Medications- hCG, Lupron, Antagon, Cetrotide, Progesterone

Human chorionic gonadotropin (hCG) Profasi, Pregnyl, Ovidrel

Normally, in a non-stimulated cycle, once the egg(s) is/are mature, the hypothalamus signals the pituitary to release large amounts of luteinizing hormone which triggers ovulation. IVF patients usually receive medications (Lupron, Antagon, and Cetrotide) that prevent the LH surge. This is because ovulation must not occur before the eggs are mature and the IVF team is ready for the retrieval.

hCG (the pregnancy hormone) is produced by the placenta once pregnancy occurs and it is the hormone measured by most pregnancy tests. The body reacts to hCG in the same manner as LH. A surge in hCG levels will also trigger ovulation.

Once the eggs are mature, hCG is administered by injection thirty five to thirty-six hours prior to the egg retrieval, or intrauterine insemination. This signals the final maturation of the egg and signals the body that ovulation will soon occur. Production of other hormones, such as progesterone, increases.

Profasi and Pregnyl are "natural products". being extracted from placental tissue. Ovidrel is a pure hCG identical to that produced by the body. It is produced using genetic recombinant production technology and has no impurities. All of these products have the same effect of inducing ovulation.

Lupron, Antagon, Cetrotide

The primary use for these medications it to prevent premature ovulation (before the eggs are mature) in IVF cycles. They are administered according to patient specific treatment protocols.

Antagon and Cetrotide are gonadotropin releasing hormone (GnRH) antagonists while Lupron is a GnRH agonist. GnRH is the hormone that signals the pituitary to produce follicle stimulating hormone, which initiates and supports follicular development, and leutinizing hormone.

Lupron blocks GnRH's action by suppressing pituitary and ovarian function while Antagon and Cetrotide block the production at the pituitary gland. Therefore, the antagonists cause a greater suppression of FSH and LH.

Lupron is commonly used to treat endometriosis because it indirectly lowers the levels of estrogen upon which endometrial cells depend. All of these products produce an "artificial menopause" with the accompanying symptoms.

Lupron is administered to "down regulated" IVF patients in order to better control and stimulate follicular development. The physician determines the treatment protocol for each patient based upon numerous evaluations, including day three FSH and LH measurements, patient's age, body mass index, and number of follicles on day 2 or 3 on transvaginal ultrasound. Dosing is modified during the cycle based upon estradiol and ultrasound measurements.

Some physicians prefer Antagon and Cetrotide because fewer injections are required and the suppression of LH is greater.

Progesterone

Progesterone stimulates the endometrium (lining of the uterus) causing it to thicken and become more vascular. This thickening is necessary to support the developing embryo.

After the egg is ovulated from the follicle, the corpus luteum forms from the remnants of the follicle (after ovulation has occurred) and begins to produce progesterone. Once the embryo is implanted in the endometrium, the placenta begins to produce progesterone.

Progesterone is administered in IVF cycles to insure adequate levels and offset the effects of high estrogen levels produced by the stimulation. Furthermore, in IVF cycles, since ovulation did not occur, there is no corpus luteum to produce the progesterone. Progesterone can be given by intramuscular injection, vaginally, or by mouth.

Metformin (glucophage)

Polycystic ovarian syndrome (PCOS) is a very common cause of infertility. The symptoms of PCOS include increased levels of male hormones (androgens), a pear shaped body appearance, excess body hair, irregular ovulation. And enlarged ovaries with many cysts.

PCOS patients are usually insulin resistant, meaning that the body is insensitive to the insulin that is being made so to over compensate by producing excess amounts of insulin. This is due to increased production of androgens (and other factors) by the ovaries. Increased androgens lead to the common symptoms of PCOS including lack of ovulation, and excess facial, chest, or abdominal hair growth.