MEDICATIONS USED FOR IN VITRO FERTILIZATION AND EMBROY TRANSFER

MEDICATIONS USED FOR IN VITRO FERTILIZATION AND EMBROY TRANSFER

In vitro fertilization (IVF)—IVF is a procedure where mature eggs are retrieved from the female and fertilized with the male partner’s sperm in a laboratory. If healthy embryos are produced, they are then implanted in the uterus 3 to 5 days after fertilization

Intracytoplasmic sperm injection (ICSI)—a procedure in which a single sperm is injected directly into the egg as part of an IVF procedure

Intrauterine insemination (IUI), or artificial insemination—a procedure in which specially prepared sperm are injected directly into the uterus near the time of ovulation

Common causes of female infertility

In about 1/3 of cases, female reproductive health issues are the cause of infertility. Some common causes of female infertility include:

• Endometriosis
• Polycystic ovary syndrome, or PCOS
• Primary ovarian insufficiency, or POI
• Fallopian tube damage or blockage
• Uterine fibroids
• Pelvic adhesions
• Elevated prolactin, or hyperprolactinemia

Common causes of male infertility

Male infertility is responsible for about 1/3 of infertility cases. Common causes may include:

·         Low sperm count -Defined as fewer than 20 million sperm per milliliter of semen, low sperm count means reduced odds that one will fertilize an egg.

·         Abnormal sperm movement or shape -Atypical sperm shape or damaged sperm motility (movement) can affect the sperm's ability to travel to and/or penetrate the egg.

Infertility Testing

Ovulation test—tests hormone levels in your blood to determine if you are ovulating

Hormone test—tests the levels of certain sex hormones in your blood

Genetic test—tests for potential genetic causes of infertility

Pelvic ultrasound—this procedure can help your doctor to identify any infection or other blockage in the uterus

Hysterosalpingography—assesses the condition of your uterus and fallopian tubes. Fluid is injected into the uterus and an X-ray is taken to determine if anything is affecting the natural flow, such as a blockage, which may be correctable with surgery

Laparoscopy—in this procedure, the doctor will make a tiny incision below your navel and insert a slim viewing device to clearly assess your uterus, ovaries, and fallopian tubes

Tests specifically for men include: hormone testing, sperm analysis, and transrectal/scrotal ultrasound (to check for blockages)

A course of IVF is referred to as a cycle because there are many steps involved.

Phase 1 – is the ovulation induction (OI)

One or more medications are used to stimulate follicle growth. It may also include treatment with GnRH analog to regulate follicle growth. A few days before start of period FSH and/or hMG or other drugs given, days 8-14 MD evaluates hormone levels and examine follicles by ultrasound to assess development, when follicles almost mature MD will advise on when to take hCG that will cause the eggs to reach full maturity about 35 hours before egg retrieval is scheduled.

Phase 2 – Egg retrieval

An ultrasound probe with a thin needle used to draw the fluid and egg form each follicle, takes under an hour with general anesthesia or sedation.

Phase 3 – Sperm retrieval

Phase 4 – Fertilization

Partner’s sperm will be separated from the semen, then incubated with the eggs. Embryologist will check that eggs are fertilized and developing properly.

Phase 5 – Embryo transfer

Once determined that embryos are health and developed transfer is done. A higher number increases the likelihood of pregnancy and multiple births. They are transferred via a narrow hollow tube or catheter directly to the uterus.

Luteal Phase

Prescription of progesterone started th day after egg retrieval, progesterone helps prepare the uterus to support a pregnancy and can be continued for up to 10 weeks after positive pregnancy test. It can be given vaginally, orally, or as an injection.

Treatment options to help you conceive

1.      Clomiphene citrate-an oral drug used to promote ovulation by causing the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH), the hormones that stimulate the growth of an egg-containing ovarian follicle

2.      Follicle stimulating hormone-an injected drug that stimulates egg maturation in women with healthy ovaries who are unable to develop eggs; also used for follicle stimulation in ovulation induction (OI), intrauterine insemination (IUI), or in vitro fertilization (IVF)

3.      Human menopausal gonadotropin (hMG)- an injected drug that contains LH and FSH and is used to stimulate egg maturation in women with healthy ovaries who are unable to develop eggs; also used to stimulate follicles in women undergoing IVF

4.      Human chorionic gonadotropin (hCG)- used in addition to clomiphene, hMG, or FSH for follicle stimulation and to induce egg maturation in women who do not ovulate and do not have ovarian failure

5.      Gonadotropin releasing hormone (GnRH) analogs-act to suppress the hormones involved in ovulation for a more “controlled” cycle; these medications come in several forms and are usually used with FSH, hMG, or hCG

Most common fertility medications are classified as ovulation induction drugs.  They are approved for patients with various ovulation disorders with the goal of producing a single mature egg during a treatment cycle

They may also be used for “super” ovulation in patients with normal ovulation function to stimulate the ovaries to produce more than the usual one follicle per month thus increasing the number of eggs exposed to sperm and increasing the chance for pregnancy

Another type of ovulation induction medication is gonadotropins (Repronex, Follistim, Gonal-F.) they stimulate the ovaries to produce many dominant follicles each cycle. They are administered by injection. They can be used in combination with sexual intercourse, intrauterine insemination (IUI), or in vitro fertilization (IVF) to enhance chances of conception.

MEDICATIONS COMMONLY USED DURING IVF CYCLE

1.      Lupron – temporarily suppresses pituitary and ovarian hormone production and prevents ovulation from occurring prior to oocyte retrieval.

2.      Gonadotropins - stimulate the development of multiple ovarian follicles so that multiple eggs can be retrieved from the ovaries. Gonadotropins consist of a mixture of the natural hormones FSH (follicle stimulating hormone) and LH (luteinizing hormone), or contain FSH alone. Commonly used gonadotropin preparations include Repronex, Gonal F, Follistim, Bravelle, and Menopur. Of these, only Repronex can be injected either under the skin (subcutaneously) or into the muscle (intramuscularly). All others can only be injected subcutaneously.

3.      Antagon or Cetrotide - These medications, known as gonadotropin-releasing hormone antagonists, are not used in all cycles. Like Lupron, they suppress pituitary and ovarian hormone production and prevent premature ovulation. These medications are administered by subcutaneous injections and are generally not started until the largest follicle is 12-14 millimeters in size.

4.      Human Chorionic Gonadotropin Hormone (HCG) - his medication has various brand names, including Pregnyl, Profasi, Novarel, or Ovidrel. HCG induces the final maturity of the egg and initiates release of the eggs from the follicles. Pregnyl, Profasi, and Novarel are given intramuscularly. Ovidrel is given subcutaneously. The egg retrieval is scheduled approximately 34 to 36 hours after the injection, before the actual release of any eggs.

5.      Progesterone - Progesterone is a hormone essential for establishing and maintaining pregnancy. Progesterone may be administered in a few different forms including vaginal suppositories, intramuscular injections and oral preparations. While progesterone injections are often uncomfortable, the scientific literature reports that intramuscular injection is the most efficacious delivery method.

6.      Antibiotics - Doxycycline or another antibiotic is routinely given the night before the egg retrieval to possibly minimize the risk of infection.

7.      Steroids - Medrol is a steroid hormone commonly used in IVF cycles. While the actual benefit of Medrol has not been established, it may help prevent the body from rejecting the transferred embryos.

EXAMPLES

1.      BRAVELLE  contains human FSH used to stimulate egg maturation in women whose ovaries are healthy but unable to develop eggs on their own.  (urofollitropin for injection, purified)

2.      MENOPUR^® is a purified preparation of gonadotropins used as part of an ART program to  promote the development of multiple eggs and pregnancy in women who are unable to produce and release eggs (ovulate). (menotropins for injection)

3.      REPRONEX^® is a purified preparation of naturally derived gonadotropins. Like BRAVELLE, REPRONEX stimulates eggs to mature in otherwise healthy ovaries that are unable to develop eggs without assistance. (menotropins for injection)

4.      ENDOMETRIN^® is a vaginal progesterone insert approved for use in ART treatment. Progesterone is a natural hormone often prescribed following ovulation and egg retrieval to help prepare the uterine lining (endometrium) to receive and retain a fertilized egg.(progesterone vaginal insert 100mg)

5.      NOVAREL^® is an hCG used to stimulate ovulation in women who have not ovulated but the cause of infertility is not due to primary ovarian failure and they have already been treated with BRAVELLE, MENOPUR, REPRONEX, or similar therapies.(chorionic gonadotropin for injection)

6.      Clomiphene - it is used to induce ovulation who don’t produce eggs. It’s an ovulatory stimulant, works similarly to estrogen. Brand names are Clomid, Milophene, and Serophene