The grandfather of all of these drugs

The grandfather of all of these drugs was Pergonal. Pergonal was a mixture of FSH and LH. It was literally extracted from the urine of postmenopausal nuns. In Italy especially and other countries there are convents for retired postmenopausal nuns. Because of the way your endocrine system works, these women were excreting huge amounts of FSH and LH each day in their urine. The drug companies collected the urine and extracted the hormones to make Pergonal.

Because this was a biologic extract, it contained a great deal of extraneous protein material and, therefore, had to be dissolved in a fairly large volume of water.

In an attempt to simplify the process, the genes for FSH were isolated. This allowed the drug companies to manufacture pure FSH using recombinant DNA technology. Because this is a highly purified substance, it can be dissolved in a very small amount of liquid and can, therefore, be given just under the skin. Pergonal had to be given deep into the muscle of the buttock.

For these reasons they were more economic and political than scientific, the drug companies that manufacture pure FSH went to great lengths to try to convince physicians that the cycles obtained with this drug were just as good as the cycles obtained with Pergonal. The claim was made that pure FSH stimulated the ovaries just as well as the FSH/LH combination.

Now, in the summer of 1999, an article was published that clearly showed that there are a number of women who definitely need to be on the combined preparation - women for whom the pure FSH alone simply does not do an optimum job. It is easy to detect such women. First, there are those who are obviously not stimulating well. There are also a group of women who appear to be stimulating "OK" but who are still not getting pregnant and in whom the feeling is that these cycles could be better.

What this study showed is that if these women's serum LH level while they are on pure FSH stimulation is significantly low then they stimulate better using the combined preparation.

The two drugs that are currently available on the market for stimulation that contain both FSH and LH are either Humegon or Repronex. Because they are similar to Pergonal, they are probably best administered in the buttock as described earlier in this pamphlet.

People have tried to inject Repronex subcutaneously using a very small amount of liquid. Some women are able to tolerate this and do quite well. Other women have a rather significant local reaction to the injection and have to go to an intramuscular injection. It is impossible to predict which will be which and, therefore, it is a matter of trial and error.

 Most Reproductive Endocrinologists have switched their patients to the pure FSH preparations (Gonal F or Follistim, you  need to be aware that there is still a substantial place for the combined FSH/LH preparations even though the route of administration may be more uncomfortable.