Monitoring

Careful monitoring of treatment cycles using injectable gonadotropins is very important. This is because the normal control relationships between the follicles developing in the ovary and the pituitary gland are bypassed when the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are given directly. The goal of monitoring is to make sure that sufficient, but not excessive, stimulation is being provided to the developing follicles.

Most cycles are monitored with a combination of ultrasounds (to determine the number and size of the developing follicles) and blood work (to measure the estrogen being produced). The results of this monitoring, along with knowing the duration of the stimulation and your medical history, allow your doctor to determine the optimal dosage to administer. He/she can then determine when the follicles are mature and ready to ovulate.

A mid-cycle LH surge is required to induce the final maturational changes in the egg, to release the egg from the wall of the follicle, and to stimulate the actual release of the egg from the follicle. Most women will not have a spontaneous LH surge during stimulated cycles. A "surrogate" LH surge may be provided by the injection of hCG, a hormone that is generally produced after a woman becomes pregnant. hCG has the same stimulatory effects on the ovary that LH does, but has a longer duration of action and is therefore more practical and effective.

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