Your IVF stimulation cycle begins on the first day of your menstrual cycle (the day you get your period). From there, you will typically have baseline tests, including an ultrasound and blood tests, completed on the third day of your cycle. On this day, you will begin administering your IVF stimulation medications leading up to your egg retrieval.
IVF medications have 2 main functions:
Here are the most common types of IVF medications:
These are synthetic forms of the reproductive hormones FSH and/or LH that hyper-stimulate the ovaries so multiple follicles (with eggs inside of them) grow.
Note: Menopur is the only gonadotropin that contains both FSH and LH. Follistim and Gonal-F only contain FSH.
Review: During the first half of a menstrual cycle, the brain naturally releases the hormones FSH and LH. FSH (and LH, to a lesser extent) cause multiple follicles (with eggs inside) to grow in the ovaries, but only one follicle ends up becoming the dominant follicle. The dominant follicle contains the egg that will be ovulated that cycle. The other follicles that started to grow will all degenerate as the FSH levels decrease and ovulation approaches.
But... you want there to be multiple eggs retrieved for your IVF cycle so you have a higher chance of getting at least one healthy embryo from the cycle. Gonadotropins supply your body with a steady supply of FSH and/or LH, which in turn causes multiple follicles (eggs) to grow and not degenerate. Thus, there will be multiple mature eggs available for our IVF cycle instead of just one.
Gonadotropins are typically administered through a subcutaneous (under the skin) injection with a pre-filled pen at the start of IVF stimulation. The dosage can be adjusted depending on how your body is responding to the medications.
Side effects of gonadotropins may include headaches, hot flashes, breast tenderness, bloating, nausea, fatigue, and irritation/infection of the injection side.
These injectable medications block GnRH activity in the brain to prevent premature ovulation.
Review: During a normal menstrual cycle, one part of the brain releases the hormone GnRH, which in turn causes another part of the brain to release the hormone LH (luteinizing hormone). A surge of LH released by the brain triggers ovulation to occur.
So, if GnRH is not being released, then LH is also not being released. No LH surge means no ovulation. This is helpful during an IVF cycle because it prevents ovulation from occurring too early (if ovulation occurs too early, the eggs cannot be retrieved). In a sense, GnRH antagonists put the body into a brief menopausal state in order to control when ovulation occurs.
GnRH antagonists are administered via a subcutaneous (below the skin) injection either between the belly button and the bikini line, or at the top of the thigh. The medication will come in a pre-filled pen with a dial on the side. You can adjust the dosage by changing the dial on the pen (per your doctor's instructions). GnRH antagonists are normally administered for a few days in a row during IVF stimulation as the follicles begin to grow.
Side effects of GnRH antagonists can include hot flashes, mood swings, headaches, nausea, abdominal pain/tenderness, and injection site pain.
Ovulation trigger medications (Ovidrel, Novarel, Lupron, Pregnyl, hCG)
These injectable medications cause the eggs in the ovaries to finish maturing and trigger ovulation to occur.
Review: During the first half of a menstrual cycle, a surge of LH is released by the brain to trigger ovulation.
Administering an ovulation trigger medication mimics the LH surge which, in turn, triggers ovulation to occur.
Egg retrievals are scheduled for 35-36 hours after the trigger is administered so that the eggs have time to finish maturing, but ovulation has not yet occurred. If ovulation occurs prior to an egg retrieval, the eggs cannot be retrieved. Thus, the timing of the trigger administration is essential in order to have a successful egg retrieval.
Most ovulation trigger medications are given via an intramuscular (into the muscle) injection, though Ovidrel is given subcutaneously (under the skin) with a pre-filled syringe.
Side effects of ovulation trigger medications can include headaches, bloating, pelvic/abdominal pain, dizziness, injection site pain/tenderness, and OHSS.
hCG is the hormone that the embryo secretes when it implants into the uterine lining, but it turns out that hCG and LH are actually very similar (except that hCG lasts longer in your body). So, administering a low-dose hCG medication is just like supplying your body with LH, which works with FSH to help your follicles grow as the eggs inside of them mature.
Note: low-dose hCG only needs to be administered with Follistim or Gonal-F since they do not contain LH. If you are taking Menopur, you will not need to take low-dose hCG since Menopur contains both FSH and LH.
Low-dose hCG is typically administered subcutaneously (under the skin) with a cold, pre-mixed solution that is drawn from a vial. This solution needs to be kept cold to be effective. Low-dose hCG is administered at the beginning of the IVF stimulation alongside the Follistim or Gonal-F.
Side effects of low-dose hCG may include headaches, fatigue, mood swings, and injection site pain/tenderness.
These injectable medications stimulate the brain to briefly release a lot of hormones, but then cause the hormone levels to fall rapidly.
Review: When the female brain discovers that a pregnancy has not occurred, a new menstrual cycle begins. The brain begins to release GnRH, which in turn causes the release of FSH and LH. FSH stimulates egg growth in the ovaries, while LH triggers ovulation. The brain can also adjust how much of these hormones are released.
GnRH agonists stimulate the brain to produce a lot of FSH and LH, so there will be a higher level of these hormones than normal. The brain quickly detects these high levels of FSH and LH in the body and stops releasing them, so the levels of these hormones will rapidly decline.
For these reasons reason, GnRH agonists can be given at 3 times:
While Lupron is given as an intramuscular (in the muscle) shot, other GnRH agonists are now available as nasal sprays or implants.
Side effects of GnRH agonists can include hot flashes, headaches, nausea, mood swings, and body aches.
If you are opting to do a fresh embryo transfer (a transfer 5 days after your egg retrieval), you will likely need to take progesterone leading up to your transfer.
Review: in the second half of the menstrual cycle, the corpus luteum (which was the dominant follicle prior to ovulation) secretes progesterone to help the endometrium (uterine lining) thicken in preparation for embryo implantation. The corpus luteum secretes progesterone until the placenta takes over a few weeks after embryo implantation.
Progesterone can be taken as an injection, pill, or a vaginal suppository/gel to help prepare the endometrium for implantation. It is typically administered before the egg retrieval and is continued for 8-12 weeks if a pregnancy occurs (until the placenta takes over progesterone secretion).
Note: Progesterone is also administered prior to a frozen embryo transfer in order to prepare the uterine lining for embryo implantation and to help sustain the pregnancy after the embryo has been transferred.
Side effects of progesterone can include headaches, breast tenderness, injection site pain/tenderness, nausea, and mood swings.
Birth control pills are typically prescribed to patients in the weeks or months prior to an IVF cycle in order to prepare the body for an upcoming IVF stimulation.
Birth control pills have two main goals when it comes to IVF stimulation:
The side effects of birth control pills are minimal but may include headaches, nausea/dizziness, or mood swings.