Monitor estrogen replacement therapy.
Monitor antiestrogen therapy.
Detect estrogen-producing tumors
As part of the assessment of bone mineral density measurement in the fracture risk evaluation.
In males, measurement of estradiol levels can be performed in situations such as:
Assessment of feminization disorders, including gynecomastia (enlarged breasts).
To help diagnose estrogen-producing neoplasms.
A small amount of blood will be drawn from a vein in your arm by using a needle.
No fasting or other preparations are needed. Inform your healthcare practitioner if you are taking any over-the-counter or prescription medications since you might be asked to temporarily stop taking certain drugs that may affect your test results.
You may feel a little sting when the needle is inserted and extracted but otherwise is a quick procedure. You may also experience bruising and a little bleeding, as well as mild soreness for a short amount of time after the extraction.
Normal estradiol levels widely vary depending on the person’s age, sex, and pregnancy status.
Usually, estrogen levels are not used on its own to assess a condition or disorder, but rather in conjunction with other tests. E2 values must be corroborated with a woman’s menstrual cycle or pregnancy status.
High
Heightened levels of estradiol in females can be due to:
Early puberty
Hyperthyroidism (overactive thyroid gland)
Tumors of the ovary
Tumors of the adrenal glands
Cirrhosis (liver scarring)
Heightened levels of estradiol in males can be due to:
Gynecomastia (enlarged breasts)
Cirrhosis
Delayed puberty
Hyperthyroidism
Testicular cancer
Tumors of the adrenal glands
Low
Decreased levels of estradiol in women are seen in:
Turner syndrome (a genetic condition in women caused by a missing or abnormal X chromosome)
Hypopituitarism
Menopause
Hypogonadism (diminished functional activity of the ovaries)
Eating disorders, like anorexia
Polycystic ovarian syndrome
Strenuous exercise
Decreased levels of estradiol in men are seen in:
Hypopituitarism
Hypogonadism (diminished functional activity of the testes)
In premenopausal women, estradiol along with follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, define the stage of the menstrual cycle.
EEST - Clinical: Estradiol, Serum [accessed on Oct 31, 2018]
004515: Estradiol | LabCorp [accessed on Oct 31, 2018]
Estradiol (Blood) - Health Encyclopedia - University of Rochester Medical Center [accessed on Oct 31, 2018]
Estrogens [accessed on Nov 06, 2018]
Estradiol [accessed on Nov 06, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (12)
Ovary and Fallopian Tube
Illustration of ovary and fallopian tube. The major female sex hormones, estrogen and progesterone are produced in the corpora lutea of the ovaries. Estrogen plays a major role in the maintenance of the reproductive organs and the development of secondary sex characteristics. Progesterone plays a role in preparing and maintaining the uterus which supports the development of the embryo.
Image by TheVisualMD
Estrogen Levels and Peak Fertility During the Menstrual Cycle
Estrogen Levels and Peak Fertility During the Menstrual Cycle: The uterus is like a self-cleaning oven - every month it cycles out the residue of reproduction to start fresh again. During the early phase of the menstrual cycle, rising estrogen levels cause the lining of the uterus to thicken. This rise in estrogen is stimulated by the follicle stimulating hormone (FSH), which is made in the anterior pituitary gland. The follicle is the receptacle in the ovary in which the egg develops, and the FSH stimulates the egg's growth while it is in the follicle. At the middle of the cycle, there is a surge of another pituitary hormone, the luteinizing hormone (LH). Now ovulation, release of the egg, occurs. At this point, the cells that had been nurturing the egg start producing the sex hormone progesterone, which causes the uterine lining to further thicken and prepare for pregnancy. If pregnancy does not occur, estrogen and progesterone levels fall and the uterus sheds its thickened lining to prepare for another reproductive cycle. This shedding, menstruation, usually lasts 3 to 7 days and removes both blood and tissue from the uterus.
Image by TheVisualMD
Estradiol
Estradiol-17-beta is the most potent form of mammalian estrogenic steroids.
Estradiol, Estrone, And Estriol, How Do They Differ?
Video by EmpowHER/YouTube
Menopause: Hormone Replacement Therapy
Video by Everyday Health/YouTube
Hormone Replacement Therapy (HRT) - Benefits and Dangers
Video by Rehealthify/YouTube
Breast tenderness and hormone replacement therapy (HRT) - from Tonic TV
Video by NPS MedicineWise/YouTube
Hormone replacement therapy (HRT) for menopause - from Tonic TV
The Hormone Therapy Debate (Treating Menopause #1)
Video by Healthguru/YouTube
Hormone Therapy (Treating Menopause #2)
Video by Healthguru/YouTube
Estrogen Molecules
Estrogens are a group of steroids that function as the main female sex hormones. More than 20 forms exist, but the most common forms of estrogens tested are estrone (E1), estradiol (E2), and estriol (E3). Total estrogens are most commonly measured in blood or urine. E1 and E2 are the two main estrogens in non-pregnant females, while E3 is the main pregnancy hormone (Progesterone is another major female hormone that also plays key roles in pregnancy and menstruation). High levels of estrogen may accompany early onset of puberty, tumors of the ovary, hyperthyroidism and cirrhosis (and in males, breast enlargement or tumors of the testes). Low levels of estrogen may be due to hypopituitarism, genetic disorders, pregnancy complications, post menopause or extreme exercise.
Image by TheVisualMD
Ovary and Fallopian Tube
TheVisualMD
Estrogen Levels and Peak Fertility During the Menstrual Cycle
TheVisualMD
Estradiol
3:34
Estradiol, Estrone, And Estriol, How Do They Differ?
EmpowHER/YouTube
1:43
Menopause: Hormone Replacement Therapy
Everyday Health/YouTube
1:35
Hormone Replacement Therapy (HRT) - Benefits and Dangers
Rehealthify/YouTube
6:33
Breast tenderness and hormone replacement therapy (HRT) - from Tonic TV
NPS MedicineWise/YouTube
10:11
Hormone replacement therapy (HRT) for menopause - from Tonic TV
The Hormone Therapy Debate (Treating Menopause #1)
Healthguru/YouTube
3:21
Hormone Therapy (Treating Menopause #2)
Healthguru/YouTube
Estrogen Molecules
TheVisualMD
Inhibin B Test
Inhibin B Test
Inhibin is a hormone produced by the ovaries and testes. There are two types of inhibin, which are termed inhibin A and inhibin B. Abnormal levels of the inhibin B hormone can be related to infertility, ovarian cancer, low production of sperm, and several other conditions.
Inhibin B Test
Inhibin is a hormone produced by the ovaries and testes. There are two types of inhibin, which are termed inhibin A and inhibin B. Abnormal levels of the inhibin B hormone can be related to infertility, ovarian cancer, low production of sperm, and several other conditions.
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Use the slider below to see how your results affect your
health.
pg/mL
139
Your result is Normal.
Normal results vary according to the day of the menstrual cycle and based on the laboratory and the method used.
Related conditions
Inhibin is a hormone produced by the ovaries in females and by the testes in males. Its main function is believed to be the inhibition of the secretion of another hormone called follicle-stimulating hormone (FSH), which is secreted by the pituitary gland (a small gland located at the base of the brain).
There are two subunits of inhibin, which are termed inhibin A and inhibin B. An inhibin B test measures the amount of the B subunit in a sample of your blood.
Your doctor may want to order an inhibin test in the following conditions:
As an aid in the diagnosis of ovarian cancer, in this case usually accompanied by other test known as cancer antigen 125 (CA 125).
To assess the ovaries function.
To aid in the diagnosis of precocious puberty in females.
Along with other tests, to help evaluate infertility in both males and females.
To evaluate the potential for natural pregnancy in aged women.
As a tool to help predict the success rate of fertility treatments.
To predict the onset of menopause.
To assess the testicles function.
To assess the production of sperm in males.
A needle will be used to take a blood sample from a vein in your arm.
No fasting is needed. You should inform your healthcare practitioner if you are taking any over-the-counter or prescription drugs. You may be asked to stop taking vitamin B7 (biotin) supplements for at least 72 hours before the test.
If you are a woman, you may be asked to wait for a specific time in your period for this test to be done because inhibin levels fluctuate during the menstrual cycle.
You may feel discomfort when the needle is inserted and extracted but otherwise is a quick procedure. You may also experience bruising and a little bleeding, as well as mild soreness for a short amount of time after the blood extraction.
High levels of inhibin B in males has been related to testicular dysfunction, low sperm production, and infertility.
Abnormal levels of inhibin B in females has been related to early onset of puberty, dysfunction of the ovaries, infertility, ovarian cancer (in this case inhibin B levels tend to be elevated about 60-fold over the reference range value), and imminent onset of menopause. However, since inhibin B levels vary in relation to the menstrual cycle, the results must be interpreted by a healthcare professional.
Talk to your healthcare professional to know what the results mean in your specific case.
INHB - Clinical: Inhibin B, Serum [accessed on Aug 28, 2018]
Fertility Testing - AACC.org [accessed on Aug 28, 2018]
146795: Inhibin B | LabCorp [accessed on Aug 28, 2018]
INHAB - Clinical: Inhibin A and B, Tumor Marker, Serum [accessed on Aug 28, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Clomiphene Citrate Challenge Test
Clomiphene Citrate Challenge Test
Also called: CCCT, Clomid® Challenge Test
The Clomiphene Citrate Challenge Test (CCCT) measures certain hormones in a woman’s blood before and after taking the fertility drug clomiphene citrate. This is done to estimate her supply of ovules (eggs) and predict the success rate of pregnancy with in vitro fertilization (IVF).
Clomiphene Citrate Challenge Test
Also called: CCCT, Clomid® Challenge Test
The Clomiphene Citrate Challenge Test (CCCT) measures certain hormones in a woman’s blood before and after taking the fertility drug clomiphene citrate. This is done to estimate her supply of ovules (eggs) and predict the success rate of pregnancy with in vitro fertilization (IVF).
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Use the slider below to see how your results affect your
health.
(mi.U.)/mL
10
12.5
15
Your result is Normal.
This is a normal response. However, it does not mean that IVF will be successful, and it does not prove that your ovaries are functioning well.
Related conditions
Every female is born with a lifetime supply of ovules (eggs) in her ovaries. This is called ovarian reserve. Since puberty and through the woman’s reproductive years, her ovules are released on a monthly basis. When a woman reaches menopause, her egg supply is used up, which means that her potential fertility is exhausted.
Clomiphene citrate is a fertility drug that’s taken orally to induce ovulation, so more than one egg is released in every cycle; this increases the chances of fertilization and successful pregnancy.
The Clomiphene Citrate Challenge Test (CCCT) measures several hormones involved in the ovulation process, including LH (luteinizing hormone), FSH (follicle stimulating hormone), and estradiol (E2).
The CCCT is used to estimate the woman’s ovarian reserve. This can indicate the woman’s chances for a successful pregnancy with in vitro fertilization (IVF).
Your doctor may want to order this test in the following situations:
As part of the work-up for infertility and assisted reproduction techniques
To evaluate ovulatory dysfunction
To assess the chances of successful pregnancy following IVF
A needle will be used to take a blood sample from a vein in your arm; this is done on day 3 of your menstrual cycle. Then, from days 5 to 9 of your period, you will take clomiphene citrate pills.
On day 10 of your menstrual cycle, a new blood sample will be drawn.
No special preparations are necessary.
You may feel a little sting when the needle is inserted and extracted but otherwise is a quick procedure. You may also experience bruising and a little bleeding, as well as mild soreness for a short amount of time after the extraction.
Besides luteinizing hormone (LH) and estradiol (E2), the follicle stimulating hormone (FSH) is also measured on your menstrual cycle day 3 (basal) and day 10 (after intake of clomiphene citrate). Both FSH levels must be below 10 IU/L to be considered as a normal response.
FSH from 10-12.5 mIU/mL: predicts resistance to fertility drugs and it has been associated with a poor prognosis (outcome).
FSH from 12.5-15 mIU/mL: it has been associated with a poor prognosis; however, pregnancies can occur with aggressive treatment.
FSH greater than 15 mIU/mL: this indicates that infertility treatment is highly likely to fail. In this case, egg donation should be considered.
It is important to point out that a normal CCCT response does not mean that IVF will be successful, and it does not prove that the woman’s ovaries are functioning well. While, on the other hand, and abnormal CCCT response is highly predictive of IVF failure.
Some fertility clinics do not offer IVF to people with an abnormal CCCT response, while other clinics do so, but making clear the poor success rate of pregnancy.
CCCT: Infertility Test Reproductive Medicine Treatment Center | RMACT [accessed on Oct 02, 2018]
Clomid Challenge Test | IVF1 [accessed on Oct 02, 2018]
Clomid Challenge Test (CCCT) - Infertility Workup & Treatment Plans - HRC Fertility [accessed on Oct 02, 2018]
An Update on Ovarian Aging and Ovarian Reserve Tests [accessed on Dec 12, 2018]
What is Ovarian Reserve, and How is it Tested? - Dominion Fertility [accessed on Dec 12, 2018]
DEFINE_ME [accessed on Dec 20, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Antral Follicle Count
Antral Follicle Count
Also called: AFC
The Antral Follicle Count (AFC) is a painless and risk-free test in which a transvaginal ultrasound is performed to assess a woman’s ovarian reserve (egg supply). This indicates the woman’s fertility potential, and it’s usually ordered as part of an in vitro fertilization work-up.
Antral Follicle Count
Also called: AFC
The Antral Follicle Count (AFC) is a painless and risk-free test in which a transvaginal ultrasound is performed to assess a woman’s ovarian reserve (egg supply). This indicates the woman’s fertility potential, and it’s usually ordered as part of an in vitro fertilization work-up.
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Use the slider below to see how your results affect your
health.
5
9
20
Your result is Normal ovarian reserve.
This is considered an appropriate ovarian reserve. The response to ovarian stimulation is usually normal, and the chances of pregnancy are high.
Related conditions
An antral (resting) follicle is a small sac filled with fluid that contains an immature ovule (egg).
Every female is born with a lifetime supply of ovules in her ovaries; since puberty and through the woman’s reproductive years, these ovules are released on a monthly basis. When a woman reaches menopause, her egg supply is used up, which means that her potential fertility is exhausted.
The Antral Follicle Count (AFC) test is an ultrasound study that assesses a woman’s remaining egg supply (ovarian reserve), which is indicative of her fertility potential.
The AFC, along with other factors such as the woman’s age and hormone levels, are used as indicators for estimating her ovarian reserve. This can indicate the woman’s chances for a successful pregnancy with in vitro fertilization (IVF). The number of eggs correlates directly with IVF success rates.
Your doctor may want to order this test in the following situations:
As part of the work-up for infertility and assisted reproduction techniques
To help predict the onset of menopause
To evaluate ovulatory dysfunction
To assess the chances of successful pregnancy following IVF
To help decide the appropriate dosage of fertility drugs, thus decreasing the chances of either poor ovarian response or exaggerated response (hyperstimulation)
You will be asked to remove your underwear and lie on your back. Then, a healthcare practitioner will apply a water-based gel on a probe that has been previously covered with a condom, and the probe will be carefully inserted on your vagina. This is called a transvaginal ultrasound.
During the procedure, the healthcare practitioner will move the probe a little bit to examine each ovary properly.
The procedure usually takes no more than 20 minutes, and there is no need for an anesthetic because it’s painless.
No special preparations are necessary. You will be asked to urinate right before the exam.
This test must be done between menstrual cycle day 2 and 5.
There are no risks related to a transvaginal ultrasound test. You may feel slight discomfort during the procedure.
It is normal for a woman’s ovarian reserve to go down with age. Therefore, in normal conditions, a 20-year-old will not have the same ovarian reserve as a 35-year-old woman.
The AFC includes follicles with a diameter ranging from 2 to 10 mm. According to the number of follicles found, the results are:
AFC 0-4: This indicates a very low functional ovarian reserve. The risk of poor response to ovarian stimulation is very high, and the chances of pregnancy are low. This AFC number has also been related to an increased risk of menopause within 7 years.
AFC 5-8: This indicates a low functional ovarian reserve. The risk of poor response to ovarian stimulation is high, and it has also been associated with a reduced pregnancy rate.
AFC 9-19: This is considered an appropriate ovarian reserve. The response to ovarian stimulation is usually normal, and the chances of pregnancy are high.
AFC ≥ 20: This indicates a high functional ovarian reserve. The response to ovarian stimulation is usually exaggerated, which means a higher risk of ovarian hyperstimulation syndrome. The pregnancy rates are usually elevated.
The number of antral follicles can vary from month to month, and it’s "observer-dependent." This means that different trained ultrasonographers can get slightly different results on the same woman, on the same day.
How Ovarian and Antral Follicles Relate to Fertility [accessed on Oct 02, 2018]
Antral Follicle Counts, Testing Ovarian Reserve Predicts IVF Response [accessed on Oct 02, 2018]
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.18945 [accessed on Dec 11, 2018]
Basal Antral Follicle Count: Transvaginal Ultrasound Test | RMACT [accessed on Dec 11, 2018]
Antral follicle count | Radiology Reference Article | Radiopaedia.org [accessed on Dec 11, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (50)
Hormonal Regulation of Ovulation
The hypothalamus and pituitary gland regulate the ovarian cycle and ovulation. GnRH activates the anterior pituitary to produce LH and FSH, which stimulate the production of estrogen and progesterone by the ovaries.
Image by CNX Openstax
Document by Office on Women's Health, U.S. Department of Health and Human Services
Emergency contraception
Document by Office on Women's Health, U.S. Department of Health and Human Services
Document by Office on Women's Health, U.S. Department of Health and Human Services
Fallopian Tube and Ovary
Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans. The ovaries are the site of egg production and maturation within the human female. Each month, an oocyte is ejected from a mature follicle to the surface of one of the two ovaries. This event is called ovulation. The finger-like projections of the fallopian tube (fimbriae) sweep up the oocyte into the duct where it awaits fertilization. The remains of the ruptured follicle in the ovary are transformed into a structure called the corpus luteum. Upon fertilization, the egg secretes a hormone called human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick uterine lining of the womb. If fertilization does not occur, the corpus luteum degenerates into a corpus albicans, which is essentially scar tissue and is mostly comprised of collagen.
Image by TheVisualMD
Ovary and Fallopian Tube
Visualization of ovary and fallopian tube based on real human data. The ovaries produce female gametes, the eggs, and hormones such as estrogen and progesterone. The fallopian tubes form the first part of the female duct system. During ovulation, the egg is released from a follicle at the surface of the ovary and finger-like projections of the fallopian tube, fimbrae, sweep it into the uterine tube where it awaits fertilization.
Image by TheVisualMD
Woman with visible Brain revealing Pituitary Gland
The pituitary gland is a pea-sized endocrine gland located at the base of the skull, between the optic nerves. It is often referred to as the endocrine system's \"master gland\" because it regulates the activities of other glands. The pituitary, however, takes its orders from the hypothalamus, which decides which particular hormones the pituitary should release and when. The pituitary governs testosterone and estrogen production, as well as ovulation and breast milk production; it also helps regulate growth, blood pressure, maintain proper fluid balance, and other aspects of metabolism.
Image by TheVisualMD
Primary Follicle
Primary Follicle
Secondary Follicle
Secondary Follicle
Corpus Luteum
Corpus Luteum
Image by TheVisualMD
Regression
Regression
Image by TheVisualMD
Vesicular Follicle
Vesicular Follicle
Image by TheVisualMD
Corpus Luteum
Visualization of the corpus luteum. The corporus luteum is a secretory structure formed at the site of a ruptured ovarian follicle after it has discharged it's ovum. It is the structure responsible for the synthesis and secretion of estrogens and progesterone. Estrogen plays a major role in the maintenance of the reproductive organs and the development of secondary sex characteristics. Progesterone plays a role in preparing and maintaining the uterus which supports the development of the embryo.
Image by TheVisualMD
Illustration of a man and woman painting the walls of a nursery room
For those who dream of being parents, pregnancy problems can be tremendously frustrating. A wide range of approaches can help struggling couples have healthy babies.
Image by NIH News in Health
Human Fertilization
Human Fertilization. The sperm and ovum unite through fertilization, creating a zygote that (over the course of 8-9 days) will implant in the uterine wall, where it will reside over the course of 9 months.
Image by Ttrue12
Implantation (human embryo)
Illustration of Implantation of a human embryo
Image by OpenStax College
Uterine anatomy
The female reproductive tract is shown in panel A comprising a cervix, uterus, and Fallopian tubes. Histologically, the uterine wall can be subdivided into the outer perimetrium, inner endometrium, and intermediate myometrium. Panel B shows cyclic changes during the menstrual cycle. In the sexually mature woman, the uterus goes through monthly cycles in which the functionalis portion of the endometrial lining of the uterus is stimulated to grow by estrogen, which is produced by the ovary. After ovulation, progesterone is also produced by the ovary causing the lining of the uterus to stop growing. If pregnancy is not established, the functionalis is mostly shed, i.e. menstruation.
Image by Teixeira, J., Rueda, B.R., and Pru, J.K., Uterine Stem cells (September 30, 2008), StemBook
Follicle-stimulating hormone
The time scale starts with the (LMP), given as day number. Day number 1 corresponds to 0 to 0.99 days from LMP, and Day number 2 corresponds to 1.00 to 1.99 days from LMP and so forth. The time scale ends at whatever is the actual next menstruation, which marks the beginning of the next cycle, which is equivalent to starting all over again from the beginning of the time scale.
Infertility Awareness Infographic - This infographic defines infertility and provides facts about the causes and prevalence of infertility.
Image by National Institute of Child Health and Human Development, National Institutes of Health
Human Fertilization
Sperm Fertilization
Image by OpenStax College
Human Fertilization
Human Fertilization. The sperm and ovum unite through fertilization, creating a zygote that (over the course of 8-9 days) will implant in the uterine wall, where it will reside over the course of 9 months.
Image by heblo
Ovulation
Menstrual Cycle
Image by Lyrl
Ovum and ovulation
Ovuláció
Image by Gaboka86
Fertilization
Fertilization. See a full animation of this medical topic.
Image by Blausen.com staff (2014). \"Medical gallery of Blausen Medical 2014\"
Plasminogen
Plasmin is an important enzyme present in blood that degrades many blood plasma proteins, most notably, fibrin clots. The degradation of fibrin is termed fibrinolysis. In humans, the plasmin protein is encoded by the PLG gene. Apart from fibrinolysis, plasmin proteolyses proteins in various other systems: It activates collagenases, some mediators of the complement system and weakens the wall of the Graafian follicle (leading to ovulation). It cleaves fibrin, fibronectin, thrombospondin, laminin, and von Willebrand factor. Plasmin, like trypsin, belongs to the family of serine proteases.
Image by TheVisualMD
Pre-Embryonic Development
Ovulation, fertilization, pre-embryonic development, and implantation occur at specific locations within the female reproductive system in a time span of approximately 1 week.
Image by CNX Openstax
Development of Cervical Cancer
In most cases, cells infected with the HPV virus heal on their own. In some cases, however, the virus continues to spread and becomes an invasive cancer.
Image by CNX Openstax
Fallopian Tube and Ovary
Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans. The ovaries are the site of egg production and maturation within the human female. Each month, an oocyte is ejected from a mature follicle to the surface of one of the two ovaries. This event is called ovulation. The finger-like projections of the fallopian tube (fimbriae) sweep up the oocyte into the duct where it awaits fertilization. The remains of the ruptured follicle in the ovary are transformed into a structure called the corpus luteum. Upon fertilization, the egg secretes a hormone called human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick uterine lining of the womb. If fertilization does not occur, the corpus luteum degenerates into a corpus albicans, which is essentially scar tissue and is mostly comprised of collagen.
Image by TheVisualMD
Regulation of Body Processes
Hormonal regulation of the female reproductive system involves hormones from the hypothalamus, pituitary, and ovaries.
Image by CNX Openstax
Human Reproductive Anatomy and Gametogenesis
Oocytes develop in (a) follicles, located in the ovary. At the beginning of the menstrual cycle, the follicle matures. At ovulation, the follicle ruptures, releasing the egg. The follicle becomes a corpus luteum, which eventually degenerates. The (b) follicle in this light micrograph has an oocyte at its center. (credit a: modification of work by NIH; scale-bar data from Matt Russell)
Image by CNX Openstax
Hormonal Control of Human Reproduction
Hormones control sperm production in a negative feedback system.
Image by CNX Openstax
Hormonal Control of Human Reproduction
This mature egg follicle may rupture and release an egg. (credit: scale-bar data from Matt Russell)
Image by CNX Openstax (credit: scale-bar data from Matt Russell)
Human Pregnancy and Birth
In humans, fertilization occurs soon after the oocyte leaves the ovary. Implantation occurs eight or nine days later.(credit: Ed Uthman)
Image by CNX Openstax (credit: Ed Uthman)
Birth Control Patch
Birth Control Patch
Image by Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014"
OrthoEvra contraceptive patch on white computer paper
OrthoEvra contraceptive patch on white computer paper
Image by Keitei
Effectiveness of Family Planning Methods
Effectiveness of Family Planning Methods
Image by CDC
Effectiveness of Family Planning Methods
Effectiveness of Family Planning Methods
Image by CDC
Fallopian Tube and Ovary - Upon fertilization, the egg secretes a hormone called human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick uterine lining of the womb.
Fallopian Tube and Ovary: Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans. The ovaries are the site of egg production and maturation within the human female. Each month, an oocyte is ejected from a mature follicle to the surface of one of the two ovaries. This event is called ovulation. The finger-like projections of the fallopian tube (fimbriae) sweep up the oocyte into the duct where it awaits fertilization. The remains of the ruptured follicle in the ovary are transformed into a structure called the corpus luteum. Upon fertilization, the egg secretes a hormone called human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick uterine lining of the womb. If fertilization does not occur, the corpus luteum degenerates into a corpus albicans, which is essentially scar tissue and is mostly comprised of collagen.
Image by TheVisualMD
Interpreted drawing of a human ovum cell containing labels and annotations of cell components and organelles.
Interpreted drawing of a human ovum cell containing labels and annotations of cell components and organelles.
Image by Mia Nicolacoudis
Breastfeeding fact sheet
Document by Office on Women's Health, U.S. Department of Health and Human Services
Your Guide to Breastfeeding
This easy-to-read publication has how-to information and support to help women breastfeed.
Document by Office on Women's Health, U.S. Department of Health and Human Services
Surrogates and Gestational Carriers
Image by TheVisualMD
Questions to Ask before ART/IVF
Questions to Ask before ART/IVF
Image by TheVisualMD
Fallopian Tube and Ovary
Medical visualization of a cross-section of the ovary, as well as the associated fallopian tube; seen inside the cross-section are a developing follicle, corpus luteum, and corpus albicans. The ovaries are the site of egg production and maturation within the human female. Each month, an oocyte is ejected from a mature follicle to the surface of one of the two ovaries. This event is called ovulation. The finger-like projections of the fallopian tube (fimbriae) sweep up the oocyte into the duct where it awaits fertilization. The remains of the ruptured follicle in the ovary are transformed into a structure called the corpus luteum. Upon fertilization, the egg secretes a hormone called human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick uterine lining of the womb. If fertilization does not occur, the corpus luteum degenerates into a corpus albicans, which is essentially scar tissue and is mostly comprised of collagen.
Image by TheVisualMD
Sensitive content
This media may include sensitive content
Female Reproductive Organ
Estrogen is produced primarily by developing follicles in the ovaries, the corpus luteum, and the placenta. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate the production of estrogen in the ovaries. Some estrogens are also produced in smaller amounts by other tissues such as the liver, adrenal glands, and the breasts. These secondary sources of estrogen are especially important in postmenopausal women.
Image by TheVisualMD
Estrogen Levels and Peak Fertility During the Menstrual Cycle
Estrogen Levels and Peak Fertility During the Menstrual Cycle: The uterus is like a self-cleaning oven - every month it cycles out the residue of reproduction to start fresh again. During the early phase of the menstrual cycle, rising estrogen levels cause the lining of the uterus to thicken. This rise in estrogen is stimulated by the follicle stimulating hormone (FSH), which is made in the anterior pituitary gland. The follicle is the receptacle in the ovary in which the egg develops, and the FSH stimulates the egg's growth while it is in the follicle. At the middle of the cycle, there is a surge of another pituitary hormone, the luteinizing hormone (LH). Now ovulation, release of the egg, occurs. At this point, the cells that had been nurturing the egg start producing the sex hormone progesterone, which causes the uterine lining to further thicken and prepare for pregnancy. If pregnancy does not occur, estrogen and progesterone levels fall and the uterus sheds its thickened lining to prepare for another reproductive cycle. This shedding, menstruation, usually lasts 3 to 7 days and removes both blood and tissue from the uterus.
Image by TheVisualMD
Hormonal Regulation of Ovulation
CNX Openstax
Office on Women's Health, U.S. Department of Health and Human Services
Emergency contraception
Office on Women's Health, U.S. Department of Health and Human Services
Office on Women's Health, U.S. Department of Health and Human Services
Fallopian Tube and Ovary
TheVisualMD
Ovary and Fallopian Tube
TheVisualMD
Woman with visible Brain revealing Pituitary Gland
TheVisualMD
Primary Follicle
Secondary Follicle
Corpus Luteum
TheVisualMD
Regression
TheVisualMD
Vesicular Follicle
TheVisualMD
Corpus Luteum
TheVisualMD
Illustration of a man and woman painting the walls of a nursery room
National Institute of Child Health and Human Development, National Institutes of Health
Human Fertilization
OpenStax College
Human Fertilization
heblo
Ovulation
Lyrl
Ovum and ovulation
Gaboka86
Fertilization
Blausen.com staff (2014). \"Medical gallery of Blausen Medical 2014\"
Plasminogen
TheVisualMD
Pre-Embryonic Development
CNX Openstax
Development of Cervical Cancer
CNX Openstax
Fallopian Tube and Ovary
TheVisualMD
Regulation of Body Processes
CNX Openstax
Human Reproductive Anatomy and Gametogenesis
CNX Openstax
Hormonal Control of Human Reproduction
CNX Openstax
Hormonal Control of Human Reproduction
CNX Openstax (credit: scale-bar data from Matt Russell)
Human Pregnancy and Birth
CNX Openstax (credit: Ed Uthman)
Birth Control Patch
Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014"
OrthoEvra contraceptive patch on white computer paper
Keitei
Effectiveness of Family Planning Methods
CDC
Effectiveness of Family Planning Methods
CDC
Fallopian Tube and Ovary - Upon fertilization, the egg secretes a hormone called human chorionic gonadotropin (HCG) which signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick uterine lining of the womb.
TheVisualMD
Interpreted drawing of a human ovum cell containing labels and annotations of cell components and organelles.
Mia Nicolacoudis
Breastfeeding fact sheet
Office on Women's Health, U.S. Department of Health and Human Services
Your Guide to Breastfeeding
Office on Women's Health, U.S. Department of Health and Human Services
Surrogates and Gestational Carriers
TheVisualMD
Questions to Ask before ART/IVF
TheVisualMD
Fallopian Tube and Ovary
TheVisualMD
Sensitive content
This media may include sensitive content
Female Reproductive Organ
TheVisualMD
Estrogen Levels and Peak Fertility During the Menstrual Cycle
TheVisualMD
Clomiphene
Clomifene ball-and-stick
Image by MarinaVladivostok
Clomifene ball-and-stick
Clomifene ball-and-stick
Image by MarinaVladivostok
Clomiphene or Clomiphene Citrate Treatment for Female Infertility
Clomiphene is a medication patients take by mouth (orally). It causes the body to make more of the hormones that cause the eggs to mature in the ovaries. If a woman does not become pregnant after taking clomiphene for six menstrual cycles, a health care provider may prescribe other fertility treatments.
Patients take clomiphene in the beginning of the menstrual cycle.
Clomiphene causes ovulation to occur in 80% of women treated. About half of those who ovulate are able to achieve a pregnancy or live birth.
Use of clomiphene increases the risk of having a multiple pregnancy. There is a 10% chance of twins, but having triplets or more is rare—less than 1% of cases.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Clomiphene
Clomiphene
Also called: Clomiphene Citrate, Clomid®, Serophene®
Clomiphene citrate is a prescription medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovary syndrome (PCOS) or other problems with ovulation. It is also used in women with normal ovulation to increase the number of mature eggs produced.
Clomiphene
Also called: Clomiphene Citrate, Clomid®, Serophene®
Clomiphene citrate is a prescription medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovary syndrome (PCOS) or other problems with ovulation. It is also used in women with normal ovulation to increase the number of mature eggs produced.
Clomiphene is a medication patients take by mouth (orally). It causes the body to make more of the hormones that cause the eggs to mature in the ovaries. If a woman does not become pregnant after taking clomiphene for six menstrual cycles, a health care provider may prescribe other fertility treatments.
Patients take clomiphene in the beginning of the menstrual cycle.
Clomiphene causes ovulation to occur in 80% of women treated. About half of those who ovulate are able to achieve a pregnancy or live birth.
Use of clomiphene increases the risk of having a multiple pregnancy. There is a 10% chance of twins, but having triplets or more is rare—less than 1% of cases.
Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Impediments to achieving pregnancy must be excluded or adequately treated before beginning clomiphene citrate therapy. Those patients most likely to achieve success with clomiphene therapy include patients with polycystic ovary syndrome, amenorrhea-galactorrhea syndrome, psychogenic amenorrhea, post-oral-contraceptive amenorrhea, and certain cases of secondary amenorrhea of undetermined etiology.
Do not take clomiphene if you:
are pregnant
have a known hypersensitivity or allergy to clomiphene citrate or to any of its ingredients.
Before you take clomiphene, tell your healthcare provider about all your medical conditions, including if you have:
liver disease or a history of liver dysfunction
abnormal uterine bleeding of undetermined origin
ovarian cysts or enlargement not due to polycystic ovarian syndrome
uncontrolled thyroid or adrenal dysfunction or in the presence of an organic intracranial lesion such as pituitary tumor
Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
Know the medicines you take. Keep a list of them and show your healthcare provider and pharmacist when you get a new medicine.
Taking clomiphene increases the chance of multiple pregnancy (twins or more). Talk to your doctor about the risks of multiple pregnancy.
Clomiphene citrate, at recommended dosages, is generally well tolerated. Adverse reactions usually have been mild and transient and most have disappeared promptly after treatment has been discontinued.
Adverse experiences reported in patients treated with clomiphene citrate during clinical studies are:
These are not all the possible side effects of clomiphene. For more information, ask your healthcare provider or pharmacist.
Store at controlled room temperature 15°-30°C (59°-86°F).
Protect from heat, light, and excessive humidity, and store in closed containers.
Keep clomiphene and all medicines out of the reach of children.
Fertility Treatments for Females. NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. [accessed on Jan 10, 2019]
Infertility FAQs. Centers for Disease Control and Prevention. [accessed on Jan 10, 2019]
LABEL: CLOMIPHENE CITRATE- clomiphene citrate tablet. Packager: Par Pharmaceutical, Inc. [accessed on Jan 10, 2019]
Clomiphene. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]
These FAQs provide a summary of the most important information about Clomiphene. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.
Additional Materials (14)
Clomifene ball-and-stick
Clomifene ball-and-stick
Image by MarinaVladivostok
Polycystic Ovary Syndrome (PCOS)
Document by Office on Women's Health, U.S. Department of Health and Human Services
What is Clomid, and what should I know about it?
Video by IntermountainMoms/YouTube
Mini IVF| Fertility Expert Randy Morris answers - Is it right for you?
Video by Infertility TV/YouTube
Infertility Treatment for Women - Fertility Drugs - Infertility TV
Video by Infertility TV/YouTube
IVF Procedure. A simple Explanation of an In vitro Fertilization cycle
Video by Andrea Vidali/YouTube
Infertility Hormonal Treatments • WCWRC
Video by West Coast Women's Reproductive Center/YouTube
Of Pills and Eggs: Clomiphene Versus Letrozole
Video by InfertilityChannel/YouTube
Female Infertility Causes
Video by MonkeySee/YouTube
Polycystic Ovary Syndrome (PCOS)
Video by Center for Human Reproduction/YouTube
Causes of Female Infertility: PCOS & Insulin Resistance
Video by douglasplano/YouTube
Fertility Tips for Women Over 35 -- The Doctors
Video by The Doctors/YouTube
Getting Pregnant: When is Too Old? (Pregnancy Health Guru)
Video by Healthguru/YouTube
The Facts about Female Fertility, Melbourne IVF
Video by Melbourne IVF/YouTube
Clomifene ball-and-stick
MarinaVladivostok
Polycystic Ovary Syndrome (PCOS)
Office on Women's Health, U.S. Department of Health and Human Services
3:30
What is Clomid, and what should I know about it?
IntermountainMoms/YouTube
2:47
Mini IVF| Fertility Expert Randy Morris answers - Is it right for you?
Infertility TV/YouTube
2:37
Infertility Treatment for Women - Fertility Drugs - Infertility TV
Infertility TV/YouTube
3:20
IVF Procedure. A simple Explanation of an In vitro Fertilization cycle
Andrea Vidali/YouTube
3:47
Infertility Hormonal Treatments • WCWRC
West Coast Women's Reproductive Center/YouTube
8:27
Of Pills and Eggs: Clomiphene Versus Letrozole
InfertilityChannel/YouTube
2:43
Female Infertility Causes
MonkeySee/YouTube
7:41
Polycystic Ovary Syndrome (PCOS)
Center for Human Reproduction/YouTube
2:05
Causes of Female Infertility: PCOS & Insulin Resistance
douglasplano/YouTube
5:02
Fertility Tips for Women Over 35 -- The Doctors
The Doctors/YouTube
1:37
Getting Pregnant: When is Too Old? (Pregnancy Health Guru)
Healthguru/YouTube
3:25
The Facts about Female Fertility, Melbourne IVF
Melbourne IVF/YouTube
Letrozole
Letrozole
Image by MindZiper
Letrozole
Ball-and-stick model of the Letrozole molecule C17H11N5
Image by MindZiper
Letrozole Treatment for Female Infertility
Letrozole is an oral pill that decreases the amount of estrogen a woman makes, stimulating her ovaries to release eggs.
Patients take letrozole toward the end of their menstrual cycle for around 5 days.
A 2015 study by researchers in the NICHD Reproductive Medicine Network found that about 19% of couples with unexplained infertility went on to have a live birth after using letrozole for 4 months. This rate was slightly lower than the live birth rate for couples using clomiphene (23%).
Other studies have found that letrozole may work better than clomiphene in women with polycystic ovary syndrome.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Letrozole
Letrozole
Also called: Femara®
Letrozole is a prescription medicine used for the treatment of postmenopausal women with certain types of breast cancer. It may also be used off-label to cause ovulation. It works by temporarily lowering a woman’s progesterone level, which causes the brain to naturally make more FSH.
Letrozole
Also called: Femara®
Letrozole is a prescription medicine used for the treatment of postmenopausal women with certain types of breast cancer. It may also be used off-label to cause ovulation. It works by temporarily lowering a woman’s progesterone level, which causes the brain to naturally make more FSH.
Letrozole is an aromatase inhibitor which is used in the treatment of hormonally-responsive breast cancer after surgery in postmenopausal women. Letrozole has also been used off-label for ovarian stimulation by fertility doctors since 2001 because it has fewer side effects than clomiphene citrate and less chance of multiple pregnancy.
Do not take letrozole if you:
are pregnant
have known hypersensitivity to the active substance, or to any of the other ingredients.
Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
Know the medicines you take. Keep a list of them and show your healthcare provider and pharmacist when you get a new medicine.
Letrozole is available in 2.5 mg tablets in generic forms and under the brand name Femara.
Take letrozole according to your health care provider’s instructions. Your health care provider will tell you how much letrozole to take and when to take it. Before you start letrozole and each time you get a refill, read any printed information that comes with your medicine.
Letrozole can cause drowsiness and sleepiness. Avoid drinking alcohol, operating machinery, and driving a car when taking letrozole. Avoid taking other medicines that may cause drowsiness without talking to your healthcare provider first.
Letrozole may cause serious side effects. Serious side effects include:
Decreases in bone mineral
Increases in total cholesterol levels
Fatigue, dizziness and somnolence
Embryo-fetal toxicity: Can cause fetal harm when administered to pregnant women.
The most common adverse reactions (greater than 20%) were hot flashes, arthralgia; flushing, asthenia, edema, arthralgia, headache, dizziness, hypercholesterolemia, sweating increased, bone pain; and musculoskeletal.
These are not all the possible side effects of letrozole. For more information, ask your healthcare provider or pharmacist.
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).
Keep letrozole and all medicines out of the reach of children.
LETROZOLE (letrozole tablets) tablet, film coated [accessed on Jan 10, 2019]
Letrozole. LiverTox. [accessed on Jan 10, 2019]
Fertility Treatments for Females. NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. [accessed on Jan 10, 2019]
Kar S. Current evidence supporting "letrozole" for ovulation induction. J Hum Reprod Sci. 2013;6(2):93–98. doi:10.4103/0974-1208.117166 [accessed on Jan 10, 2019]
Letrozole. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]
These FAQs provide a summary of the most important information about Letrozole. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.
Additional Materials (2)
Infertility Hormonal Treatments • WCWRC
Video by West Coast Women's Reproductive Center/YouTube
Of Pills and Eggs: Clomiphene Versus Letrozole
Video by InfertilityChannel/YouTube
3:47
Infertility Hormonal Treatments • WCWRC
West Coast Women's Reproductive Center/YouTube
8:27
Of Pills and Eggs: Clomiphene Versus Letrozole
InfertilityChannel/YouTube
Gonadotropins/hCG
Gonadotropin releasing hormone
Image by Fvasconcellos
Gonadotropin releasing hormone
Gonadotropin releasing hormone
Image by Fvasconcellos
Gonadotropins and Human Chorionic Gonadotropin (HCG) Treatment for Female Infertility
Gonadotropins such as follicle-stimulating hormone (FSH) are hormones that are injected in a woman to directly stimulate eggs to grow in the ovaries, leading to ovulation. Health care providers normally prescribe gonadotropins when a woman does not respond to clomiphene or to stimulate follicle growth for assisted reproductive technology (ART).
Gonadotropins are injected in the early part of the menstrual cycle for 7 to 12 days.
While a woman is treated with gonadotropins, a health care provider uses transvaginal ultrasound to monitor the size of the developing eggs, which grow inside tiny sacs called follicles. The health care providers also draw blood frequently to check the ovarian production of estrogen.
The chance of a multiple birth is higher with gonadotropins than with clomiphene, and 30% of women who conceive a pregnancy with this medication have multiple births. About two-thirds of multiple births are twins. Triplets or larger multiple births account for the remaining third.
hCG is a hormone similar to luteinizing hormone that can be used to trigger release of the egg after the follicles have developed.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
HCG Injection
HCG Injection
Also called: Human Chorionic Gonadotropin Injection, Choriogonadotropin Alfa Injection, Choragon®, Chorex®, Novarel®, Ovidrel®, Pregnyl®, Profasi®
Human chorionic gonadotropin (HCG) is a hormone that supports the normal development of an egg in a woman's ovary, and stimulates the release of the egg during ovulation. HCG is used to cause ovulation and to treat infertility in women, and to increase sperm count in men among other indications.
HCG Injection
Also called: Human Chorionic Gonadotropin Injection, Choriogonadotropin Alfa Injection, Choragon®, Chorex®, Novarel®, Ovidrel®, Pregnyl®, Profasi®
Human chorionic gonadotropin (HCG) is a hormone that supports the normal development of an egg in a woman's ovary, and stimulates the release of the egg during ovulation. HCG is used to cause ovulation and to treat infertility in women, and to increase sperm count in men among other indications.
Choragon contains a hormone produced in women called chorionic gonadotrophin. It works by helping reproductive organs to work normally in both women and men.
In women, Choragon is used for infertility caused by eggs not being produced or released properly (anovulatory infertility).
In men, Choragon is used for:
Delayed puberty.
Testicles which have not dropped (cryptorchidism).
Low sperm count (oligospermia).
Choragon should only be given by a specialist doctor who has the facilities needed to monitor you.
You must not be given Choragon if:
You have a condition that is made worse by increasing levels of male sex hormones (such as testosterone).
If you are not sure if this applies to you, talk to your doctor, nurse or pharmacist before you are given this medicine.
Check with your doctor, nurse or pharmacist before you are given your medicine if:
You have asthma.
You have epilepsy.
You get migraines.
You have heart or kidney problems.
You are allergic to any of the ingredients of the medicine. You may be given a skin test first if your doctor thinks that you might have an allergic reaction to Choragon.
If any of the above apply to you (or if you are not sure), talk to your doctor, nurse or pharmacist before you are given Choragon.
Choragon will be given to you by a doctor.
It will be given to you as an injection into a muscle.
The dose depends on what you are being treated for. The usual doses are given below.
Women
For infertility
Before you have Choragon, your doctor will take blood samples to check the level of estrogen (a hormone) in your blood.
If your estrogen is at the right level, you will be given 10,000 units of Choragon.
It will be given to you in the middle of your menstrual cycle.
Men
For delayed puberty
The usual starting dose is 500 units twice a week.
During your treatment, your doctor will take blood samples. This is to check the levels of testosterone (a hormone) in your blood. Your doctor may then adjust your dose.
Treatment normally lasts for 4 to 6 weeks.
For testicles which have not dropped
Treatment should begin before the child reaches puberty. The best age to start treatment is between 7 and 10 years.
The doctor will decide how much the child needs and how often they need it.
The usual starting dose is 500 units three times a week. However, this may be increased up to 4000 units three times a week if necessary.
Treatment normally lasts for 6 to 10 weeks.
In males over 17 years of age, a starting dose of 1000 units twice a week can be given. Treatment is normally continued for 1 to 2 months after the testicles have dropped.
For low sperm count
The starting dose is 500 units two or three times a week.
During your treatment, your doctor will check semen samples to see how well the treatment is working. Your doctor may then adjust your dose.
Treatment normally lasts for 16 weeks.
If you think you have been given too much Choragon, tell your doctor, nurse or pharmacist.
If you think that you have missed a dose, tell your doctor, nurse or pharmacist.
Like all medicines, Choragon can cause side effects, although not everybody gets them.
The following side effects may happen in women or men:
Allergic reactions.
Headaches.
Feeling tired.
Mood changes.
The following side effects may happen in women:
An increase in the size of the ovaries.
Cysts in the ovary.
Sudden tummy pain (acute abdominal pain).
The production of more than one egg at a time by the ovaries (superovulation).
Being pregnant with two or more babies at one time (multiple pregnancies).
The following side effects may happen in men:
An increase in breast size.
A growth spurt.
When Choragon is used to for testicles which have not dropped, it may cause early puberty.
If any of the side effects become serious, or if you notice any side effects not listed in this information guide, please tell your doctor, nurse or pharmacist.
Keep out of the reach and sight of children.
Do not use Choragon after the expiry date which is stated on the carton and ampoules (glass bottles). The expiry date refers to the last day of that month.
Store Choragon below 77°F or 25°C and protect it from light.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines that are no longer required. These measures will help to protect the environment.
CHORAGON® 5,000U and CHORAGON SOLVENT (chorionic gonadotrophin) Patient Information [accessed on Dec 06, 2018]
LABEL: CHORIONIC GONADOTROPIN- chorionic gonadotropin. Packager: Fresenius Kabi USA, LLC. [accessed on Dec 06, 2018]
LABEL: NOVAREL- gonadotrophin, chorionic. Packager: Ferring Pharmaceuticals Inc. [accessed on Dec 06, 2018]
LABEL: PREGNYL- choriogonadotropin alfa [accessed on Dec 06, 2018]
Human chorionic gonadotropin (HCG) (injectable). University of Michigan Health System (UMHS). [accessed on Dec 06, 2018]
Human Chorionic Gonadotropin, HCG injection. Cleveland Clinic. [accessed on Jul 16, 2019]
These FAQs provide a summary of the most important information about HCG Injection. If you would like more information or have any questions, talk to your healthcare provider.
Additional Materials (7)
How To Inject Low-Dose hCG | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Pregnyl® (hCG) Subcutaneously | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Pregnyl® (hCG) Intramuscularly | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Self-Inject Novarel® Fertility Treatment
Video by YourFreedomFertility/YouTube
How To Inject Ovidrel® | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Novarel® 5,000 IU Subcutaneously | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Novarel® 5,000 IU Intramuscularly | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
5:46
How To Inject Low-Dose hCG | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
6:06
How To Inject Pregnyl® (hCG) Subcutaneously | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
6:22
How To Inject Pregnyl® (hCG) Intramuscularly | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
5:04
How To Self-Inject Novarel® Fertility Treatment
YourFreedomFertility/YouTube
3:10
How To Inject Ovidrel® | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
6:01
How To Inject Novarel® 5,000 IU Subcutaneously | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
6:25
How To Inject Novarel® 5,000 IU Intramuscularly | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
Follitropin Alfa Injection
Follitropin Alfa Injection
Also called: Gonal-f®, Gonal-f® RFF
Follitropin alfa injection stimulates ovarian follicular growth in women who do not have primary ovarian failure. This medicine contains human follicle stimulating hormone (FSH) preparation of recombinant DNA origin.
Follitropin Alfa Injection
Also called: Gonal-f®, Gonal-f® RFF
Follitropin alfa injection stimulates ovarian follicular growth in women who do not have primary ovarian failure. This medicine contains human follicle stimulating hormone (FSH) preparation of recombinant DNA origin.
LABEL: GONAL-F - follitropin alfa [accessed on Nov 13, 2018]
LABEL: GONAL-F RFF - follitropin alfa [accessed on Nov 13, 2018]
Follitropin, r-FSH injection (Gonal-F(R)). U.S. Department of Veterans Affairs. [accessed on Nov 13, 2018]
These FAQs provide a summary of the most important information about Follitropin Alfa Injection. If you would like more information or have any questions, talk to your healthcare provider.
Additional Materials (5)
Nurse Linda IVF Medication Injections - Gonal-F
Video by Sher Fertility Institute/YouTube
Infertility Treatment for Women - Fertility Drugs - Infertility TV
Video by Infertility TV/YouTube
How To Inject Gonal-f® RFF 75 IU Vial | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Gonal-f® Multi-Dose Vial | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Gonal-f® RFF Redi-ject Pen | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
7:38
Nurse Linda IVF Medication Injections - Gonal-F
Sher Fertility Institute/YouTube
2:37
Infertility Treatment for Women - Fertility Drugs - Infertility TV
Infertility TV/YouTube
5:07
How To Inject Gonal-f® RFF 75 IU Vial | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
4:53
How To Inject Gonal-f® Multi-Dose Vial | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
6:26
How To Inject Gonal-f® RFF Redi-ject Pen | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
Follitropin Alfa and Lutropin Alfa Injection
Follitropin Alfa and Lutropin Alfa Injection
Also called: Pergoveris®
Pergoveris (follitropin alfa and lutropin alfa) is used to treat adult women who have low levels of two hormones that stimulate the ovaries - follicle-stimulating hormone (FSH) and luteinising hormone (LH).
Follitropin Alfa and Lutropin Alfa Injection
Also called: Pergoveris®
Pergoveris (follitropin alfa and lutropin alfa) is used to treat adult women who have low levels of two hormones that stimulate the ovaries - follicle-stimulating hormone (FSH) and luteinising hormone (LH).
Pergoveris (follitropin alfa / lutropin alfa). European Medicines Agency. [accessed on Jul 16, 2019]
These FAQs provide a summary of the most important information about Follitropin Alfa and Lutropin Alfa Injection. If you would like more information or have any questions, talk to your healthcare provider.
Follitropin Beta Injection
Follitropin Beta Injection
Also called: Follistim®, Puregon®
Follitropin beta injection is a prescription medicine used to treat infertility in both men and women. This medicine contains a man-made hormone called follicle-stimulating hormone (FSH).
Follitropin Beta Injection
Also called: Follistim®, Puregon®
Follitropin beta injection is a prescription medicine used to treat infertility in both men and women. This medicine contains a man-made hormone called follicle-stimulating hormone (FSH).
Follitropin beta is a prescription medicine that contains follicle-stimulating hormone (FSH).
It is used:
In women:
to help healthy ovaries to develop (mature) and release eggs
as part of treatment programs that use special techniques (skills) to help women get pregnant by causing their ovaries to produce more mature eggs
In men:
to help bring about the production and development of sperm
Do not take follitropin beta if you are a Woman or Man who:
is allergic to recombinant human FSH products
has a high level of FSH in your blood indicating that your ovaries (women only) or testes (men only) may be permanently damaged and do not work at all
has uncontrolled thyroid, pituitary, or adrenal gland problems
is allergic to streptomycin or neomycin (types of antibiotics)
has a tumor of the hypothalamus, pituitary gland, breast, uterus (women only), ovary (women only), or testis (men only)
Do not take follitropin beta if you are a Woman who:
is pregnant or think you may be pregnant
has heavy or irregular vaginal bleeding and the cause is not known
has ovarian cysts or enlarged ovaries, not due to polycystic ovary syndrome (PCOS)
Talk to your healthcare provider before taking this medicine if you have any of the conditions listed above.
Before you take follitropin beta, tell your healthcare provider if you:
have an increased risk of blood clots (thrombosis)
have ever had a blood clot (thrombosis), or anyone in your immediate family has ever had a blood clot (thrombosis)
had stomach (abdominal) surgery
had twisting of your ovary (ovarian torsion)
had or have a cyst in your ovary
have polycystic ovary disease
have any other medical conditions
are breastfeeding or plan to breastfeed. It is not known if the medicine in follitropin beta passes into your breast milk. You and your healthcare provider should decide if you will take follitropin beta or breastfeed. You should not do both.
Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
Know the medicines you take. Keep a list of them and show your healthcare provider and pharmacist when you get a new medicine.
Your healthcare provider will do blood and urine hormone tests while you are taking follitropin beta. Make sure you follow-up with your healthcare provider to have your blood and urine tested when told to do so.
Women:
Your healthcare provider may do ultrasound scans of your ovaries. Make sure you follow-up with your healthcare provider to have your ultrasound scans.
Men:
Your healthcare provider may test your semen while you are taking follitropin beta. Make sure you follow-up with your healthcare provider to give a semen sample for testing.
Follitropin beta may cause serious side effects.
Serious side effects in women include:
Ovarian enlargement
Ovarian hyperstimulation syndrome (OHSS). OHSS is a serious medical problem that can happen when the ovaries are over stimulated. In rare cases it has caused death. OHSS causes fluid to build up suddenly in your stomach and chest areas and can cause blood clots to form. Call your healthcare provider right away if you have:
pain in your lower stomach area
nausea
vomiting
weight gain
diarrhea
decreased urine output
trouble breathing
Lung problems. Follitropin beta can cause you to have fluid in your lungs (atelectasis) and trouble breathing (acute respiratory distress syndrome).
Blood clots. Follitropin beta may increase your chance of having blood clots in your blood vessels. Blood clots can cause:
blood vessel problems (thrombophlebitis)
stroke
loss of your arm or leg
blood clot in your lungs (pulmonary embolus)
heart attack
Ovarian torsion. Follitropin beta may increase the chance of twisting of the ovaries in women with certain conditions such as OHSS, pregnancy and previous abdominal surgery. Twisting of the ovary could cause the blood flow to the ovary to be cut off.
Pregnancy and birth of multiple babies. Having a pregnancy with more than one baby at a time increases the health risk for you and your babies. Discuss your chances of multiple births with your healthcare provider.
Birth defects. A woman's age, certain sperm problems, genetic background of both parents and a pregnancy with multiple babies can increase the chance that your baby might have birth defects.
Ectopic pregnancy (pregnancy outside of the womb). The chance of a pregnancy outside of the womb is increased in women with damaged fallopian tubes.
Miscarriage. The chance of loss of an early pregnancy may be increased in women who have difficulty with becoming pregnant at all.
The most common side effects of follitropin beta include:
In women:
headache
nausea
stomach pain
discomfort or pain in the lower stomach area
cyst (closed sac) in the ovary
feeling tired
In men:
headache
pain at the injection site
bruising, swelling or redness at the injection site
breast enlargement
acne
These are not all the possible side effects of follitropin beta. For more information, ask your healthcare provider or pharmacist.
Call your healthcare provider immediately if you get worsening or strong pain in the lower stomach area (abdomen). Also, call your healthcare provider immediately if this happens some days after the last injection has been given.
Tell your healthcare provider if you have any side effect that bothers you or that does not go away.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
LABEL: FOLLISTIM AQ- follitropin injection, solution [accessed on Nov 13, 2018]
Follitropin, r-FSH injection (Follistim(TM)). U.S. Department of Veterans Affairs. [accessed on Nov 13, 2018]
These FAQs provide a summary of the most important information about Follitropin Beta Injection. If you would like more information or have any questions, talk to your healthcare provider.
Menotropins Injection
Menotropins Injection
Also called: Menopur®, Follicle Stimulating Hormone / Luteinizing Hormone Injection, Human Menopausal Gonadotropin, hMG
Menopur (menotropins for injection) is a prescription medicine that contains follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones stimulate healthy ovaries to make eggs and is used for women who need medical help to get pregnant.
Menotropins Injection
Also called: Menopur®, Follicle Stimulating Hormone / Luteinizing Hormone Injection, Human Menopausal Gonadotropin, hMG
Menopur (menotropins for injection) is a prescription medicine that contains follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones stimulate healthy ovaries to make eggs and is used for women who need medical help to get pregnant.
Menopur is a prescription medicine that contains follicle stimulating hormone (FSH) and luteinizing hormone (LH). Menopur causes your ovaries to make multiple (more than 1) eggs as part of an Assisted Reproductive Technology (ART) cycle.
Do not use Menopur if you:
are allergic to menotropins or any of the ingredients in Menopur. See the end of this leaflet for a complete list of ingredients in Menopur.
have ovaries that no longer make eggs (primary ovarian failure)
are pregnant or think you may be pregnant. If Menopur is taken while you are pregnant, it may harm your baby.
have problems with your thyroid gland, adrenal gland, or pituitary gland that are not controlled by taking medicine.
have a tumor in your female organs, including your ovaries, breast, or uterus that may get worse with high levels of estrogen
have a tumor of your pituitary gland or hypothalamus
have abnormal bleeding from your uterus or vagina and the cause is not known
have ovarian cysts or enlarged ovaries, not due to a problem called polycystic ovary syndrome (PCOS)
Before you use Menopur, tell your healthcare provider if you:
have been told by a healthcare provider that you are at an increased risk for blood clots (thrombosis)
have ever had a blood clot (thrombosis), or anyone in your family has ever had a blood clot
had twisting of your ovary (ovarian torsion)
had or have a cyst in your ovary
have any other medical conditions
are breast feeding or plan to breast feed. It is not known if Menopur passes into your breast milk. You and your healthcare provider should decide if you will use Menopur or breastfeed. You should not do both.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.
Read the Instructions for Use at the end of the patient information leaflet that comes with your medicine about the right way to use Menopur or Menopur mixed with BRAVELLE® (urofollitropin for injection, purified).
Use Menopur exactly as your healthcare provider tells you to use it.
Your healthcare provider will tell you how much Menopur to use and when to use it.
Your healthcare provider may change your dose of Menopur if needed.
If you miss a dose of Menopur, call your healthcare provider right away. Do not double the amount of Menopur you are using.
You may need more than 1 vial of Menopur for your dose.
Menopur may be mixed with BRAVELLE in the same syringe.
Menopur may cause serious side effects, including:
ovaries that are too large. Menopur may cause your ovaries to be abnormally large. Symptoms of large ovaries include bloating or pain in your lower stomach (pelvic) area. If your ovaries become too large, your healthcare provider may tell you that you should not have intercourse (sex) so you do not rupture an ovarian cyst.
ovarian hyperstimulation syndrome (OHSS). Using Menopur may cause OHSS. OHSS is a serious medical condition that can happen when your ovaries produce too many eggs (overstimulated). OHSS can cause fluid to suddenly build up in the area of your stomach, chest, heart, and cause blood clots to form. OHSS may also happen after you stop using Menopur. Stop using Menopur and call your healthcare provider or go to the nearest hospital emergency room right away if you have any of the following symptoms of OHSS:
severe pelvic or stomach pain
nausea
vomiting
sudden weight gain
swollen stomach
diarrhea
trouble breathing
decreased or no urine
lung problems. Menopur may cause serious lung problems that can sometimes lead to death including fluid in the lungs, trouble breathing, and worsening of asthma.
blood clots. Menopur may increase your chance of having blood clots in your blood vessels. Blood clots can cause:
blood vessel problems (thrombophlebitis)
stroke
loss of your arm or leg
blood clot in your lung (pulmonary embolus)
twisting (torsion) of your ovary. Menopur may increase the chance of your ovary twisting, if you already have certain conditions such as OHSS, pregnancy, and previous abdominal surgery. Twisting of your ovary may lead to blood flow being cut off to your ovary.
pregnancy with and birth of multiple babies. Menopur may increase your chance of having a pregnancy with more than 1 baby. Having a pregnancy and giving birth to more than 1 baby at a time increases the health risk for you and your babies. Your healthcare provider should talk to you about your chances of multiple births before you start using Menopur.
birth defects. Babies born after ART may have an increased chance of birth defects. Your age, certain sperm problems, your genetic background, and that of your partner, and a pregnancy with more than 1 baby at a time may increase the chance that your baby may have birth defects.
ectopic pregnancy (pregnancy outside your womb). Menopur may increase your chance of having a pregnancy that is abnormally outside of your womb. Your chance of having a pregnancy outside of your womb is increased if you also have fallopian tube problems.
miscarriage. Your chance of loss of an early pregnancy may be increased if you had difficulty becoming pregnant.
tumors of the ovary. If you have used medicines like Menopur more than 1 time to get pregnant, you may have an increased chance of having tumors in your ovaries, including cancer.
The most common side effects of Menopur include:
stomach cramps, fullness or pain
headache
injection site swelling, heat, redness and pain
These are not all the possible side effects of Menopur. For more information, ask your healthcare provider or pharmacist.
Tell your healthcare provider if you have any side effect that bothers you or that does not go away.
Before mixing, store Menopur powder in the refrigerator or at room temperature between 37ºF to 77ºF (3ºC to 25ºC).
Protect Menopur from light.
Menopur should be used right after mixing.
Throw away any unused Menopur.
Keep Menopur and all medicines out of the reach of children.
LABEL: MENOPUR- menotropins. Packager: Ferring Pharmaceuticals Inc. [accessed on Dec 04, 2018]
MENOPUR® (menotropins for injection). Ferring Pharmaceuticals Inc. [accessed on Dec 04, 2018]
These FAQs provide a summary of the most important information about Menotropins Injection. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.
Additional Materials (6)
Menopur Injection Instructions with Q Cap
Video by Aspire Fertility Centers/YouTube
Menopur Injection Instructions
Video by Procreate Fertility Center of Virginia/YouTube
How To Inject Menopur® With Q-Cap Subcutaneously | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Menopur® With Q-Cap Intramuscularly | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Menopur® With Needle Subcutaneously | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
How To Inject Menopur® With Needle Intramuscularly | Fertility Treatment | CVS Specialty®
Video by CVS Health/YouTube
6:10
Menopur Injection Instructions with Q Cap
Aspire Fertility Centers/YouTube
14:01
Menopur Injection Instructions
Procreate Fertility Center of Virginia/YouTube
6:43
How To Inject Menopur® With Q-Cap Subcutaneously | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
7:12
How To Inject Menopur® With Q-Cap Intramuscularly | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
5:58
How To Inject Menopur® With Needle Subcutaneously | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
6:30
How To Inject Menopur® With Needle Intramuscularly | Fertility Treatment | CVS Specialty®
CVS Health/YouTube
Triptorelin Injection
Triptorelin Injection
Also called: Decapeptyl®, Gonapeptyl®, Trelstar®, Triptodur®, Triptorelin Pamoate
Triptorelin is a gonadotropin-releasing hormone (GnRH) agonist that is a potent inhibitor of the synthesis of testosterone (in men) and estrogen (in women). It is used to treat advanced prostate cancer in men (Trelstar), to treat central precocious puberty in children (Triptodur) and control ovarian stimulation in women undergoing IVF treatment.
Triptorelin Injection
Also called: Decapeptyl®, Gonapeptyl®, Trelstar®, Triptodur®, Triptorelin Pamoate
Triptorelin is a gonadotropin-releasing hormone (GnRH) agonist that is a potent inhibitor of the synthesis of testosterone (in men) and estrogen (in women). It is used to treat advanced prostate cancer in men (Trelstar), to treat central precocious puberty in children (Triptodur) and control ovarian stimulation in women undergoing IVF treatment.
Triptorelin is a decapeptide and a gonadotropin-releasing hormone (GnRH) agonist used as the acetate or pamoate salts. One of its actions is to decrease the production of sex hormones in the body.
It is used:
In men. For the treatment of hormone dependent locally advanced or metastatic prostate cancer.
In women. To suppress the levels of ovarian hormones in order to:
Reduce the size of uterine myomas, (commonly known as fibroids) which are non-cancerous tumours arising from the myometrium (smooth muscle layer) of the uterus.
Treat endometriosis (the formation of uterine tissue outside the uterus).
In children. For the treatment of central precocious puberty (puberty that occurs prematurely but with the physical and hormonal changes of normal puberty).
You must not be given triptorelin:
If you are allergic to triptorelin or any of the other ingredients.
If you are allergic to gonadotropin-releasing hormone (GnRH) or any other GnRH analogues.
If you are pregnant or are breastfeeding.
There have been reports of depression in patients taking triptorelin which may be severe. If you are taking triptorelin and develop depressed mood, inform your doctor.
In rare cases treatment with triptorelin can lead to brain hemorrhage (pituitary apoplexia). Contact your doctor immediately if you experience sudden headache, vomiting or visual disturbances.
Treatment with triptorelin can led to thinning of bones which increases risk of bone injury.
If you are at additional risk of thinning of the bones (osteoporosis) you should tell you doctor before taking triptorelin. Risk factors include:
If any of your close family have thinning of the bones.
If you drink excessive amounts of alcohol, have a poor diet and/or smoke heavily.
If you are also being treated with certain medicines which may affect the strength of bone.
Men
Tell your doctor:
If you have pains in your bones, or difficulty passing urine.
If you have a secondary spinal or urinary tract tumour.
If you are castrated.
If you are diagnosed with diabetes.
If you have a high risk of heart disease, such as diagnosed high blood pressure or heart rhythm problems (arrhythmia).
If you have any heart or blood vessel conditions, including heart rhythm problems (arrhythmia), or are being treated with medicines for these conditions. The risk of heart rhythm problems may be increased when using triptorelin.
During the beginning of therapy with triptorelin you may experience a worsening in your disease symptoms. Contact your doctor if any of your symptoms of the disease get worse.
Women
Tell your doctor:
If you are experiencing bleeding mid-cycle during treatment (except for the first month).
Non-hormonal methods of contraception, such as a condom or a diaphragm, should be used during the first month after the first injection. It should also be used from 4 weeks after the last injection until the return of your periods (menstruation).
Your periods will stop during treatment. Once treatment has finished, your periods (menstruation) will resume 7-12 weeks after the final injection. If your periods (menstruation) persists during treatment, please inform your doctor.
Children
Treatment should only be started in girls under 9 years of age and boys under 10 years of age.
In the first month of treatment girls can experience mild to moderate episodes of vaginal bleeding. After finalising the therapy, development of puberty characteristics will occur. In most girls menses will start on average one year after ending the therapy, which in most cases is regular.
Using other medicines
Tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. Triptorelin might interfere with some medicines used to treat heart rhythm problems (e.g. quinidine, procainamide, amiodarone and sotalol) or might increase the risk of heart rhythm problems when used with some other drugs (e.g. methadone (used for pain relief and part of drug addiction detoxification), moxifloxacin (an antibiotic) antipsychotics used for serious mental illnesses).
Pregnancy and lactation
Triptorelin must not be used during pregnancy and lactation. If you are possibly pregnant, pregnancy should be ruled out by your doctor before you should use triptorelin. Women of childbearing potential should use effective non-hormonal contraception, such as a condom or a diaphragm, during treatment with triptorelin until menstruation resumes.
Driving and using machines
There are no known effects on the ability to drive or use machinery. However it cannot be ruled out that the ability to drive or use machinery can be affected during treatment due to some of the side effects (dizziness, sleep disturbances/insomnia and disturbed eye vision). Take extra caution if you experience these side effects.
TRIPTODUR- triptorelin Arbor Pharmaceuticals, LLC. Medication Guide. [accessed on Oct 24, 2018]
LABEL: TRELSTAR- triptorelin pamoate. Packager: Allergan, Inc. [accessed on Oct 24, 2018]
Triptorelin. LiverTox. [accessed on Oct 24, 2018]
PACKAGE LEAFLET: INFORMATION FOR THE USER GONAPEPTYL® Depot 3.75mg Powder and solvent for suspension for injection Triptorelin [accessed on Oct 24, 2018]
CONSUMER INFORMATION PrDECAPEPTYL ® Triptorelin Acetate Injection 0.1 mg/mL [accessed on Oct 24, 2018]
Triptorelin Injection. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]
These FAQs provide a summary of the most important information about Triptorelin Injection. If you would like more information or have any questions, talk to your healthcare provider.
Additional Materials (1)
DECAPEPTYL 0.1 Self-administration
Video by Girexx xarxes/YouTube
5:46
DECAPEPTYL 0.1 Self-administration
Girexx xarxes/YouTube
Urofollitropin Injection
Urofollitropin Injection
Also called: Bravelle®, uFSH
Urofollitropin injection is a prescription medicine that contains highly purified human-derived FSH (follicle stimulating hormone). It is used to treat female infertility in women with anovulation that have been unresponsive to treatment with clomiphene citrate; and to induce the development of multiple follicles for assisted reproductive technologies (ART).
Urofollitropin Injection
Also called: Bravelle®, uFSH
Urofollitropin injection is a prescription medicine that contains highly purified human-derived FSH (follicle stimulating hormone). It is used to treat female infertility in women with anovulation that have been unresponsive to treatment with clomiphene citrate; and to induce the development of multiple follicles for assisted reproductive technologies (ART).
BRAVELLE® is a prescription medicine that contains follicle stimulating hormone (FSH). BRAVELLE® is used to treat women:
who need help developing and releasing eggs (ovulating) and have already received a medicine to control their pituitary gland
with healthy ovaries so they can make multiple (more than 1) eggs as part of an Assisted Reproductive Technology (ART) Cycle
Do not use BRAVELLE® if you:
are allergic to urofollitropin or any of the ingredients in BRAVELLE®. See the end of the leaflet that comes with your medicine for a complete list of ingredients.
have ovaries that no longer make eggs (primary ovarian failure)
are pregnant or think you may be pregnant. If BRAVELLE® is taken while you are pregnant, it may harm your baby.
have problems with your thyroid gland or adrenal gland or pituitary gland that are not controlled by taking medicine
have a tumor in your female organs, including your ovaries, breast, or uterus that may get worse with high levels of estrogen
have a tumor of your pituitary gland or hypothalamus
have abnormal bleeding from your uterus or vagina and the cause is not known
have ovarian cysts or enlarged ovaries, not due to a problem called polycystic ovary syndrome (PCOS)
Before using BRAVELLE®, tell your healthcare provider if you:
have been told by a healthcare provider that you are at an increased risk for blood clots (thrombosis)
have ever had a blood clot (thrombosis), or anyone in your family has ever had a blood clot
had stomach (abdominal) surgery
had twisting of your ovary (ovarian torsion)
had or have a cyst in your ovary
have any other medical conditions
are breast feeding or plan to breast feed. It is not known if BRAVELLE® passes into your breast milk. You and your healthcare provider should decide if you will use BRAVELLE® or breastfeed. You should not do both.
Tell your healthcare provider all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.
Read the Instructions for Use at the end of the patient information leaflet that comes with your medicine about the right way to use BRAVELLE® or BRAVELLE® mixed with MENOPUR®.
Use BRAVELLE® exactly as your healthcare provider tells you to use it.
Your healthcare provider will tell you how much BRAVELLE® to use and when to use it.
Your healthcare provider may change your dose of BRAVELLE® if needed.
If you miss a dose of BRAVELLE®, call your healthcare provider right away. Do not double the amount of BRAVELLE® you are taking.
You may need more than 1 vial of BRAVELLE® for your dose.
BRAVELLE® may be given under your skin (subcutaneously) or into your muscle (intramuscularly). Your healthcare provider will tell you where and how to give your BRAVELLE®.
Your healthcare provider will give you BRAVELLE® intramuscularly.
BRAVELLE® may be mixed with MENOPUR® in the same syringe when you give it subcutaneously.
BRAVELLE® may cause serious side effects, including:
serious allergic reactions. Symptoms of allergic reactions include:
rash
swelling of your face and throat
rapid swelling all over your body
trouble breathing
If you have a serious allergic reaction, stop using BRAVELLE® and call your healthcare provider or go to the nearest hospital emergency room right away.
ovaries that are too large. BRAVELLE® may cause your ovaries to be abnormally large. Symptoms of large ovaries include bloating or pain in your lower stomach (pelvic) area. If your ovaries become too large your healthcare provider may tell you that you should not have intercourse (sex) so you do not rupture an ovarian cyst.
ovarian hyperstimulation syndrome (OHSS). Using BRAVELLE® may cause OHSS. OHSS is a serious medical condition that can happen when your ovaries produce too many eggs (overstimulated). OHSS can cause fluid to suddenly build up in the area of your stomach, chest, and heart, and cause blood clots to form. OHSS may also happen after you stop using BRAVELLE®. Stop using BRAVELLE® and call your healthcare provider or go to the nearest hospital emergency room right away if you have any of the following symptoms of OHSS:
severe pelvic or stomach pain
nausea
vomiting
sudden weight gain
swollen stomach
diarrhea
trouble breathing
decreased or no urine
lung problems. BRAVELLE® may cause serious lung problems that can sometimes lead to death including fluid in the lungs, trouble breathing, and worsening of asthma.
blood clots. BRAVELLE® may increase your chance of having blood clots in your blood vessels. Blood clots can cause:
blood vessel problems (thrombophlebitis)
stroke
loss of your arm or leg
blood clot in your lung (pulmonary embolus)
twisting (torsion) of your ovaries. BRAVELLE® may increase the chance of your ovary twisting, if you already have certain conditions such as OHSS, pregnancy and previous abdominal surgery. Twisting of your ovary may lead to blood flow being cut off to your ovary.
pregnancy with and birth of multiple babies. BRAVELLE® may increase your chance of having a pregnancy with more than 1 baby. Having a pregnancy and giving birth to more than 1 baby at a time increases the health risk for you and your babies. Your healthcare provider should talk to you about your chances of multiple births before you start using BRAVELLE®.
birth defects in your unborn baby. Babies born after ART may have an increased chance of birth defects. Your age, certain sperm problems, your genetic background and that of your partner, and a pregnancy with more than 1 baby at a time may increase the chance that your baby may have birth defects.
ectopic pregnancy (pregnancy outside your womb). BRAVELLE® may increase your chance of having a pregnancy that is abnormally outside of your womb. Your chance of having a pregnancy outside of your womb is increased if you also have fallopian tube problems.
miscarriage. Your chance of loss of an early pregnancy may be increased if you had difficulty becoming pregnant.
tumors of the ovary. If you have used medicines like BRAVELLE® more than 1 time to get pregnant, you may have an increased chance of having tumors in your ovaries, including cancer.
The most common side effects of BRAVELLE® include:
stomach cramps
stomach fullness and bloating
headache
nausea
pain
pelvic pain
hot flashes
trouble breathing
pain after egg removal (retrieval)
These are not all the possible side effects of BRAVELLE®. For more information, ask your healthcare provider or pharmacist.
Tell your healthcare provider if you have any side effect that bothers you or that does not go away.
Before mixing, store BRAVELLE® powder in the refrigerator or at room temperature between 37ºF to 77ºF (3ºC to 25ºC).
Protect BRAVELLE® from light.
BRAVELLE® should be used right after mixing.
Throw away any unused BRAVELLE®.
Keep BRAVELLE® and all medicines out of the reach of children.
LABEL: BRAVELLE- urofollitropin. Packager: Ferring Pharmaceuticals Inc. [accessed on Dec 04, 2018]
Ferring Pharmaceuticals Inc. BRAVELLE® (urofollitropin for injection, purified). [accessed on Dec 04, 2018]
These FAQs provide a summary of the most important information about Urofollitropin Injection. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.
Bromocriptine/Cabergoline
A synthetic scheme for the production of bromocriptine is disclosed.
Image by Nuklear
A synthetic scheme for the production of bromocriptine is disclosed.
A synthetic scheme for the production of bromocriptine is disclosed.
Image by Nuklear
Bromocriptine or Cabergoline Treatment for Female Infertility
Bromocriptine and cabergoline are pills taken orally to treat abnormally high levels of the hormone prolactin, which can interfere with ovulation. Pituitary growths; certain medications, including antidepressants; kidney disease; and thyroid disease can cause high levels of prolactin.
Bromocriptine or cabergoline allow 90% of women to have normal prolactin levels.
Once prolactin levels become normal, 85% of women using bromocriptine or cabergoline ovulate.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Bromocriptine
Bromocriptine
Also called: Cycloset®, Parlodel®
Bromocriptine is a prescription medicine used to treat menstrual problems, growth hormone overproduction, Parkinson's disease, and pituitary tumors (Parlodel). It can also help control blood sugar levels in people with type 2 diabetes (Cycloset). Bromocriptine is also used to induce ovulation for assisted reproductive technologies (ART).
Bromocriptine
Also called: Cycloset®, Parlodel®
Bromocriptine is a prescription medicine used to treat menstrual problems, growth hormone overproduction, Parkinson's disease, and pituitary tumors (Parlodel). It can also help control blood sugar levels in people with type 2 diabetes (Cycloset). Bromocriptine is also used to induce ovulation for assisted reproductive technologies (ART).
Bromocriptine is a prescription medicine used with diet and exercise to lower blood sugar in adults with type 2 diabetes. Bromocriptine may be taken alone or with other medicines that also help to control blood sugar.
Bromocriptine is an oral dopamine receptor agonist, therefore it can also treat menstrual problems, growth hormone overproduction, Parkinson's disease, and pituitary tumors. It can also stop breast milk production.
The generic form of bromocriptine and its brand-name version Parlodel® are used to treat symptoms of Parkinson’s disease. They’re also used to treat symptoms of other conditions caused by very high levels of prolactin and growth hormone. The brand-name version Cycloset® is used to treat type 2 diabetes.
Bromocriptine has not been studied in children.
Do not take bromocriptine if you:
are allergic to bromocriptine or any of the other ingredients in bromocriptine capsules or tablets
take ergot medicines, such as ergotamine and dihydroergotamine. Ask your healthcare provider for a list of these medicines, if you are not sure.
are breastfeeding
have fainting (syncopal) migraine headaches
uncontrolled hypertension
Talk to your healthcare provider before taking bromocriptine if you have any of these conditions.
Before taking bromocriptine, tell your healthcare provider about all of your medical conditions, including if you:
have type 1 diabetes mellitus
have diabetic ketoacidosis
have ever passed out or fainted
have migraine headaches
have or have had low blood pressure (hypotension)
have or have had a mental health condition, especially a psychotic disorder
are pregnant or plan to become pregnant. It is not known if bromocriptine will harm your unborn baby. Talk with your healthcare provider if you are pregnant or plan to become pregnant.
Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take medicines for:
mental health conditions, especially anti-psychotic medicines
migraine or other types of headaches
type 2 diabetes
Ask your healthcare provider or pharmacist for a list of medicines taken for these conditions, if you are not sure.
Bromocriptine may affect the way other medicines work, and other medicines may affect how bromocriptine works.
Know the medicines you take. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.
Take bromocriptine exactly as your healthcare provider tells you to take it.
It is recommended that bromocriptine tablets and capsules be taken with food.
During periods of stress on the body, such as fever, trauma, infection, or surgery, your medication needs may change. Contact your healthcare provider right away.
If you take too much bromocriptine, call your healthcare provider or go to the nearest emergency department right away.
While taking bromocriptine:
check your blood sugar as your healthcare provider tells you to
stay on your prescribed diet and exercise program
learn to prevent, recognize, and manage low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), and complications of diabetes
see your healthcare provider for regular blood tests, including your blood sugar levels and hemoglobin HbA1c
Bromocriptine may cause serious side effects, including:
Low blood pressure
Fainting
Severe dizziness which can be caused by postural hypotension. This can happen when your blood pressure lowers rapidly after you stand up from a lying down position.
The most common side effects of bromocriptine include:
nausea
headache
fatigue (somnolence). If you have somnolence from bromocriptine you should not drive or use other heavy machines until the somnolence is better.
dizziness
vomiting
low blood sugar (hypoglycemia), especially when used with another type of diabetes medicine known as a sulfonylurea
Tell your healthcare provider if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of bromocriptine. For more information, ask your healthcare provider or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Store bromocriptine at or below 77°F (25°C).
Protect from light.
Keep bromocriptine and all medicines out of the reach of children.
LABEL: CYCLOSET- bromocriptine mesylate tablet [accessed on Nov 14, 2018]
LABEL: BROMOCRIPTINE MESYLATE- bromocriptine mesylate tablet BROMOCRIPTINE MESYLATE- bromocriptine mesylate capsule [accessed on Nov 14, 2018]
BROMOCRIPTINE. LIVERTOX®. U.S. National Library of Medicine. [accessed on Nov 06, 2018]
Bromocriptine. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]
These FAQs provide a summary of the most important information about Bromocriptine. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.
Cabergoline
Cabergoline
Cabergoline is a prescription medicine used for the treatment of hyperprolactinemic disorders (excessive prolactin blood levels), either idiopathic (unknown cause) or due to pituitary adenomas. It is also used to induce ovulation for assisted reproductive technologies (ART).
Cabergoline
Cabergoline is a prescription medicine used for the treatment of hyperprolactinemic disorders (excessive prolactin blood levels), either idiopathic (unknown cause) or due to pituitary adenomas. It is also used to induce ovulation for assisted reproductive technologies (ART).
Cabergoline. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]
These FAQs provide a summary of the most important information about Cabergoline. If you would like more information or have any questions, talk to your healthcare provider.
ART and Multiple Births
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
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9 Month Old Twins in-Utero
Interactive by TheVisualMD
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
9 Month Old Twins in-Utero
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Camera is zoomed into face of one fetus. The camera then zooms out to show twins within the womb. The womb is shown positioned above the pelvic girdle. There is no background, only the pelvis gives context of environment. The womb is rendered in the glass-style and the fetuses are semi- translucent. The fetuses are at full term.
Interactive by TheVisualMD
ART and Multiple Births
Key Findings: Fertility Treatments and Multiple Births
Multiple births—the delivery of twins, triplets, or more—is common with fertility treatments. During the use of assisted reproductive technology (ART)—such as in vitro fertilization (IVF)—multiple births primarily result from transfer of more than one embryo during the procedure. Non-ART fertility treatments include oral medications or injections used to boost ovulation among women who do not ovulate or to stimulate the development of multiple eggs among women who have trouble getting pregnant. Because it is difficult to predict or control the number of eggs that will be fertilized during non-ART fertility treatments, many of these treatments also result in multiple births. Although some infertility patients may prefer to have twins, all multiple births, including twin births, have higher risks for both mother and infants.
The following key findings can be used by patients, providers, researchers, and public health specialists to better understand how fertility treatments contribute to multiple births and ways to improve the chance of healthy infant birth when using fertility treatments.
Are multiple births increasing or decreasing in the United States? How do fertility treatments contribute to this trend?
Over the last 4 decades, twin births nearly doubled. Triplet and higher-order births quadrupled. This increasing trend coincided with the introduction of fertility treatments such as ovulation induction, ovarian stimulation, and in vitro fertilization.
After taking maternal age into account, more than one-third of twins and more than three-quarters of triplets and higher order multiples in the United States resulted from conception assisted by fertility treatments.
ART practices are improving. Over the past decade, fewer embryos have been transferred during ART, resulting in fewer multiple births from ART.
Non-ART fertility treatments of ovulation induction and ovarian stimulation contribute to a portion of the increasing number of multiple births. However, the outcomes of these treatments are not routinely tracked in the United States. To better understand trends in births from non-ART fertility treatments, these data are needed.
How many embryos should be transferred during an ART cycle to achieve the best outcome?
Our findings can inform the development of future guidelines on the number of embryos transferred during ART by providing a measure of success that emphasizes good perinatal outcome.
The best outcomeof ART is the birth of one healthy infant. Among younger patients undergoing their first ART cycle, the best outcome can be achieved when a single embryo is selected for transfer.
Source: Centers for Disease Control and Prevention (CDC)
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Ovarian Stimulation
Ovarian stimulation is an infertility treatment in which medicines, called fertility drugs, are used to boost ovulation among women who do not ovulate or to stimulate the development of multiple eggs among women who have trouble getting pregnant. Learn about the most common medications used to treat infertility by stimulating ovulation.