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Follicle stimulating hormone (FSH) or follitropin is a gonadotropin type hormone produced by the human body. It is a glycopolypeptide which is synthesized and secreted by gonadotroph cells from the anterior part of the pituitary gland.
FSH regulates pubertal maturation and it stimulates the maturation of oocytes in the ovary and the production of estradiol (estrogenic hormone) in women. It regulates the production of sperm in men.
There are human follitropin preparations (urofollitropin from human menopausal gonadotropin (HMG)) while others are obtained from recombinant engineering (follitropin alpha, beta and delta and Corifollitropin alfa) with similar effectiveness and uses (Weiss 2019, Taketani 2010, Baker 2009).
FSH or follitropin is commonly used alone or together with luteinizing hormone (LH) in infertility treatments to induce ovulation in anovulatory patients who do not respond to clomiphene and to stimulate the development of multiple follicles (ovarian hyperstimulation) in ovulatory patients during assisted reproduction protocols.
Human chorionic gonadotropin hormone (HCG) is usually administered afterwards to trigger ovulation.
Subcutaneous or intramuscular administration is given daily in one dose and is followed by an ovarian ultrasonographic evaluation or by a measurement of urinary estrogen after 10 to 35 days, depending on the indication.
At date of this last update we did not find published data regarding its excretion in breast milk.
Due to its high molecular weight it is very unlikely to be excreted in breast milk.
Due to its glycoprotein nature it is inactivated in the gastrointestinal tract without being absorbed (oral bioavailability practically null). This hinders or prevents the passage to infant plasma from ingested breast milk, except in the case of premature babies and during the immediate neonatal period, in which there may be greater intestinal permeability.
It is not proven that its estrogenic effect decreases milk production.
LACTATION AND INFERTILITY TREATMENTS
In assisted reproduction treatments (ART) for infertility, two issues must be taken into account:
1. The possible effects of ART on the infant or lactation.
The medications generally used do not interfere with breastfeeding and do not affect the infant. Also, during this treatments, lactating children tend to be older than 6 months and usually above 1 year of age.
2. Possible interference of breastfeeding with ART.
Breastfeeding, especially when its frequent, could hinder ovulation. Treatments tend to be financially and emotionally costly and therefore assisted reproduction services usually recommend suspending breastfeeding before starting any treatment protocols.
To date there is no published data showing that breastfeeding is incompatible with assisted reproduction techniques (ART).
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