Medications Commonly Used During the IVF Cycle
After a series of diagnostic tests are performed on the patient or couple, the in vitro fertilization process generally begins with medications used to prevent natural ovarian stimulation and ovulation. These medications allow the physicians to control and optimize ovarian stimulation.
Depending on the protocol prescribed, Lupron is often the first medication used in the IVF cycle. Lupron temporarily suppresses pituitary and ovarian hormone production and prevents ovulation from occurring prior to oocyte retrieval. This medication is generally started one week before the next expected period and continued until two days prior to the egg retrieval. The most common side effects of Lupron include hot flashes, vaginal dryness, and irritability. These side effects last a few days only, and typically disappear or lessen once gonadotropins are started.
Gonadotropins stimulate the development of multiple ovarian follicles so that multiple eggs can be retrieved from the ovaries. Gonadotropins consist of a mixture of the natural hormones FSH (follicle stimulating hormone) and LH (luteinizing hormone), or contain FSH alone. Commonly used gonadotropin preparations include Repronex, Gonal F, Follistim, Bravelle, and Menopur. Of these, only Repronex can be injected either under the skin (subcutaneously) or into the muscle (intramuscularly). All others can only be injected subcutaneously.
One or more gonadotropin preparations are administered at about the same time each night (between 7-9 pm). Some patients inject medications twice per day (12 hours apart). When gonadotropins are started, the daily Lupron dose may be decreased. Side effects of gonadotropins may include bloating, abdominal distention, nausea, breast tenderness, and fatigue.
Antagon or Cetrotide
These medications, known as gonadotropin-releasing hormone antagonists, are not used in all cycles. Like Lupron, they suppress pituitary and ovarian hormone production and prevent premature ovulation. These medications are administered by subcutaneous injections and are generally not started until the largest follicle is 12-14 millimeters in size.
Human Chorionic Gonadotropin Hormone (HCG)
This medication has various brand names, including Pregnyl, Profasi, Novarel, or Ovidrel. HCG induces the final maturity of the egg and initiates release of the eggs from the follicles. Pregnyl, Profasi, and Novarel are given intramuscularly. Ovidrel is given subcutaneously. The egg retrieval is scheduled approximately 34 to 36 hours after the injection, before the actual release of any eggs.
Progesterone is a hormone essential for establishing and maintaining pregnancy. Progesterone may be administered in a few different forms including vaginal suppositories, intramuscular injections and oral preparations. While progesterone injections are often uncomfortable, the scientific literature reports that intramuscular injection is the most efficacious delivery method.
Doxycycline or another antibiotic is routinely given the night before the egg retrieval to possibly minimize the risk of infection.
Medrol is a steroid hormone commonly used in IVF cycles. While the actual benefit of Medrol has not been established, it may help prevent the body from rejecting the transferred embryos.
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