A variety of drugs are used in a typical IVF cycle. These drugs are divided into several categories, and each is an important part of a stimulated cycle. The types and amounts of drugs used vary according to the drug protocol prescribed by the doctor who deals with your IVF treatment.
What are the aims of ovarian stimulation drugs?
The aim of using drugs is to produce a high number of eggs that naturally develop once a month to achieve success, ensure egg maturation, prevent early shattering of the eggs, and get the endometrium ready for conception.
Follicle-stimulating and luteinizing hormones, abbreviated as FSH and LH, respectively, are used to stimulate the ovaries. Drugs administered orally, vaginally, or intramuscularly at the start and throughout treatment are used to achieve these objectives.
Additionally, it should be mentioned that different personal features, the most determining being the body mass index (BMI) affect how much medication should be given to women to promote the formation of eggs in the quantity and quality necessary for treatment.
What are the most commonly used drugs to stimulate the ovaries in IVF?
GnRH Agonists
Gonadotropin-releasing hormone (GnRH) is a hormone produced in the brain that indirectly stimulates ovarian function. GnRH agonists do not directly induce this hormone’s follicle development or ovulation. However, GnRH agonists are synthetic forms that have become very important in IVF treatment.
GnRH agonist use has various benefits, including the following:
- Given that the patient’s own hormone production is being restrained, they help to regulate ovarian stimulation.
- Compared to patients who don’t take GnRH agonists, those who do are likely to produce a higher percentage of mature oocytes.
- For the majority of patients, GnRH agonists greatly lower the chance of cycle cancellation. Before their use, patients would experience an early LH surge with spontaneous ovulation, which resulted in 20 to 50 percent of IVF-ET cycles being canceled. The chance of cycle cancellation when utilizing GnRH agonists is less than 5%.
- With GnRH agonists, ovarian activity can be inhibited for varying lengths of time as desired, giving cycle planning flexibility.
GnRH Antagonists
GnRH antagonists are also usable (Cetrotide® and Antagon®). Compared to Lupron®, these are started later in the cycle and instantly stop the production of FSH and LH. These medications may be used in protocols that require fewer injections. When to begin using these drugs is decided by ultrasound assessments of follicular development.
Gonadotropins
To enhance the chance of pregnancy with IVF, more than one oocyte must be produced. Gonadotropins, which are hormonal medications that directly stimulate the ovaries, are given to do this. Different medication regimens can be used to stimulate.
Because the hormone level used in IVF is more than what the body usually generates, the ovaries typically develop more than one oocyte, muclithan a natural cycle.
Gonadotropins directly stimulate the growth of follicles in the ovary (structures in the ovaries containing eggs). Inside the follicles, granulosa cells multiply and develop. The follicles enlarge and fill with follicular fluid as a result of this.
Transvaginal ultrasonography can be used to count and measure these growing follicles. A lab blood test can be used to measure the increased estrogen production that occurs as follicles expand.
Human Chorionic Gonadotropin
An injectable medication called human chorionic gonadotropin (hCG) is used to complete the maturation of oocytes. Human chorionic gonadotropin is structurally similar to LH produced by a woman’s pituitary gland. Similar to LH, hCG promotes oocyte development in the follicle. Additionally, after egg retrieval, it encourages the ovary to produce progesterone. This progesterone is necessary to get the uterus ready for the embryo’s implantation. (1)
Risks and Side Effects of Ovarian Stimulation Drugs
Ovarian stimulation drugs are essential in in vitro fertilization treatments, designed to encourage the ovaries to produce multiple eggs. However, these medications come with their share of potential side effects. Firstly, there is the Ovarian Hyperstimulation Syndrome (OHSS). This condition manifests when the ovaries respond too vigorously to the drugs. The severity of OHSS ranges from mild discomfort due to bloating to intense abdominal pain and significant fluid accumulation.
Moreover, individuals may experience reactions at the site of injection. Symptoms include redness, swelling, or bruising. Additionally, the treatment can lead to emotional instability. Patients often report experiencing mood swings alongside headaches.
The list of possible side effects extends to include:
- Nausea
- Vomiting
- Tenderness in the breasts
- Overall fatigue
Despite these concerns, it is crucial to remember that these risks are comparatively low. Physicians closely monitor their patients throughout the treatment process to mitigate these side effects. This careful supervision aims to ensure the safety and efficacy of the ovarian stimulation process.
Source:
The entire article is written based on: https://www.sart.org/patients/a-patients-guide-to-assisted-reproductive-technology/general-information/art-medications/
ESHRE Guideline Group on Ovarian Stimulation, Bosch, E., Broer, S., Griesinger, G., Grynberg, M., Humaidan, P., … & Broekmans, F. (2020). ESHRE guideline: ovarian stimulation for IVF/ICSI. Human reproduction open, 2020(2), hoaa009.
