There are numerous, perfectly valid medications and therapies that are not mentioned here. Do not be discouraged if you do not see something mentioned.
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Synthroid money saving tips and coupon
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CLOMID (clomiphene citrate)
ORAL
Clomid is used for the induction of ovulation, and frequently for women with disorders like PCOS and anovulation (anovulation: absence of ovulation or failure to ovulate). Please note that while Clomid is among the most common prescribed fertility meds, this does not mean it is for everyone. For example, it is not generally effective for women over age 40. Only women with specific symptoms and/or disorders should take Clomid, as indicated by a doctor. Please be sure your doctor does proper testing (bloodwork, sperm analysis, and HSG at a minimum) before jumping to treatment. Clomid cycles should be monitored with blood work and ultrasound to prevent complications with your health, and to avoid risk of High Order Multiples (HOM).
Clomid works through a complex interaction of brain chemistry and glandular hormone production. In short, clomid induces ovulation by affecting the brain/pituitary gland and by impacting key reproductive hormones that facilitate ovulation. Clomid works through the following contiguous steps (though this is a bit oversimplified):
- Clomid is taken early in the cycle as prescribed by your doctor.
- Clomid sends a message to the brain that estrogen levels are low.
- This causes the brain to release more GnRH, a hormone.
- This tells the pituitary gland to make the hormone follicle stimulating hormone (FSH) and luteinizing hormone (LH).
- FSH stimulates the development/maturation of the follicle or egg. LH is the hormone that facilitates ovulation.
- Ovulation is the release of the egg: Hence, clomid "induces" ovulation.
Side effects: hot flashes, abdominal or pelvic pain and/or bloating, upset stomach and vomiting, breast tenderness, headache, spotting between periods, change in vision, vaginal dryness, insomnia, nervous tension, and lightheadedness.
FEMARA / LETROZOLE
ORAL
In many fertility centers, clomiphene citrate (Clomid) has been the drug of first choice for either ovulation induction or superovulation for many years. In general, it has been a relatively effective medication. However, Clomid lasts for a long time in the body and may therefore have an adverse effect on the cervical mucus and uterine lining. Some groups of patients, such as women with PCOS, do not respond well to Clomid.
One of the earliest studies using letrozole as a fertility drug looked at 12 women with inadequate response to Clomid. Ovulation on letrozole occurred in 9 of 12 cycles and 3 patients conceived. A later study by the same investigators compared the effects of letrozole to those of Clomid. This time 19 women were studied. Ten women received Clomid and nine women received letrozole. This study was unable to demonstrate any difference in the number of women who ovulated, the number of eggs that developed in each woman, or the thickness of the uterine lining during treatment. However, a more recent study by a different group of investigators found that compared with Clomid, letrozole is associated with a thicker uterine lining and a lower miscarriage rate.
Side effects: headache, hot flashes, and breast tenderness.
GONADOTROPINS
INJECTABLE, SUBCUTANEOUS (SOMETIMES INTRAMUSCULAR)
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are necessary for egg production. Early in the menstrual cycle, a woman with low hormone levels who is not ovulating can have daily human menopausal gonadotropin (hMG) or recombinant human FSH (rFSH) injections for an average of 12 days. If this helps develop mature follicles, the ovary is ready to ovulate. One dose of human chorionic gonadotropin (hCG) is then used to stimulate ovulation.
Gonadotropins differ for oral medications in that FSH is directly administered into your system. Oral medications (Clomid/Femara) trick your body into producing more FSH of it's own. They work in completely different ways, and you cannot compare oral medication cycles to injectable cycles without considering the method of action.
In women Gonadotropins may be used:
- To stimulate ovulation related to low natural gonadotropin or estrogen levels. (This is most commonly seen in women with excessive exercise or eating disorders.)
- When clomiphene alone or clomiphene combined with another medicine has been ineffective for correcting irregular or no ovulation caused by PCOS.
- For developing multiple egg follicles on the ovaries. Multiple eggs are harvested and used in assisted reproductive techniques such as in vitro fertilization or gamete intrafallopian transfer.
- In combination with IUI for couples with unexplained infertility when clomiphene has not worked.
Side effects: OHSS, headache, abdominal pain, ovarian enlargement and tenderness. In men it may increase breast size.
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There are several brand names for this injectable medication including Gonal-F, Repronex, Menopur, Follistm, Bravelle, Luveris.
Video links on administering the shots:
Gonal-f Pen
Gonal-f Vial
Follistm Pen
Menopur (also, You Tube VIDEO)
Ferring Fertility video training guides
(BRAVELLE/MENOPUR/REPRONEX/NOVAREL)
hCG (TRIGGER)
INJECTIONS, INTRAMUSCULAR
Human chorionic gonadotropin (hCG) is a hormone closely similar in its biologic effect to LH, which induces ovulation, and is taken once testing indicates the oocytes on the ovaries are ready to be released. It performs two functions: structural changes inside the eggs to make them able to be fertilized and expansion of the fluid inside the follicles (egg sacs) that would eventually lead to rupture and ovulation. Ovulation normally occurs between 36-42 hours after HCG administration. Follow your doctors instructions closely as to how much, and when to administer.
In the event that you may be at risk for OHSS, your trigger may be at a lower dose, or Lupron may be substituted.
Brand names for hCG include Ovidrel, Novarel and Pregnyl, as well as generic versions.
Side effects: redness, bruising and tenderness in the injection site, nausea, vomiting.
Video instructions:
Ovidrel
Novarel
GANIRELIX AND CETROTIDE (ANTAGONISTS)
INJECTABLE, SUBCUTANEOUS
These both block the effects of the naturally occurring gonadotropin-releasing hormone (GnRH). GnRH controls the release of another hormone, luteinizing hormone (LH), which induces ovulation (release of an egg from the ovary) during the menstral cycle. During hormone treatment for ovarian stimulation, premature ovulation may lead to eggs that are not suitable for fertilization. Both Ganirelix (premixed syringes) and Cetrotide (vials) are used to prevent premature ovulation during controlled ovarian stimulation.
LUPRON (leuprolide acetate) (ANTAGON)
INJECTABLE, SUBCUTANEOUS
Is an analog of gonadotropin releasing hormone (GnRH). When given as a subcutaneous (just below the skin) injection, it will stimulate the "turning-off" of your pituitary gland. We are able to take advantage of the suppressive actions to improve the recruitment of multiple follicles and prevent premature ovulation. Room temperature storage is advised. Be sure not to keep each vial past the expiration date. One vial will provide approximately four weeks of injections.
Side effects: Hot flashes may be felt when your estrogen level lowers and will disappear when you begin gonadotropin injections. Occasionally, patients experience headaches as well.
BIRTH CONTROL PILLS (BCP)
For IVF It has become popular in some centers, to place all women on birth control pills as the start of an IVF cycle. This may be fine for women with a lot of eggs but it does not work very well for the women with fewer eggs. Birth control pills are used to help coordinate the start of an IVF cycle so that the egg retrieval procedures of a group of women will occur at roughly the same time, making it easier for the doctors and laboratory. For the women with fewer eggs however, the suppressive effects of the birth control pills can limit the number of eggs that are retrieved and leads to the use of much more medication in the process.
For Cysts If you have a functional cyst that is larger in size and causing some symptoms, birth control pills may be prescribed. The purpose of birth control pills is to alter your hormone levels so the cyst will shrink. Birth control pills will reduce the probability of other cysts growing.
ANTIBIOTIC (Doxycycline, Tetracycline, Keflex)
Generally only the woman will take antibiotics. When performing the procedure to retrieve the eggs, a needle is placed through the vaginal wall and into the abdominal space. Antibiotics minimize the risk of an infection due to this puncture, as fevers are not good for developing embryos. If men have an infection documented on semen analysis, they may be treated with antibiotics.
Side effects: stomach upset, allergic reactions (hives, itching, swelling) vaginal yeast infections in women.
PROGESTERONE
INJECTIONS, INTRAMUSCULAR; SUPPOSITORIES
This hormone will act upon the lining of the uterus (the endometrium) to make it receptive for embryo implantation. As part of the egg retrieval process, progesterone-producing cells are removed along with the follicular fluid and oocytes, making the ovaries unable to produce progesterone sufficiently. Progesterone is vital for endometrial development and continued embryo support. Typical administration is intramuscular injections or suppositories, or a combination of both.
Progesterone and IVF
Other uses for progesterone
Side effects: Breast tenderness, soreness at the injection sites, delayed onset of your period (even in the absence of pregnancy)
PRE-NATAL VITAMINS
Studies have shown that increasing the intake of folic acid prior to conception helps to decrease the chances of certain spinal-cord-defects in babies. It is also a good idea from a general health point of view to be on these multi-vitamins, prior to and throughout pregnancy.
Side effects: Stomach upset, nausea, constipation
METHYLPREDNISOLONE (Medrol)
This steroid hormone is sometimes taken in conjunction with the Embryo Transfer, often with procedures like Assisted Hatching. It is taken to suppress any inflammatory reaction that might occur between the embryo(s) and the endometrial lining.
Side effects: Fluid retention
LOW-DOSE ASPIRIN
A very high blood level of estrogen, which will result from the gonadotropin drugs, can have the potential effect of increasing the coagulation factors in the bloodstream (especially in the small vessels that supply the uterus and ovaries). Aspirin, in low doses, will decrease the effects of those clotting factors, and in turn, increase blood flow to the tissue.
Administration: 1 (80mg) tablet, by mouth, per day.
Side effects: Stomach upset, prolonged bleeding time
DEXAMETHASONE (Decadron)
Patients who are found to have an immunologic problem (presence of certain antibodies) that could be potentially affecting their fertility will be given a course of this steroid medication. Steroids work by suppressing the body’s response to detected antibodies.
Side effects: Reported side-effects normally occur only at higher doses, and when taken for extended periods of time
ESTROGEN
ORAL, SUPPOSITORY, OR PATCH
Estrogen helps maintain the endometrial lining of the uterus. While some early studies have shown that patients taking both progesterone and estrogen supplements during an IVF cycle after the egg retrieval have higher clinical pregnancy rates, newer studies seem to dispute this. However, as more research is still needed to study this, some Reproductive Endocrinologists (REs) prescribe estrogen supplements to help support the growth of the endometrium.
Can also be used as part of Estrogen Priming Protocol for IVF.
Information and Video Instruction
http://www.villagefertilitypharmacy.com/medications-and-video-injection-lessons
http://www.nyufertilitycenter.org/ivf/injections
http://ivfshootemup.blogspot.com/
Tips
http://twincranes.wordpress.com/tag/injections-for-ivf/
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EMD 3.19.2011
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