IVF Medications and timing

Image of various IVF medications and injectionsIVF medications and timing

There is no doubt about it, IVF is a tough process, both physically and emotionally. A large part of the success depends upon the right preparation and precision timings. IVF medications are key to preparing your body for the IVF process. Many women starting the IVF journey are nervous, understandably, about the number of injections required as part of this process and how, what, where and when to use them.

What happens during IVF, and the medications provided, may differ slightly from clinic to clinic but a typical treatment follows the steps below. You can get more information from qualified clinicians at your chosen clinic.

What is an IVF ‘protocol’?

You will hear ‘long protocol’ and ‘short protocol’ mentioned if you are going through the IVF process. Don’t worry, it is not related to the dictionary definition around “the official procedure or system of rules governing affairs of state or diplomatic occasions”. A ‘protocol’ is simply a treatment plan used to stimulate your ovaries to enable the clinic to collect a number of eggs for insemination, rather than the usual one that happens in a natural cycle. Most people tend to be issued the ‘long protocol’, which as the name suggests, takes longer than the short protocol. In total, a ‘long protocol’ can take approximately four weeks.

A ‘short protocol’ is used when there is a chance of you ‘over responding’ to the treatment, creating a risk of Ovarian Hyperstimulation Syndrome (OHSS), which can be a serious condition. This may also be used for those who are not responding well to stimulation. Short protocols begin much earlier in your cycle and is a much quicker process but your clinic will discuss with you the protocol that is right for you and will go through exactly what you need to do and when.

So, what medications are there and what do they do?

The medications below are an overview of some of the possible treatments available but your clinic will determine what is best for your individual situation.

Oral contraceptives: 

May be initially used to help regulate and control your cycle.

Steriod (Medrol):

This steroid can be prescribed to help with any inflammation and to prepare the uterus for an embryo implantation.

Clomiphene citrate (Clomid):

This medication is prescribed to help the pituitary gland secrete more follicle stimulating hormone (FSH). Commonly known as Clomid or Serophene, this medication is often prescribed orally, often for a maximum of six months.

Metformin:

Metformin isn’t technically a fertility drug; it’s a drug used in the treatment of people with diabetes. However it can be used by some women with polycystic ovaries who aren’t ovulating properly because of abnormal insulin levels in the body. Metformin reduces insulin in the body to normal levels, allowing ovulation to return to normal.

GnRH Agonists:

This kind of medication can be administered through a nasal spray (Synarel) or through injections (Lupron or Zoladex), with the goal of helping the body produce more eggs from the follicles. They also help prevent hormone surges that cause an IVF cycle to fail.

Down regulation drugs (GnRH Antagonists such as Cetrotide/Cetrorelix, Buserelin): 

To get the multiple mature eggs needed for IVF, the patient’s own natural ovarian function needs to be suppressed by using a medication that ‘switches off’ natural ovulation and hormones (known as down regulation), so that the medications for successful follicle growth can work properly. This puts the patient in a temporary state of menopause to give the clinic control over the cycle and prevents early ovulation. These medications are administered daily through self-injection, using precise doses tailored to the individual.

Human Menopausal Gonadotropins (hMG) (such as Gonal-F, Menopur, Bemfola, Meriofert):

These injections contain follicle stimulating hormones and luteinizing hormone to help stimulate the ovaries to produce several eggs. These are also taken as injections. Monitoring takes place during this time, performing blood and ultrasound testing every few days to track follicle development.

Synthetic hCG (such as Gonasi, Pregnyl, Ovitrelle):

When scans and tests show that the follicles are the right size, it’s time for an injection of Human Chorionic Gonadotrophin, known as hCG. This medication triggers ovulation. It helps the eggs to go into a final stage of maturation, so they’re ready for retrieval and fertilisation through IVF.

Progesterone and Oestrogen (such as Cyclogest, Evorel):

After egg collection progesterone medication is used to help the womb lining to grow ready for embryo implantation and pregnancy. Progesterone medication, in conjunction with oestrogen, is also used if a patient is having frozen embryo transfer or using donor eggs to conceive.

An example of IVF ‘long protocol’ timings:

Day 1 of cycle:

You need to call the clinic who will then book your treatment plan as discussed in your planning appointment. Day 1 is the first day of your period.

Day 21:

You start the drugs (e.g. Buserelin) which is single, daily injection at night, for 14 days. This suppresses your hormones so the clinic can take control of when you ovulate. This is called down-regulation and basically puts your body into a temporary state of menopause. Unfortunately, yes, you can start to get some menopausal side effects here.

The average cycle is 28-32 days – clinics would expect patients to have a bleed during this 14 days as you want to have a thin lining and no ovarian activity during this period.

The drugs are often delivered to your home address and need to be kept in the fridge, but your clinic will advise you. Some clinics may ask you to come into the clinic for ‘real time injection teach’ where they go through the first injection with you, as you need it, to make sure you start at the right time and do it in the right way.

If everything has gone to plan, the patient then starts daily injections of stimulation drugs, which are designed to stimulate follicle growth (e.g. Gonal-F/ Menopur). You will take these injections for 12 days, and may continue with the Buserelin too during this period.

Around day 8/9 of the 12 days:

The clinic will check the follicle growth. You may have a number of short, monitoring appointments throughout this period to see how you are responding to the stimulation drugs.

About 36 hours before your egg collection:

You need to administer a final HcG hormone injection called ‘the trigger shot’. This hormone helps your eggs to mature. The clinic will give you a specific date and time to administer this injection and it must be given at this exact time to give yourself the best chance in egg collection.

36 hours after the HcG trigger injection:

You will go to theatre for egg and semen collection.

IVF patient blog:

We have found a blog from someone who has actually been through the process and describes her treatment journey in an easy to understand and light-hearted way. Everyone is different and your clinic will notify you what is best for you. You may also have a slightly different experience but this lady’s account might help put it into context: The Preggers Kitchen blog 2018

 

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