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The gonadotrophins (FSH and LH) are released from the pituitary and they stimulate the ovaries (Figure 10.1). Gonadotrophins have become commercially available using extraction techniques on urine from menopausal women (HMG) who have high levels of gonadotrophins. The objective of gonadotrophin therapy is to produce mature follicles, which can be released by injection of HCG. For low-tech treatment the objective is to stimulate maturation preferably of one follicle but with a maximum of three follicles. Patients who fail to ovulate or conceive with clomiphene or tamoxifen are candidates for gonadotrophin therapy. Tubal patency, normal prolactin levels and satisfactory semen analysis are essential pre-re quisites. Patients with hypergonadotrophic hypogonadism (menopausal gonadotrophin levels) do not respond to gonadotrophin therapy. There have been a variety of regimens for the administration of gonadotrophins. The fixed regimen involves a predetermined dose administered in a single intra-muscular injection on three alternate days e.g. Days 1, 3 and 5 of the menstrual cycle and HCG is given three days later if the oestrogen response is in the accepted range. In the variable regimen, gonadotrophins tended to be administered daily, the dose being adjusted according to plasma or urinary oestradiol results. In the early days of gonadotrophin therapy, the only investigation for monitoring ovarian response was oestrogen assay of urine or blood. Ultrasound tracking of follicular development (pelvic ultrasound), initially transabdominally and more recently by the transvaginal route, has provided a valuable addition for the monitoring of gonadotrophin therapy. Related Medical Abstracts - Click on the paper title:-
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