Fertility Medication

Suppression Medication

Ovulation suppression or downregulation is usually the first stage of a high stimulation IVF protocol – medication is used to shut down the natural menstrual cycle. It can take around 2.5 - 4.5 weeks. Some IVF cycles don’t need downregulation.

GnRH agonist medication

Lupron (leuprolide) / Buserelin (taken as a daily injection) or Synarel (nafarelin) (taken as a nasal spray twice a day). It acts slowly, taken before gonadotropins start. Used in long protocols of down regulation. It floods the body with ‘fake’ GnRH, ovaries become overwhelmed and production of LH and FHS stop.

GnRH antagonist medication

Ganirelix Acetate Injection or Cetrotide, which acts fast, taken a few days after gonadotropins. The antagonist binds to the receptor on GnRH and inhibits LH and FSH production, has no flare effect, shortens the IVF process, therefore requiring less medication and injections. Used in short protocols of down regulation. Antagonists are as effective as agonists, but require less time and are easier to use.

Stimulation Medication

Stimulation medication is used to stimulate the ovaries to develop and mature several follicles at the same time.

Gonadotropins

FSH (Follistim, Gonal-f, and Bravelle): All FSH preparations require injections, that start on day 2, 3, or 4 at 75 IU (international units) to 225 IU or more per day. Dosage may be adjusted as the cycle progresses. This will be determined through blood (measuring oestrogen levels) and ultrasound monitoring (measuring follicular growth)

FHS + LH (Menopur, Repronex, hMG): contain equal amounts of both FSH and LH. Doctors often prescribe these medications because they have LH activity, and it is thought that LH is essential to the follicles ability to produce oestrogen. Given by subcutaneous injection once or twice a day. Doses vary depending on patient response and type of treatment.

Side effects of gonadotropins are generally minor but may include discomfort at the injection site, headaches and fatigue.

Clomiphene

Clomiphene or clomid is used to induce ovulation, to correct irregular ovulation, to help increase egg production, and to correct luteal phase deficiency. Clomiphene triggers the hypothalamus and pituitary gland to release GnRH (gonadotropin releasing hormone), FHS and LH. These hormones will trigger the ovaries to develop more eggs. Common dosage: dose between 50mg to to the maximum dose of 200mg daily. Side effects: include hot flashes, blurred vision, nausea, bloating, and headache.

Letrozole

Letrozole or Femara is increasingly used to induce ovulation. It is as safe as clomiphene. Among women with PCOS, especially those with obesity, letrozole may work better. A 2014 study found that 27.5 percent of women with PCOS who took letrozole eventually gave birth, compared to 19.1 percent of those who took clomiphene.

Trigger Medication

Trigger medications are used to mimic the activity of the LH surge and stimulate the final stages of egg maturation and the release of the egg from the follicle. This is a timed medication, that must be taken 36 hours before the egg collection procedure. The clinic will tell you at what time the injection must be taken. It is usually late at night. The egg collection will happen before the eggs are ovulated.

Although both hCG and Lupron trigger egg maturation prior to egg retrieval, Lupron can only be effective if the antagonist is used earlier during IVF stimulation. Lupron will not trigger egg maturation if used earlier for down regulation. Therefore, Lupron can effectively trigger maturation only if the antagonist is used earlier during the IVF stimulation.

Human chorionic gonadotropin – hCG

HCG is a common trigger medication since the early 80s

Lupron

Lupron started to be used in the early 90’s, to trigger egg maturation while minimizing or eliminating the side effects of hyperstimulation. It has gained popularity as a single higher dose (4mg) with supplementation of oestrogen and progesterone after egg collection.

Supporting Endometrium

Progesterone production is generated by the corpus luteum, and is essential for helping maintain a pregnancy. Doctors usually prescribe progesterone after the egg retrieval to prepare the uterine lining for embryo implantation. If pregnancy is confirmed, progesterone is often continued for the first 6-12 weeks post pregnancy. It can be taken as an injection or vaginal pessary