What drugs are used in IVF treatments?

The developments in the pharmaceutical technologies brought about new and effective medication against infertility. The purpose of these drugs is to ensure that the adequate size and number of follicles are formed in the ovaries and to increase the conception ratio. Obtaining multiple follicles is one of the most important factors particularly in the assisted reproduction techniques (IVF, ICSI). FSH (follicle stimulating hormone) and LH (luteinizing hormone) that are responsible for egg production are used for stimulating the ovaries.

Clomiphene

Clomiphene increases the FSH release and it is one of the first medication prescribed during infertility treatment. The medication that is available in tablet form is usually taken  in the 5th to 9th day of the menstruation and it induces multiple follicle formation in the ovaries. 

Human Menopausal Gonadotropins (HMG)

Menotropins are Medication that is extracted from the urine of postmenopausal women and contains FSH and LH hormones are used for the stimulation of the ovaries and obtaining multiple follicles for IVF and ICSI treatment. It is used a subcutaneous injection.

Recombinant FSH

Recombinant FSH preparations are 100% pure and produced through genetic engineering laboratory conditions. Recombinant FSH is intended to production of more than one eggs for IVF and ICSI by ensuring multiple follicles through ovarian stimulation. The drug, administered as a subcutaneous injection, is now available in the form of a pen that makes dose adjustment automatically.

Gonadotropin Releasing Hormone Agonists (GnRHa)

These agonists are the synthetically-derived form of the gonadotropin-releasing hormone which helps release of FSH and LH hormones from the pituitary gland and is released from the center called hypothalamus in the brain. These are also available in injection or nasal spray forms.

Early increase in the LH (Luteinizing Hormone) is one of the major problems for the treatment with assisted reproductive techniques. This leads hatching of the eggs before the estimated duration and decrease the chance of obtaining sufficient number and quality of eggs. As the administration of GnRH agonists prevents such early increase in the LH hormone released during the hormonal ovarian stimulation, it minimizes the chance of obtaining eggs with less number and low quality. This is no longer is used for treatments at our clinic.

GnRH Antagonists

Even though it has the same functional effect as GnRH analogues, the efficacy duration and the period of use is relatively shorter so, the number of patient visits are less, and this reduces the costs of treatment. Another advantage is the lower number of injections. The daily dose of 0.25mg is started on the 6th day of the stimulation and continued until completion of the egg development.

Human Chorionic Gonadotrophin (hatching injection)

It is injected approximately 35-36 hours before the retrieval of eggs and the follicle rupture occurs and eggs are released 36-38 hours after this injection. This hormone’s function is to prepare the eggs in follicles for the fertilization and initiate the progesterone release. These medications that are similar to LH which is a natural hormone causes rupture of the egg. The timing of HCG injection is very important; therefore, it should be administered at the specified time.

Progesterone

This hormone is needed for the healthy growth and development of the endometrium layer covering inner face of the uterus where fertilized egg is implanted and healthy transplantation of embryo in the endometrium will not be possible in case of inadequate release of this hormone. Therefore, this hormone is administered externally to support the endometrium in IVF and ICSI procedures. Treatment, called luteal phase support, is administered as a vaginal suppository or gel. In our clinic, on the day of egg retrieval, the vaginal capsule is given to as 1 pessary for 3 times a day and it is continued until the pregnancy test.  If the pregnancy test is positive, it will continue to be used as a vaginal suppository until the 8th week of pregnancy. As the progesterone preparations given in our clinic are natural, there is no side effect on pregnancy.

Letrazol

The medicine that is used for patients having difficulty with the egg development will be started on the 2nd-4th day of the menstruation and it will be taken as 2 tablets per day for 5 days. If there is no egg development, it can be used for 3-4 consecutive menstruation.

Other Medications

• Tetra 500 Capsule: Tetra, administered as a preservative for preventing possible infections in female reproductive system to interfere with the occurrence of pregnancy, is an antibiotic. Tetra is started on the day of the egg retrieval and continued for a period of 4 days.
• Prednol 16 mg Tablet: The use of this drug, used in order to prevent the possible refusal reaction to the immune system that may develop during the occurrence of pregnancy, is started on the day of the egg retrieval and continued for a period of 4 days. Prednol is used as a single dose at bedtime.
• Folic acid (Folbiol or Centrum): This is a vitamin that is given daily from the start of the treatment in order to prevent the emergence of disabled infants.
• Parlodel SRO Capsule: This drug, which is administered to patients with a high prolactin hormone, should be taken after dinner.
• Luveris Ampoule: This LH-containing drug is used for some patients, and the dosage and usage will be determined and delivered to you by your physician.