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IVF Medications
There
are a number of different types of medications that may be used to increase the number of eggs which develop to maturity in
women undergoing in vitro fertilization (IVF). The specific medications, the dose of those medications, the times at which
they are administered, and the duration of the treatment vary markedly from patient to patient and are based on their individual
needs.
GnRH Agonists
- Lupron, taken as an injection just below the skin and Synarel, a nasal spray are two agonists. An agonist inhibits your pituitary’s production of FSH and LH.
This allows some of the other medications to provide a very even and balanced stimulation to the developing follicles.
Lupron will allow patients to produce greater numbers of higher quality eggs during a given treatment cycle. Additionally,
it prevents a spontaneous midcycle hormonal surge which may result in cycle cancellation.
Antagonists
- Antagon and Cetrotide are antagonists of gonadotropin releasing hormone (GnRH) and are used to prevent premature ovulation.
These medications are given by injection and the duration of treatment is usually three or four days.
Gonadotropins
- Gonadotropins are taken as subcutaneous injections that provide stimulation to the follicles that contain the eggs
during the stimulation phase. Gonal F, Bravelle, Follistim, Pergonal and Repronex are the most commonly used gonadotropins.
Gonal F, Follistim, or Fertinex
These
are highly purified preparations of follicle stimulating hormone (FSH) which are taken as subcutaneous injections. The FSH
provides the critical stimulation to the follicles containing the eggs that are developing during the stimulation phase of
the cycle.
Repronex
A highly purfiied
preparation of follicle stimulating hormone (FSH) and lutenizing hormone (LH) which is taken as a subcutaneous injection.
It is similar to Gonal F, Follistim and Fertinex but it also contains some LH. This may allow some (but not all) patients
to respond somewhat faster and produce somewhat higher estrogen levels.
HCG- hCGs are taken as an
intramuscular injection and are used to induce the final maturational changes in the eggs and prepare them for retrieval.
The most commonly prescribed hCGs are Pregnyl, Profasi and Novarel. NOTE:
After receiving this medication you will have a positive pregnancy test for the following 10-12 days (whether you are pregnant
or not). Do not be misled by the results of a home pregnancy test!
Doxycycline - Doxycycline, an antibiotic administered in pill form, which is a tetracycline
derivative given to the male partner during the wife’s stimulation cycle. This antibiotic is given orally and is used
to reduce the low levels of bacteria that may be found in the semen (even in men without symptoms or any other evidence of
infection) and which may compromise the performance of the sperm during an IVF cycle. It is also given to the female partner
to reduce the risk of infection following aspiration of the follicles at the time of egg retrieval.
Medrol -
Medrol is a steroid hormone given daily, typically for a period of four days during the cycle, to transiently
suppresses immune function to assist pre-embryo implantation.
Progesterone - Natural progesterone normally taken as a daily intramuscular injection beginning 2 days following egg retrieval and
continues until the placenta is making adequate amounts of progesterone. (Progesterone injections will be discontinued following
your serum pregnancy test if it is negative). Depending on the protocol, progesterone can also be given in the form a vaginal
gel (Crinone) or suppositories or pills (Prometrium) given vaginally. | |
SIDE EFFECTS OF GONADOTROPINS
There are many types of
gonadotropins used alone or in combination for ovulation induction. They include hMG (human menopausal
gonadolropin, PergonalŽ, or Humegon|M), hFSII (human follicle stimulating hormone, MetrodinŽ), and UCG (human chorionic gonadolropin, ProfasiŽ,
APLŽ, or PregnylŽ). During the use of these drugs careful monitoring is required to minimize the risk of side effects, discussed below.
1) Ovarian Hyperstinulation (OIISS). Occurring in I to 5 percent of cycles, the chance of OHSS
is increased in women with polycyslic ovarian syndrome and in conception cycles. When severe, it can result in blood clots, kidney damage, ovarian
twisting (torsion), and chest and abdominal fluid collections.
In severe cases, hospitalization is required for monitoring but the condition is transient, lasting only a week
or so. Occasionally, drawing fluid out of the chest
or abdominal cavity helps. The best prevention is to not give hCG to induce ovulation at the end of an overly vigorous stimulation cycle.
2) Multiple Gestation. Up to 20 percent of pregnancies resulting from gonadotropins
are multiple, in contrast to a rate of 1 to 2 percent in the general population. While most of these pregnancies are twins, a significant percentage
are triplets or higher. High order multiple gestation pregnancy is associated with increased risk of pregnancy
loss, premature delivery, infant abnormalities, handicap due to the Consequences of very premature delivery, pregnancy induced hypertension,
hemorrhage, and other significant
maternal complications.
3) Ectopic (Tubal)
Pregnancies. While ectopic pregnancies occur 1
to 2 percent of the time, in gonadotropin cycles the
rate is slightly increased
at I to 3 percent. These can be treated with medicine or surgery. Combined lubal and inlrauterine pregnancies
(heterotropic pregnancies) occasionally occur with hMG and need to be treated with surgery.
4) Birth Defects. The rate of birth defects after gonadotropin cycles is no higher than in the general
population, at 2 to 3
percent. Furthermore, these children are developmentally no different than their peers.
5) Adnexal Torsion (Ovarian Twisting).
Less than 1 percent of the time, the stimulated ovary
can twist on itself, cutting off its own blood supply. Surgery is required to untwist or
even remove it.
6) Gonadotropins and Ovarian Cancer.
The risk of ovarian cancer seems in part related to the number of times a woman ovulates. Infertility increases
this risk; birth control pill use decreases it. Controversial data exists that associate ovulation stimulation
drugs like gonadotropins
to the risk of future ovarian cancer. While research is
underway to help clarify this issue, the careful use
of gonadotropins is still reasonable, especially considering thai pregnancy and breast feeding reduce cancer risk.
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