Injectables for Fertility Treatment with PCOS, Polycystic Ovarian Syndrome
What are injectables for fertility treatments?
Injectable FSH hormone products are often referred to as injectable gonadotropins or "injectables".
- Fertility patients with PCOS have usually tried treatment with oral medications as a first-line therapy, and if that is not successful, moving on to injections is an option
- US brand names for injectables include Follistim, Gonal-F, Repronex, Bravelle, and Menopur
When are injectables used in women with PCOS?
- When oral medications, such as Clomid for PCOS or Femara for PCOS fail to result in a viable pregnancy, it used to be routine that the next step was shots for infertility
- However, because of the high risk for multiple births, particularly the risk of triplets and higher, injectables for PCOS is being used less often
- When injctables are used to stimulate ovulation in women with polycystic ovaries it is often very difficult to get only 1 or 2 follicles to develop
- Commonly there are several follicles at or near a mature size by the end of the ovarian stimulation process
- Multiple follicles close to mature size at ovulation time gives a higher risk for multiple pregnancies
- Because of these risks, and because IVF has high success rates, many couples and infertility specialists now move directly to IVF if clomiphene treatment is not successful
What is the protocol for using injectables for pregnancy with PCOS?
- These medications are usually given by subcutaneous injections on a daily basis
- The injections are started early in the menstrual cycle, which is often induced with drugs
- Daily injections continue for approximately 7 to 14 days with the doctor adjusting the dose in order to get 1 (or a few) follicles to grow
- When one (or more) mature size follicles are seen on the ovaries with ultrasound, an injection of HCG is given which induces ovulation to occur about 36 to 40 hours later
Pregnancy success rates with fertility injectables for PCOS
- Over 90% of women with infertility and PCOS will be able to develop mature follicles and ovulate with injectables
- However, the pregnancy success rate is only about 20% per month
- Injectables and then sex at the time of ovulation is more fun, but injectables plus artificial insemination, IUI is more effective
- After 3 months have been tried and failed - the success rate with continuing injectables is quite a bit lower
Treatment costs for injectables
- These drugs are expensive
- In the United States injectable gonadotropins cost about $45-80 per 75 units
- The daily dose ranges from about 50 units to 375 units or more - for 7-14 days
Ultrasound and blood monitoring costs
Ultrasound and blood monitoring of the stimulation cycle is essential when using injectable gonadotropins as there are substantial risks associated with overstimulation if the ovaries should over-respond to the medication.
This monitoring is usually done about 3 times a week during the time the woman is taking the injectable medications. This adds to the cost of the cycle.
See details about fertility treatment costs
Health Insurance Coverage for treatment with injectables
Some health insurance plans will pay for the cost of ovulation induction with injectables including medications, monitoring and insemination. Other health insurance plans will pay for some (or none) of the costs associated with this treatment.
Injectables - Risks and side effects
- Complications associated with use of these medications include the possibility of overstimulation, called ovarian hyperstimulation syndrome, or OHSS
- Hyperstimulation should be rare with this treatment since low doses should be cautiously used with close monitoring with a goal of developing only 1 or 2 mature follicles
- Injectables with PCOS can result in a high risk for multiple pregnancy and the associated complications
- The reported risks for multiples vary greatly between published studies
- Some studies show 70% singles, 20% twins, 7% triplets, 3% quadruplets and higher. In rare cases, more than 5 fetuses have implanted (for example, Jon and Kate plus 8)
- Multiples risks will depend on female age and the number and sizes of the follicles at the time of the HCG trigger shot
- More about multiple birth risks with ovarian stimulation drug treatments
Reducing risks for multiple pregnancies
- When several mature follicles develop the couple and the fertility specialist can discuss multiple pregnancy risks. There is an option of "canceling" the cycle by not giving the HCG shot that causes ovulation. This pretty much eliminates the risk of any pregnancy (single or multiple) occurring.
- Sometimes consideration is given to "converting to IVF" if there are too many medium and large follicles developing. In such a situation the stimulation is usually pushed a little more to get a good number of mature eggs for in vitro fertilization.
- IVF with blastocyst transfer can reduce multiple birth risks
- If the injectable FSH drugs are used for ovulation induction they should be used cautiously and in the lowest possible dose by an experienced specialist to minimize the number of mature follicles that develop.
- This strategy lowers the risk for twins, triplets, and higher order pregnancies.
Treatment Options After FSH Hormones Fail
Injectables for PCOS are often tried for up to about about 3 or 4 months. If this treatment does not result in pregnancy in vitro fertilization is the next step.