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    Medications Used in Ovulation Induction and Art2019-09-18T12:05:38-07:00

    Medications Used in Ovulation Induction and ART

    ART Medications Overview

    A woman’s body normally produces only one egg that is released for fertilization each month. To increase the chances for successful pregnancy, female patients are given certain medications that induce the ovaries to develop several mature eggs rather than the single egg. In addition to fertility medications, additional medications are used to schedule ART cycles, particularly for synchronizing patient cycles with egg donors or surrogates, induce ovulation at the appropriate time and enhance uterine receptivity and embryo implantation. Injectable medications commonly used in ART treatment include:

    1. Gonadotropins: Hormone medications containing follicle stimulating hormone (FSH) and/or luteinizing hormone (LH) that stimulate the ovary to produce multiple follicles (see Table 1).
    2. Human Chorionic Gonadotropin (hCG): A hormone medication with a similar chemical structure to LH, which is used to trigger ovulation at the appropriate time when the follicles are ready (see Table 1).
    3. Gonadotropin releasing hormone (GnRH) analogs: Medications used to prevent the body’s own release of LH and FSH from the pituitary gland (see Table 2). Note: The GnRH agonists (Lupron) can also be used to induce a flare-up or LH “surge.”
    4. Sex Steroids: The natural hormones estrogen and progesterone that are made in the ovary and by the placenta (see Table 3).
    5. Growth Hormone: Used as an adjunct for ovulation induction for low responders.

    Other medications can be administered by alternative routes (oral, vaginal or nasal sprays).The following is a list (in alphabetical order) of medications and hormonal preparations you may be prescribed:

    (5 mg oral tablets) is a progestin given daily for 5-10 days during the second half of the menstrual cycle for planned menstrual bleeding.
    (81 mg tablets) increases blood flow to the uterus and thus may aid in embryo implantation. It is used in frozen embryo transfer and donor egg cycles. Baby aspirin may be kept at room temperature.
    May be used prior to ovarian stimulation, particularly in synchronizing menstrual cycles in donor and surrogate cycles. These
    may be stored at room temperature.
    contains a highly purified preparation of human FSH (75 IU of FSH per vial) which is administered daily during ovarian stimulation to induce multiple follicles to develop. Bravelle may be administered subcutaneously (SC) or intramuscularly (IM), alone or in conjunction with Menopur.
    Is a dopamine agonist prescribed orally (0.5 mg/d) for 8 days starting shortly before or after egg retrieval for prevention or treatment of OHSS (ovarian hyperstimulation).
    Is a GnRH antagonist that is administered as a daily subcutaneous (Sub-Q) injection beginning several days before ovulation and continuing up to the time that hCG is given. Cetrotide suppresses the LH surge and is an alternative to down regulation with Lupron
    Is used primarily for ovarian stimulation in IUI (intrauterine insemination) and timed intercourse cycles for women who have infrequent or irregular menstrual cycles. It is also frequently used to increase the number of eggs released in treatment cycles for unexplained infertility. It has recently been used in conjunction with FSH for “Mini-IVF”. Clomiphene is a tablet taken by mouth at bedtime in doses ranging from 50 to 200 mg (1 to 4 tablets) per day. Clomiphene is usually taken starting on day 3 to 5 of the menstrual cycle, and continued for 5 days. Clomiphene works by blocking the estrogen receptors in the hypothalamus causing it to “think” there is an estrogen
    deficiency. The hypothalamus therefore orders the pituitary to secrete more FSH and LH.
    Is a synthetic corticosteroid that has immunosuppressive and anti-inflammatory effects. At low doses it can be used to augment the ovarian response. It is also used in conjunction with clomiphene to lower androgen levels in PCOS patients.
    Is a naturally occurring hormone produced by the adrenal glands. As women age, production of this weak androgen decrease. Women with low ovarian reserve may benefit by DHEA supplementation (75mg/d) for 6-8 weeks prior to ovarian stimulation. It works by conversion into testosterone via androgen receptors on small follicles, which enhances follicular response.
    (see Cabergoline)
    Is an oral antibiotic. It is prescribed to all patients and their partners who are undergoing an ART cycle to reduce the chance of infection during ART procedures. Doxycycline may be kept at room temperature.
    Is a progesterone vaginal suppository. It is commonly used for luteal support after a fresh or frozen embryo transfer.
    Is an oral estrogen. This is commonly used, instead of the injectable estradiol valerate, for uterine lining preparation in hormone–replacement cycles. Other uses include cycle priming of low responders to synchronize small antral follicles, and for luteal support after embryo transfer.