In in vitro fertilization doctors try to completely control the women’s menstrual cycle in order to produce more mature oocytes. A number of different drugs are used in the treatment cycles. Because each woman is unique, the drugs may vary even from cycle to cycle. The most common drugs used are:
A) GnRH analogues (agonists, antagonists)
These drugs down regulate the pituitary gland and suppress the production of the hormones normally produced by the brain (LH and FSH), therefore controlling the stimulation of the ovary and preventing premature ovulation. Daily injections or nasal-inhalation of medications such as Superfact, Daronda, Avercap, Cetrotide and Orgalutran are usually started the first day of the menstrual cycle and last for approximately 10 to 15 days. At the end of this period down regulation is complete. However, a 20% of the women undergoing IVF treatment have to take the GnRH analogues for a longer period in order to achieve down regulation. This is mainly due to the presence of ovarian cysts that secret estrogens. These cysts are easily treated and do not affect the rest of the treatment.
The second phase of the IVF treatment is ovarian stimulation, which starts once down regulation is confirmed. Various gonadotropins like Puregon, Gonal-F, Menogon and Altermon are prescribed in a daily dose in order to hyper-stimulate the ovaries to produce more mature oocytes. These drugs are usually injected and their dose depends on the age of the woman and her response to the medication.
C) Other Drugs
The last drug of an IVF treatment is Human Horionic Gonadotropin (hCG) commonly known as Pregnyl or Profasi, which is injected at a specific time once the ultrasound scans show that at least three follicles have matured to 18mm in diameter. This drug triggers final follicular maturation and induces ovulation 32-36 hours later.
An antibiotic called Vibramycin might be prescribed to the husband when ovarian stimulation begins and also to the wife after egg collection.
Finally, after embryo transfer Utrogestan, progesterone pills, is exogenously provided in all IVF cycles in order to support the luteal phase, prepare the uterus for embryo implantation and stabilize the endometrium during pregnancy.