Medications in Assisted Reproduction
The medication prescribed in a fertility treatment is usually a step during the period of ovarian stimulation or assisted reproduction.
And it is that undergoing fertility treatment is not something that you usually want too much. The process implies a lot of stress, both physical, emotional and also economic, so it is common to have doubts and some anxiety because it ends (well).
Much of the success depends on proper preparation and precise timing. Although there are always things that we can contribute to create the best possible conditions (food, exercise, stress control) there are other aspects that are beyond our control.
One of these elements is medication for assisted reproduction. It is the clinics that are in charge of prescribing the medications at all times. The feeling of not knowing, of depending on others, of being afraid of the unknown can cause women some discomfort.
What am I taking? So that? Why do I have to poke myself? When how where? Am I doing it right? Will it hurt? Will it have risks to my health? Will I be able to do it? What if I forget to take something?
The importance of medication guidelines in fertility treatments
Despite the fact that for the woman who is undergoing fertility treatment this will be a very important part of her life (if not the most important thing at that moment), there are times when a dose can be forgotten, a dosage change, etc. In some cases this is really important, in others not so much.
While protocols may differ slightly from clinic to clinic, They have a lot in common.
In this article we review the medications that are usually used during assisted fertility processes in a simple way without going into in any case if it is the appropriate treatment or not, this must be assessed by the health professional, customizing your treatment at all times. Here you will find a guide, not any recommendation.
Understanding always brings serenity. And that is something that you, as a woman, need right now. And if after reading this article you still have doubts, ask the professionals of the chosen clinic without fear.
Types of protocols in ovarian stimulation
The long and short protocols are nothing more than different treatment plans used to stimulate the ovaries of women in order to get more eggs in a cycle than would be normal for a woman. Depending on the characteristics of each woman, the professional chooses a long or short protocol with the ultimate goal of collecting the largest number of eggs and of the best possible quality.
long protocol
The long protocol that, as its name indicates, extends more in time. For about four weeks, the woman will have to take certain medication that stimulates follicular maturation. This protocol begins in the cycle prior to the one in which the ovarian stimulation is to be performed, that is, a period will come in between.
short protocol
This is the most commonly used protocol. As its name indicates, it is a protocol that does not last long, which is why it is called short. In this case, the woman will start treatment after the period, about 3, 4 or 5 days as directed by the medical professional.
Medication during assisted reproduction treatment
We are going to detail which medications are used, when and for what purpose, depending on the phases of assisted reproduction treatment you are in.
Medication before starting stimulation.
Examples: Buserelin, Cetrotide, Procrin, Orgalutran, Decapeptyl, or Synarel.
Before going on to explain the medication for an in vitro fertilization (IVF) process, it must be taken into account that it will always be necessary to carry out a personalized study of each patient.
The type of response depends on many factors that must be taken into account. In fact, using a similar protocol, women may have a very different response. The age of the woman, the ovarian reserve, the functioning of the ovaries, the basal hormonal levels, liver health, etc. condition the final response.
For this reason, many times the treatments are accompanied by a directed cycle, that is, a specific medication to artificially but more accurately control the reproductive functioning of the woman.
Thus prevent spontaneous ovulation or ovulation too early for what is expected, which could complicate the process.
For this purpose there are two options:
- "Trick" the brain by taking synthetic hormones. These are similar to the hypothalamus hormones that regulate the release of other hormones to ovulate (GnRH hormone agonists). The brain understands that there are already enough of this type of hormones and stops producing its own. In this way, the ovary works exclusively with hormones that are supplied from the outside. This allows the woman's cycle to be controlled precisely. They can also be applied as a nasal spray.
- Suppressing the peak of a certain hormone that is responsible for triggering ovulation (LH hormone). It is done with artificial hormones with a function opposite to the order given by the hypothalamus (GnRH antagonists). These antagonists can also be recommended at the end of the stimulation process, if there is a risk that the woman will ovulate spontaneously.
The choice of the use of agonists or antagonists of the GhRH hormone depends on the doctors and the decision is made based on the characteristics of each woman. The means to administer this mediation is usually through injections.
This process is called down regulation and basically puts the body in a temporary state like menopause. Although it is possible that there may be some side effects similar to those of menopause, it is for such a short period of time that sometimes it is not even noticeable.
As soon as it is controlled when the woman ovulates, she goes to the next step: ovarian stimulation.
Medication at the beginning of stimulation
Example: Gonal-f, Puregón and Fostipur or Menopur, Pergoveris and HMG Lepori.
The drugs to perform the stimulation must generally be kept cold, and are applied through injections. For each medicine you will find the exact specifications, read them carefully and you will see that the whole process will be very easy for you.
Chances are you've never had to give yourself an injection before. Now, during the treatment, you will have to do it daily for about 10-15 days.
So some clinics offer a little training on how to do it. It is not complicated, but it is delicate and something that sometimes costs a bit.
The stimulation lasts about 12 days with daily injections. It is interesting that it is at the same time each day and in different areas of the body.
It is mainly about the FSH hormone, that stimulates the follicles in the ovaries. The amount is usually very slight, the minimum for the general correct answer for the average woman. Sometimes, in addition to FSH, the medication also contains LH, a luteinizing hormone.
Do not be afraid. The doses of hormones are very mild... There are very few cases of women who have problems with this mediation. It is very likely that the most tedious side effects are related more to the injection than to the medication itself.
Before finishing these days of ovarian stimulation, the clinic will check the growth of the follicles in the ovaries, as well as the correct formation of the endometrium. It is even possible that the treatment is adapted a bit as you respond to the stimulation.
At the end of the days of medication, you may feel some tightness in the lower abdomen, similar to the days before menstruation. But not much else... If you have any doubts, you already know that you can consult continuously with the team of experts who are managing your cycle.
Medication 36 hours before egg collection
Examples: Ovitrelle, Gonasi, Pregnyl
When it can be seen from the ultrasound that the ovules have a correct size, it is time to apply a new injection. It is usually a day and a half before the ovarian puncture to finally extract the eggs stimulated in the previous stage.
This is an injection with an extra dose of the hormone human chorionic gonadotropin (HCG) that helps the eggs mature. It helps the eggs enter a final stage of maturation and are ready for retrieval and fertilization through IVF. It is important not to forget this step at the moment you have to be successful. in the collection of ovules and that these are mature.
Medication after ovarian puncture
Examples: Utrogestan, Progeffik, Prolutex
It is not necessary to take any extra medication for the ovarian puncture. However, during the follicular aspiration process, part of the cells that line the interior of the follicles (granulosa cells) are usually removed.
These are responsible for the production of progesterone, so an exogenous contribution (from outside) is usually recommended so that there is not a deficit.
Progesterone is known as the pregnancy hormone because it is responsible for maturing the endometrium, the place where the embryo is implanted. Progesterone is also responsible for maintaining an optimal uterine environment for the development and growth of the fetus until birth.
The extracted eggs are taken to the laboratory to fertilize them and to keep them in cultivation and see how they evolve.
Currently, they usually wait until they reach day 5 of development until the transfer of the fertilized embryos is carried out or they are cryopreserved.
This is an important moment in the evolution of these cells. If they reach day 5 correctly, they are more resistant to withstand, without being altered, subsequent cryopreservation. Progesterone can be applied in vaginal suppositories every few hours as indicated by the medical team, but injected progesterone is also often used. The treatment usually lasts about 14 days until it is known if the process has given a positive result after the betawait.
If there is finally a pregnancy, it is usually prescribed again in ovule format until the embryonic sac and the embryo with a heartbeat are visualized.
Medication for implantation
Examples of estradiol pills: Meriestra and Progynova; patches: Estradot, evo pad y Estraderm
To thicken the endometrium, estrogen intake can be prescribed in the form of a patch or a pill. Progesterone medication, along with estrogen, is also used if a patient undergoes frozen embryo transfer or uses donor eggs to conceive.
Other medications
In addition to this basic medication, there are cases in which other medications are prescribed. We list some of them:
- Oral contraceptives. They can be used initially to help regulate and control the cycle.
- Steroids (Medrol, Prednisone). It may be prescribed to help with any pre-existing inflammation and to prepare the uterus for implantation of an embryo.
- Clomiphene citrate (Clomid). This medication is prescribed to help the pituitary gland to secrete more follicle-stimulating hormone (FSH). It is prescribed orally for a maximum of six months.
- Metformin. Metformin is not technically a fertility drug, but is used in the treatment of people with diabetes. However, it is used in women with polycystic ovaries who have trouble ovulating correctly. Since abnormal insulin levels in the body alter ovulation.
- Euthyrox. There is some evidence that the thyroid-stimulating hormone (TSH) should be below 2,5 mUI/L to promote the best fertility scenario. It is not that it is impossible to conceive with a less active thyroid, but it can suppose some limitation in the options to the pregnancy.
Apart from these, there may be many other medications that your biomedical team considers relevant in your specific case. In any case, these are highly proven and safe protocols.
Adapting the medication to each woman is something that the clinic you have chosen will do. Of course, we hope that with all this information, we will help you to be calmer and more confident in the process. Remember that this It is only an information portal and you have to assess any medical information with your trusted specialists. All these medications are personalized medical prescription.