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FSH is produced by the pituitary gland and directly stimulates the ovaries to recruit and support ovarian follicles, each containing one egg. The hypothalamus adjusts the production of FSH depending upon the levels of other hormones such as estrogen.
FSH is used in stimulated IUI and assisted reproductive technology cycles (IVF) because it causes the development of numerous follicles. More follicles are needed in ART cycles because some do not fertilize or do not continue to develop.
There are several FSH products available in the United States including Follistim, Gonal-F, Bravelle, and Repronex. Follistim  and Gonal-F are produced by genetic engineering using mammalian culture cells. These products are identical to the body’s FSH. Bravelle and Repronex are derived from the urine of postmenopausal women.
Some physicians prefer Gonal-F or Follistim because they are 100% FSH. Others prefer Repronex or Bravelle (especially if the patient is down regulated with a medication such as (Lupron) because they believe that the additional LH produces a “better” stimulation. A major advantage of the urinary products is that they are less expensive. Choice of products and dosages are individualized for each patient. All products have been shown to induce ovulation effectively.
FSH is administered using patient protocols, and dosages must be adjusted based upon response. If you are undergoing ovulation induction with FSH, you will come to the clinic numerous times for ultrasound and estradiol measurements. After each of these visits, you will receive dosing instructions.
Monitoring is important in preventing serious side effects such as ovarian hyperstimulation syndrome and multiple births. FSH should only be administered by a reproductive endocrinologist who has extensive clinical training in its use. Most of the high order (>3) multiple births covered by the media come from IUI cycles. IVF causes fewer multiples because the number of embryos put back into the uterus is limited.
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