Infertility is an increasing global health concern, with nearly one in six couples experiencing difficulties in conceiving. Among the various treatment strategies, controlled ovarian stimulation with gonadotropins continues to be a cornerstone in modern reproductive medicine. By stimulating follicular development and ovulation, gonadotropins enhance the chances of conception, particularly in women with anovulation or when ovulation induction cannot be achieved with less complex methods, While it is never the first line of treatment, their role has evolved significantly over the years, supported by advances in drug formulations and improved monitoring protocols that aim to maximise efficacy while minimising risks.

Gonadotropins are naturally occurring glycoprotein hormones that regulate ovarian follicular growth and maturation. Clinically, preparations are available in urinary-derived and recombinant forms, including follicle-stimulating hormone (FSH), human menopausal gonadotropin (hMG, containing both FSH and LH activity), and recombinant LH. Human chorionic gonadotropin (hCG) is used as a trigger to mimic the natural luteinising hormone surge and induce ovulation. These agents enable a more physiological stimulation of the ovaries compared to oral ovulogens, thereby offering higher success rates in selected patient groups.

Gonadotropins are naturally occurring glycoprotein hormones that regulate ovarian follicular growth and maturation. Clinically, preparations are available in urinary-derived and recombinant forms, including follicle-stimulating hormone (FSH), human menopausal gonadotropin (hMG, containing both FSH and LH activity), and recombinant LH. Human chorionic gonadotropin (hCG) is used as a trigger to mimic the natural luteinising hormone surge and induce ovulation. These agents enable a more physiological stimulation of the ovaries compared to oral ovulogens, thereby offering higher success rates in selected patient groups.

In the context of IUI, gonadotropins further enhance fertility outcomes by promoting the growth of multiple follicles and optimising the timing of insemination. The treatment typically begins with a baseline ultrasound to rule out ovarian cysts and assess ovarian reserve, followed by controlled low-dose stimulation with FSH or hMG. Follicular monitoring is conducted until the leading follicle reaches 18 to 20 mm, after which ovulation is triggered with hCG, and insemination is scheduled 34 to 36 hours later. When used appropriately, gonadotropin-stimulated IUI cycles yield pregnancy rates of 10 to 20 percent per cycle, which is significantly higher compared to natural or oral-stimulated cycles. Cumulative live birth rates also improve when multiple IUI cycles are attempted, although most guidelines recommend limiting to three or four cycles before progressing to in vitro fertilisation (IVF).

Optimising outcomes with gonadotropin therapy requires a personalised approach. Factors such as patient age, body mass index, ovarian reserve markers like anti-Müllerian hormone (AMH), and antral follicle count (AFC) should guide dose selection. The use of recombinant preparations provides consistent potency and reduced batch-to-batch variability compared with urinary-derived products, making them preferable in many clinical settings. Moreover, patient counselling plays a pivotal role in setting realistic expectations, discussing the potential risks of multiple pregnancies, and highlighting the possibility of advancing to more complex assisted reproductive technologies if required.

At Milann Infertility Centre, we bring together clinical expertise, advanced reproductive technologies, and patient-centric care to offer comprehensive fertility solutions. Through Milann Academy, we extend this commitment to education and training by equipping healthcare professionals with evidence-based knowledge and practical skills in reproductive medicine. By combining modern science with compassionate care and academic excellence, Milann continues to be a leader in shaping the future of fertility management in India.