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Drug:
Human Menopausal Gonadotrophins (H.M.G. or Pergonal)
What is amenorrhoea
If your pituitary gland fails to
produce F.S.H. and L.H. there will be no corresponding production of estrogen
by the ovaries. Consequently, you will have amenorrhoea. A Progesterone
Challenge Test will be negative in that it will not result in a withdrawal
bleed. The only way in which you are likely to be able to become pregnant
is to by-pass the pituitary by taking F.S.H. and L.H. injections directly.
What is Pergonal
Pergonal is a combination of human
F.S.H. and L.H.. These hormones have been extracted from the urine of menopausal
women and purified. Each ampoule of Pergonal contains 75 international
units each of F.S.H. and L.H.
What tests are required
before taking Pergonal
Pergonal is expensive and it has
a greater potential for causing complications than have other ovulation
inducing drugs. Before the commencement of this therapy it is essential
to determine that amenorrhea is not linked to other causes like hyperprolactinaemia
or ovarian failure. Your husband's semen will be analyzed to confirm that
it is normal. It is also imperative to check that the tubes are patent.
It will be an extremely unpleasant surprise to discover that your tubes
are blocked or that your husband is sterile after you have
spent a substantial amount on Pergonal therapy. As the treatment program
is complex, doctors generally carry out a Pergonal counseling session with
a couple, in order to ensure that they fully understand the intricacies
of treatment and how to avoid the possible problems.
How is Pergonal administered
Pergonal is given in two main ways.
It can be given by three equal alternate day injections or by a daily injection
program in which the dosage is increased until a satisfactory response
has been obtained. As long as the estrogen level is within the acceptable
range, giving an injection of 10,000 units of H.C.G stimulates ovulation.
You will not ovulate unless you are given the H.C.G. However, if the estrogen
level was very high, the H.C.G. would be withheld. Ovulation would not
occur and after a few days a period would commence and treatment could
be restarted. Sometimes improved results can be obtained by adding clomiphene
to Pergonal.
Some clinics are fortunate in having
the facility of ultrasound scanning of the ovaries before giving the H.C.G.
In this way the number of follicles likely to ovulate can be seen and actually
measured. Unfortunately, there is no definite relationship between the
number of follicles that will ovulate and the estrogen levels reached.
What do I need to do
while on Pergonal
The basis on which Pergonal therapy
works is that if you are given F.S.H. (the important component of
Pergonal) the ovary will respond with the production of estrogen. It will
be necessary to monitor your estrogen levels by means of 24-hour urine
collections. The aim of treatment is to try to produce an estrogen level
in the range of 180-514 nMol, per 24-hour urine collection. Below 180 is
usually too low for ovulation and above 514 the risk of multiple births
is increased.
What are the possible
side effects of Pergonal
If the H.C.G. injection is given
when the estrogen level is very high, there is a risk of ovarian hyperstimulation.
Mild hyperstimulation is in the region of 5% of all treatment cycles and
is marked by abdominal distension and moderate pain due to ovarian enlargement.
Severe hyperstimulation is fortunately very rare. It occurs in less than
half of 1% of treatments, but can be dangerous. Ovarian hyperstimulation
can only occur after the H.C.G. is given. In clinics without ultrasound,
they rely heavily on the readings of the final estrogen level to determine
whether or not to give the H.C.G. So the accuracy of the 24 hour urine
collection is vital.
How effective is the
Pergonal therapy
The success rate among this group
of patients is good, with at least a 60% pregnancy rate. However, the miscarriage
rate is higher than among clomiphene pregnancies, but this is probably
related to the increased number of multiple pregnancies. There is no increase
in the abnormality rate for Pergonal babies.
Does Pergonal result
in multiple births
Close to 70% of the pregnancies result
in a single baby, while 27% deliver twins. In other words, 97% of the pregnancies
produce 1 or 2 babies only. That leaves 3% of the pregnancies that may
result in 3 or more babies.
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