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Test Tube Baby from IVF Procedure Infertility Treatments in Toowoomba

On July 25, 1978, Louise Joy Brown, the world’s first successful “test-tube baby” was born in Great Britain. Australia’s first ‘test tube baby’ was born 2 years later in 1980. Since then newly developed Infertility Treatments and the IVF Procedure have become quite successful at assisting couples create their own test-tube baby and often test-tube babies. Infertility Treatments and the IVF Procedure require the use of several types of medications to balance hormonal imbalances and treat other medical conditions in infertile females and males to increase the likelihood of having their own ‘test tube baby’.

These medications include Clomid aka Serophene (Clomiphene citrate), Femara (Letrozole), Follistim (Follitropin), Gonal – F, Bravelle (Urofollitropin), Novarel (Chorionic Gonadotropin), Metformin hydrochloride (Glucophage), Endometrin® (progesterone), Clexane (Enoxaparin sodium). Subsequently, thanks to these drugs, many infertile women going through Infertility Treatments and the IVF Procedure have been fortunate enough to conceive their very own ‘test tube baby’. However these fertility medications often come with side effects. Many women have found that the emotional stress faced during Infertility Treatments and the IVF Procedure can be calmed by using Acupuncture applied by a suitably qualified acupuncture practitioner. My name is Louis Gordon and I am a Toowoomba acupuncturist. I practice acupuncture from ANTRAC Acupuncture Clinic in Middle Ridge, Toowoomba, 4350, Queensland, Australia. My 3 decades of acupuncture experience will assist in all aspects associated with Infertility Treatments and the IVF Procedure. Call for more information on (07) 4636 6100.

MISSION STATEMENT: “I aim to get my patients as WELL as possible, as quickly as possible, and then to keep them WELL”.

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 Commonly Prescribed Fertility Drugs for “Test Tube Babies”

For each ovulation problem there is usually a particular protocol for medical treatment. While these drugs are referred to as “fertility drugs”, in reality they are ovulatory induction drugs. The major cause of infertility in women is associated with the ovulation process. Fertility drugs are prescription medications that are used to influence ovulation in a positive way. These medications initiate ovulation and cause the release of one or more eggs. Fertility medications are the most frequently used treatment for couples who are facing infertility. Generally, it is the female that is prescribed fertility drugs. However, males can also be prescribed fertility drugs.

Remember, that once ovulation occurs while taking the following medications, ovulation will only continue with regularity if the medication program is continued each month. There is rarely any permanent cure due to the medications. This is one area where acupuncture treatment excels, because often once the underlying root cause is corrected, the cycle will be more regulated, and consistent ovulation will persist. Booster acupuncture treatments may be required to maintain the correction. It must be emphasised that once ovulation occurs, it does not automatically mean that the patient will become pregnant during the first month.

Doctors generally insist that couples must go for a period of at least twelve months without conceiving before prescription fertility drugs are prescribed. This is not unreasonable, as many healthy couples fail to conceive within a 12-month time period. Interestingly, only 25% of couples will conceive within their first month of trying. Sixty percent of couples will conceive within six months. Seventy five percent of couples will conceive within nine months and 90% of couples will conceive within 18 months. So don’t despair if you have not fallen pregnant yet. If you have confirmed ovulation problems, then it may be time to look further afield. This may include a course of acupuncture treatment and the inclusion of neutriceuticals and herbs to help harmonise the gynaecological and endocrine systems.

There are several basic stages involved in the IVF procedure. However, do not be surprised if the stages that you follow are slightly different to other individuals that you know about. Every woman is an individual and the preliminary tests ordered for you may differ to another woman you know about. Further, some stages may be added or not included in your treatment protocol, and even the medications prescribed for you could be completely different than those prescribed for another woman undergoing the IVF procedure. There are almost as many IVF stimulation protocols in use in the world as there are IVF clinics.

Classical IVF Procedures involves seven main stages:

  1. Perform tests to determine the cause of infertility – endometriosis, PCOS, anovulation, coeliac disease etc and treat accordingly.
  2. Medically stimulated growth and maturation of several oocytes.
  3. Determining the exact timing of retrieval of these oocytes using blood tests (oestradiol) and vaginal ultrasound.
  4. The surgical procedure to retrieve the oocytes.
  5. Fertilisation (with sperm) of the oocytes that may become embryos.
  6. Transfer of the successfully developed embryo(s) back into the uterus (Embryo Transfer), and
  7. Freezing of any remaining embryos deemed suitable.

Acupuncture Treatments in Toowoomba to Boost Fertility Naturally

I have discussed various aspects of infertility in other pages on my website, so please click the links below for more information.

There are several natural substances that have a proven track record for boosting fertility rates without the use of powerful pharmaceutical medications.

For more information about those supplements please click this link.

As all medications carry the possibility of side effects, make sure that you discuss the possible side effects that you may experience with your healthcare provider.

1 – Clomid aka Serophene (Clomiphene citrate)

While Clomid aka Serophene is amongst the fertility drugs most often prescribed initially, there are several other medications like it.  Clomid causes the release of one or more eggs during the menstrual cycle. As a tablet, it is easy to take when compared to an injectable medication, and it is reasonable priced at around $100 for a 5-day course. This drug is usually taken early in the cycle, commonly commencing on Day 5 of the cycle.

The correct dosage needs to be established for each individual. Overstimulation is prevented by ultrasound and confirmation that ovulation has occurred should be checked during each cycle. Even when Clomid (or Serophene) is taken, sometimes no ovulation will occur during the treatment cycle. Patients who do not ovulate during the cycle may not experience the general symptoms of ovulation including the hormonal effects on breasts and fluid retention, and menstruation may not occur.

Fortunately, there is no specific evidence to confirm that the prolonged, controlled usage of clomiphene citrate has any problematic effects on the female. However, using this medication for longer than 12 months is not recommended. Further, there is no definitive evidence to show that its use has any adverse effects on the child born as a result of its use.

Clomid is successful for about 80% of couples, helping to achieve pregnancy within a 6-month period. Due to the fact that Clomid often causes the release of multiple eggs in a cycle, the likelihood of having twins is highly increased when taking this medication.

N-Acetyl Cysteine (NAC) – NAC may be useful for insulin resistance, reducing homocysteine levels, and improving fertility of Clomid-resistant women.  A study of 150 Clomid-resistant women with PCOS has shown that NAC appears to make Clomid more effective.  N-acetyl cysteine also reduces excess mucus production, which from a Traditional Chinese Medicine (TCM) point of view is beneficial for PCOS.

Acupuncture Treatment is as Successful as Clomid at Boosting the Pregnancy Rate in Females

In a recent research article Dr Chang reported “When you compare the pregnancy rates for an egg producing drug such as Clomid to acupuncture alone, the rates are equal — a 50% chance of pregnancy in three months for general patients — to those not undergoing IVF.”

Reference: http://www.webmd.com/infertility-and-reproduction/features/ancient-art-of-infertility-treatment

2 – Femara (Letrozole)

Letrozole (Femara) helps to stimulate ovulation in the same way as Clomid. Letrozole is dispensed in tablet form, and was originally approved by the FDA to treat post-menopausal women with breast cancer but is becoming more popular in off-label uses to assist with unexplained infertility and to stimulate ovulation.

Letrozole More Successful Than Clomid In PCOS

When women with PCOS are not ovulating regularly an OB/GYN will commonly prescribe Clomid to induce ovulation artificially which hopefully will allow conception to occur. A new drug – Letrozole – otherwise known as Femara is often used as first-line therapy for the same purpose by fertility specialists for a number of very valid reasons.
Femara is far less likely to dry the cervical fluids which are helpful to fertility by facilitating the sperm’s passage through the cervix, and also is less likely to thin the lining of the uterus which may also encourage conception. This factor is extremely important because most OB/GYNs simply prescribe Clomid with no ultrasound monitoring to check whether the uterus lining is adequate. Femara also has a lower risk of birth defects which is another good point in it’s favour.
A 2011 study (1) has discovered another good reason for using Femara in place of Clomid: in women with PCOS Femara improves the receptivity of the uterus lining making conception more likely. In a randomized controlled trial ten similar anovulatory women with PCOS and 5 fertile ovulatory women were studied; the women received 2.5 mg of letrozole on cycle days 3–7 (5 patients, 1 cycle) or 50 mg of CC on cycle days 5–9 (5 patients, 1 cycle). The study concluded that:
“Letrozole positively influences a number of markers of endometrial receptivity compared with CC (clomid Citrate).”
A further study (2) tested the effectiveness of Clomid on sixty four anovulatory women with PCOS who had failed to ovulate on 100 mg a day of Clomid. The women received either 150 mg of Clomid a day or 7.5 mg per day of Letrozole beginning on day three of their menstrual cycle.
Twenty (62.5%) of the women in the letrozole group and 12 (37.50%) of the women in the Clomid group ovulated during the observation period. The mean endometrial thickness at ovulation was a healthy 10.37 mm in the Letrozole group and the progesterone level averaged 10.09 ng/ml compared to only 13.09 ng/mL in the Clomid group. Thirteen of the women from the Letrozole group (40.63%) and only six women from the Clomid group (18.75%) became pregnant. The researchers concluded that:
“Letrozole has better ovulation and PR (pregnancy rates) in comparison to CC (Clomid) in patients with PCOS.”
A 2012 study (3) also found higher pregnancy rates in PCOS women when Letrozole 5 mg was used in place of clomiphene 100 mg. This study treated 103 women and discovered that those treated with Letrozole (51 women) had higher pregnancy rates 21.5% versus 7.8% in Clomid-treated women, the study concluded that:
“Our study shows that Letrozole has excellent pregnancy rates compared to Clomiphene citrate. Letrozole should be considered at par with Clomiphene citrate as first line drug for ovulation induction in infertile PCOS women.”
  • By seeing a fertility specialist earlier in your fertility journey you may be offered more progressive treatments such as Letrozole (Femara) and be offered more monitoring to check that your uterus lining is adequate.
  • When the lining is too thin a number of strategies can be used to thicken it so diagnosis is very helpful.
  • Another benefit of seeing a fertility specialist is that you are more likely to be offered an hCG trigger shot to induce ovulation, hCG itself is very helpful to fertility, boosting hormone levels in the luteal phase and helping to further thicken the uterus lining reducing the possibility of luteal phase defect.
1.Fertility and Sterility. 2011 Oct;96(4):1051-6.Clomiphene citrate versus letrozole: molecular analysis of the endometrium in women with polycystic ovary syndrome.
Wallace, Kedra L.1 ; Johnson, Venessia1; Sopelak, Victoria1; Hines, Randall1
2. Fertility and Sterility. 2009 Sep;92(3):853-7. Epub 2008 Jan 4.
Comparison of efficacy of aromatase inhibitor and clomiphene citrate in induction of ovulation in polycystic ovarian syndrome.
Begum MR, Ferdous J, Begum A, Quadir E.
3. J Hum Reprod Sci. 2012 Sep;5(3):262-5. doi: 10.4103/0974-1208.106338.
Clomiphene citrate or letrozole as first-line ovulation induction drug in infertile PCOS women: A prospective randomized trial.
Kar S.
REFERENCE: http://www.bellaonline.com/articles/art174266.asp/zzz

A 2005 Canadian study suggested that babies born after Femara use have a 3-fold risk for birth defects. Many researchers suggest that the study was flawed and inconclusive. Anyway, Letrozole is not prescribed as often as Clomid. Letrozole is generally only prescribed by a doctor when Clomid is not working.

3 – Follistim (Follitropin)

Follistim is a fertility medication that has activity similar to the hormone Follicle Stimulating Hormone (FSH). Unlike Clomid and Femara, Follistim is an injection, rather than a pill. Follistim is also used for women with ovulation problems, and is generally prescribed to women who are Clomid-resistant.

Women using Follistim must be closely monitored by sonogram and blood tests every 2-3 days. Follistim is very expensive costing about $550 per month of injections.

4 – Gonal F (Follitropin alfa)

Gonal F is one of the gonadotropin medications, and is a highly effective fertility medication that contains the active substance Follitropin alfa. Follitropin alfa is a synthetic form of the naturally-occurring follicle stimulating hormone (FSH) which is produced in the pituitary gland and stimulates the development of follicle in ovaries, which ultimately helps in creating mature eggs or oocytes. Gonal F is only suitable for females who are infertile due to a functional reason. It is not suitable for patients whose infertility is due to primary ovarian failure.

Women are prescribed this medication where there are problems associated with ovulation. The medication is also beneficial for the treatment of males with a low sperm count. Gonal F is prescribed for In Vitro Fertilization (IVF) procedures for the induction of ovulation.

Gonal F is supplied in a prefilled pen that allows patients to self-administer the injectable medication, which means that it is ready to use with no mixing and loading of the cartridges required. The required dosage can be easily adjusted by turning the dial which allows patients to inject the right amount of the medication, as per the prescription.

As Gonal F is a powerful gonadotropic substance, it may cause multiple births and Ovarian Hyperstimulation Syndrome (OHSS) in women. When mild OHSS develops, the ovaries are larger than normal, and are tender and fragile. High levels of estrogen and progesterone in the bloodstream may upset your digestive system and fluid balance causing abdominal bloating and feeling of fullness, nausea, diarrhoea and slight weight gain. When severe OHSS develops symptoms include fullness and bloating above the belly button, shortness of breath, the urine is darker and reduced or stopped, calf pains and chest pains, considerable abdominal bloating or distension and pain in the lower abdomen. If these symptoms develop, you should notify your doctor immediately, and may need to be assessed.

Gonal F is not suitable for women who are hypersensitive to FSH preparations. Taking the medication is contraindicated for certain medical conditions, including thyroid disease, tumours, asthma, ovarian cyst, primary ovarian failure or primary testicular failure.

5 – Puregon (Follitropin beta)

Similar to Gonal-F, Puregon is a synthetic form of Follicle Stimulating Hormone (FSH). Puregon is injected under the skin or into a muscle. Your ART specialist will prescribe one of these two medications to stimulate the ovaries to produce several oocytes. FSH directly affects the ovaries in women and the testicles in men.

Puregon Use in Females
In nature the ovaries produce and release only one mature egg each menstrual cycle (lunar month).

Where no ovulation occurs, the ovaries must be chemically “pumped up” to make enough follicles and eggs. Several different ovarian stimulation medication protocols have been developed. Commonly used stimulation protocols include injections of follicle stimulating hormone (FSH), or the chemical equivalent of FSH. In the ovaries in women, the naturally occurring hormone FSH increases the number of growing follicles and stimulates their development. Within the follicles are the developing eggs. FSH also increases the production of oestrogen, and under the influence of this hormone, the largest follicle continues to develop.

Follitropin beta (Puregon) has the same effects as the natural FSH hormone. Puregon is used to stimulate the development of follicles and eggs in women who are unable to fall pregnant naturally due to problems with ovulation. Puregon is used for women who have been unsuccessful when they tried treatment with Clomifene, e.g. Clomid.

When the follicle has developed appropriately, another medicine called human chorionic gonadotrophin (hCG), is given. This causes ovulation to happen.

Puregon can also be used to stimulate multiple follicles and eggs to develop in women undergoing IVF Procedures. The eggs are collected and fertilised with sperm in a test tube. All going well, the resulting embryo is then implanted in the womb.

Some patients are only treated with FSH.  However, most patients will also be medicated with one of the following medications in conjunction with the FSH injections – Cetrotide, Orgalutran, Lucrin or Synarel.

Cetrotide and Orgalutran are both gonadotropin releasing hormone (GnRH) antagonists and come as injectable medications. Lucrin and Synarel are both gonadotropin releasing hormone (GnRH) agonists. Lucrin is also an injectable, while Synarel (nafarelin acetate) is a nasal spray. Synarel decreases the secretion of sex hormones (oestrogen). All four of these medications act specifically on the pituitary gland to stop ovulation occurring before the oocyte retrieval stage, commonly called Oocyte Pickup (OPU), of an IVF Procedure.

In the “Down Regulation Protocol” Lucrin or Synarel medication is commenced during the mid-luteal phase, 7 days after ovulation has occurred. Then Lucrin or Synarel medication is continued daily for 10 days. A blood sample is taken to determine suitable hormone levels. If hormone levels are not adequate Lucrin or Synarel medication is continued until blood tests confirm the hormone levels are correct. At this stage the stimulation drugs (Puregon or Gonal-F) are commenced, concurrently with the Lucrin or Synarel medication.

Puregon Use in Males
Within male testicles, the hormone FSH is necessary for the production and development of sperm. Consequently, in males with low FSH hormone levels, Puregon is used to increase sperm production. Puregon is used along with human chorionic gonadotrophin (hCG), which increases testosterone levels in the testicles which allows the FSH to work more effectively.

6 – Bravelle (Urofollitropin)

Bravelle is another Follicle Stimulating Hormone (FSH) drug which provides the hormone FSH that stimulates the ovaries to produce eggs. Bravelle is usually used in combination with another hormone – human chorionic gonadotropin (hCG) to assist the growth and release of a mature egg (ovulation).

Human chorionic gonadotropin is extracted and purified from the urine of post-menopausal women.

Bravelle is also an injectable, like Follistim. Women on this treatment program also require close monitoring by their doctor via sonogram and blood tests. Similar to Follistim, Bravelle is very expensive, costing about $2,000 per cycle.

7 – Novarel (Chorionic Gonadotropin)

Novarel is a fertility medication that mimics Luteinising Hormone (LH) in your body. Novarel is prepared from the urine of pregnant women. It is another injectable medication, and is given after completing another medication (menotropins) which help to stimulate ovulation.

Similar to the other injectable medications, medicating with Novarel requires close monitoring, and is a lot more expensive than Clomid.

8 – Ovidrel® (Choriogonadotropin alfa injection)

Ovidrel® PreFilled Syringe (Ovidrel®) contains recombinant human choriogonadotropin alfa (hCG), an injectable hormone. Ovidrel® Stimulates late follicular maturation and causes the resumption of oocyte meiosis, and then initiates rupture of the ovarian follicle. In summary, this is the hormone that causes your eggs to finish maturing and then be released from the follicle. You may be given Ovidrel® to complete this final stage of your cycle.

The syringe contains 250 mcg of the active ingredient (choriogonadotropin alfa) in 0.5 ml of liquid. Each syringe contains the single dose needed. It is intended for injection only. It cannot be taken by mouth since the acids in your stomach would destroy the hormone before it was absorbed into the body.

Doctors specializing in infertility or reproductive health prescribe Ovidrel® to those women trying to have a child, but for a variety of reasons need medical assistance. After a thorough medical exam to determine your specific medical condition, your doctor may prescribe Ovidrel® because you require hormone replacement or supplementation as part of your treatment program.

Ovidrel® may be one of several drugs prescribed to a patient as part of a multifaceted treatment program.

In infertile women undergoing Assisted Reproductive Technologies (ART) and ovulation induction (OI), Ovidrel® should not be administered until adequate follicular development is indicated by serum estradiol and vaginal ultrasonography.

Ovidrel® administration should be withheld in situations where there is an excessive ovarian response, as evidenced by multiple follicular development, clinically-significant ovarian enlargement or excessive estradiol production.

9 – Metformin hydrochloride (Glucophage)

Metformin (Glucophage) is an insulin-sensitizing biguanide that was originally developed to treat elevated blood glucose levels in people with type 2 diabetes. It is now commonly prescribed as an off-label prescription for women with Polycystic Ovarian Syndrome (PCOS) because it has similar actions in both groups. Many women prescribed Metformin develop gastrointestinal side effects such as diarrhoea, gas and bloating, abdominal discomfort, nausea, and vomiting, and must stop taking it.

Thirty percent of people receiving long-term Metformin therapy develop Vitamin B12 malabsorption, which could potentially lead to anaemia.  Several contraindications for using Metformin include liver disease, alcoholism, compromised renal function, hypoxic conditions, and moderate to severe infections.

Women with PCOS are often insulin resistant, whereby the ability of their cells to respond to the action of insulin in transporting glucose (sugar) from the blood stream into muscle and tissue is diminished. Metformin increases the cell’s correct response to insulin, and helps move glucose into the cell. Subsequently, your body does not need to make as much insulin.

If you are having an IVF procedure and having acupuncture treatment simultaneously, once you reach the implantation stage it’s absolutely imperative to have a pregnancy test before proceeding with more acupuncture treatments. Also, if you are trying to fall pregnant on your own, it is equally essential to have your pregnancy verified by an obstetrician as soon as possible. The reason for this is that some of the same acupuncture points used to stimulate the uterus and increase fertility may also cause a miscarriage. Subsequently, your acupuncturist needs to know if you are pregnant, or could possibly be pregnant.

10 – Endometrin® (progesterone)

Endometrin® (progesterone) is a vaginal insert that contains the hormone progesterone, one of the hormones essential for helping you to become and to stay pregnant. Endometrin is for women who need extra progesterone while undergoing treatment in an Assisted Reproductive Technology (ART) program. The requirement for Progesterone usage is often signalled where there have been several miscarriages. Your doctor will give you a blood test to check your progesterone levels, and if they are too low, then the medication is indicated. Endometrin should not be used if are allergic to anything in Endometrin, have unusual vaginal bleeding that has not been evaluated by a doctor, currently have or have had liver problems, or if you have or have had blood clots in the legs, lung, eyes, or elsewhere in your body.

Progesterone can increase your chance of getting blood clots. Blood clots can be serious and lead to death. Serious blood clots include those in the legs, lungs, eyes, heart, and brain. You should call your doctor and get medical help immediately if you have: persistent lower leg pain, sudden shortness of breath, coughing up blood, sudden blindness (partial or complete), severe chest pain, sudden severe headache, vomiting, dizziness, or fainting, weakness in an arm or leg, or trouble speaking, yellowing of the skin and/or white of the eyes indicating possible liver problems.

11 – Clexane (Enoxaparin sodium)

Factor V Leiden may cause recurrent miscarriages through an increased risk of blood clots at the tiny blood vessels feeding the pregnancy. Therefore, the key to treatment is to use medications that decrease this clotting. The injectable medication Clexane is one of a group of medicines called low molecular weight heparins (LMWH) that work by reducing blood clotting activity. You should not use Clexane if you have an allergy to Clexane, heparin or its derivatives including other LMWHs. Some signs and symptoms of an allergic reaction can include swelling of the face, lips or tongue, wheezing or troubled breathing, skin rash, itching hives, blisters or peeling skin.

Like most LMWHs, Clexane is generally not recommended to be used during pregnancy. However, in the case of using Clexane to treat Factor V Leiden during your pregnancy to prevent miscarriages, your doctor or pharmacist will discuss with you the benefits and risks of using it.

An article in the Australian and New Zealand Journal of Obstetrics and Gynaecology reported that Factor V Leiden has been found in a significant number of cases of obstetric complications attributable to placental thrombosis. The number of women developing miscarriages, intrauterine deaths, or infertility problems among 128 Leiden mutation carriers was compared with the number among 461 controls. The risk of having at least one miscarriage or infertility problems was 1.5 times greater for Leiden mutation carriers than controls. This result was statistically significant. The risk of having at least two miscarriages or infertility problems was 2.5 times greater for Leiden mutation carriers than controls. This was also statistically significant.

Reference: Aust N Z J Obstet Gynaecol. 2000 May;40(2):186-90.

12 – Luveris 75 IU

One vial contains 75 IU of lutropin alfa (recombinant human Luteinising Hormone {r-hLH}). Lutropin alfa is produced in genetically engineered Chinese Hamster Ovary (CHO) cells.

Luveris in association with a Follicle Stimulating Hormone (FSH) preparation is recommended for the stimulation of follicular development in adult women with severe Luteinising Hormone (LH) and FSH deficiency. In clinical trials these patients were defined by an endogenous serum LH level <1.2 IU/l.

In LH and FSH deficient women, the objective of Luveris therapy in association with FSH is to develop a single mature Graafian follicle from which the oocyte will be liberated after the administration of human chorionic gonadotropin (hCG). Luveris should be given as a course of daily injections simultaneously with FSH. Since these patients are amenorrhoeic and have low endogenous oestrogen secretion, treatment can commence at any time.

Treatment should be tailored to the individual patient’s response as assessed by measuring follicle size by ultrasound and oestrogen response. A recommended regimen commences at 75 IU of lutropin alfa (ie. one vial of Luveris) daily with 75-150 IU FSH.

In clinical trials, Luveris has been shown to increase the ovarian sensitivity to follitropin alfa. If an FSH dose increase is deemed appropriate, dose adaptation should preferably be after 7-14 day intervals and preferably by 37.5 IU-75 IU increments. It may be acceptable to extend the duration of stimulation in any one cycle to up to 5 weeks.

When an optimal response is obtained, a single injection of 250 micrograms of r-hCG or 5,000 IU to 10,000 IU hCG should be administered 24-48 hours after the last Luveris and FSH injections. The patient is recommended to have coitus on the day of, and on the day following, hCG administration. Alternatively, intrauterine insemination (IUI) may be performed.

Luteal phase support may be considered since lack of substances with luteotrophic activity (LH/hCG) after ovulation may lead to premature failure of the corpus luteum.

If an excessive response is obtained, treatment should be stopped and hCG withheld. Treatment should recommence in the next cycle at a dose of FSH lower than that of the previous cycle.

Luveris is intended for subcutaneous use. The first injection of Luveris should be performed under direct medical supervision. The powder should be reconstituted immediately prior to use with the solvent provided. Self-administration of this medicinal product should only be performed by patients who are well-motivated, adequately trained and with access to expert advice.

Reference: http://www.medicines.org.uk/emc/medicine/8289/SPC

Accupuncture, Acupunture or Accupunture common misspelling

Note that “Acupuncture” is often misspelt as accupuncture, acupunture or accupunture, that is with either too many c’s or not enough c’s. I would love to be able to clear up this very common spelling mistake, and set the record straight.

Ac·u·punc·ture – pronounced ak-yoo-puhngk-cher; Origin: 1675–85; < Latin acū with a needle (ablative of acus  needle) or acu- (as combining form of acus ) + puncture.

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