During an IVF cycle, different drugs make the ovaries release many mature eggs, which can then be collected and fertilized in a lab. Protocols for in vitro fertilization show how these drugs are given and in what order. The most widely utilized drugs and IVF specialists suggestions for some methods are discussed here.
Medication for IVF
The pituitary gland produces gonadotropins. They’re essential for keeping women’s periods regular. The two primary gonadotropins are the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Injections of synthetic or purified forms of these hormones are also used as reproductive treatments. For example, in in vitro fertilization cycles, FSH is used alone or in combination with LH to stimulate the ovaries into producing several big follicles. (An immature egg is housed in a follicle, a fluid-filled sac in the ovary.)
To prevent ovulation, fertility doctors use GnRH antagonists, drugs that stop the brain from producing GnRH (gonadotropin-releasing hormone). Used in IVF cycles, they prevent large follicles from releasing eggs and triggering ovulation.
Medications known as gonadotropin-releasing hormone agonists (GnRH agonists) can play various roles during an IVF cycle. They function similarly to gonadotropin-releasing hormone antagonists in suppressing ovulation right before egg retrieval. Sometimes they’re used to help grow eggs, and sometimes they’re used to help trigger egg maturation and ovulation (known as the trigger shot). In order to stimulate the production of endogenous gonadotropins, they act on the brain.
Pregnancy hormone hCG
In vitro fertilization (IVF) cycles, hCG is administered to women to stimulate ovulation and egg maturation right before eggs are retrieved (the trigger shot). Additionally, it is sometimes taken post-transfer to help the developing embryo and early pregnancy.
After ovulation, the ovary secretes the hormone progesterone. Extra progesterone or a related hormone (called progestin) is commonly administered during IVF rounds. It has a wide range of possible routes of administration, including orally, vaginally, and intramuscularly. Until the placenta can take over, it provides essential support for the developing baby. A common term for this is luteal support.
ANTAGONIST IVF PROTOCOL
In this IVF method, gonadotropins are administered at the beginning of the menstrual cycle to promote follicle growth. About 4–6 days later, patients begin taking a GnRH antagonist to stop the follicles from releasing an egg. Finally, the fertility doctor gives a GnRH agonist or hCG once the follicles have achieved their optimal size to stimulate the maturation of the egg. The most prominent follicles require 8-12 days of gonadotropins to attain the proper size for the trigger. Egg retrieval is typically carried out 36 hours following the triggering shot.
In general, anyone can follow this procedure, regardless of ovarian reserve. Beneficial for people who are predisposed to Ovarian Hyperstimulation Syndrome (OHSS).
LONG AGONIST IVF PROTOCOL
Women using this IVF protocol begin taking a GnRH Agonist in the middle of the luteal phase of their menstrual cycle, about a week before their scheduled cycle start. The goal is to stop the generation of reproductive hormones in the brain and stop ovulation from occurring too early in the IVF cycle. (Premature ovulation occurs when an egg ovulates and is released into the body before an egg retrieval process.) When the following menstrual cycle begins, usually around a week after starting the GnRH Agonist, IVF specialists continue injecting the patient with gonadotropins, as in the antagonist regimen above. They are still using the GnRH Agonist but at a lower dosage. The GnRH Agonist is like the brake, and the gonadotropins are like the gas; both must continue moving until the shot that pulls the trigger is given. Egg retrieval is typically carried out 36 hours after the triggering shot.
MICRODOSE FLARE IVF PROTOCOL
The drugs in this IVF method are the same as those in the Long Agonist Method. However, the GnRH agonist is administered at a lower dose and is started on day one of the cycles. In contrast, gonadotropins are initiated one or two days later in the same process. Since the GnRH agonist is administered for a shorter duration, the protocol is also referred to as the short protocol.
The GnRH agonist is administered twice in this procedure; first, in conjunction with gonadotropins, to boost follicle growth (the flare effect), and again, in the later stages of the stimulation phase, to avoid premature ovulation.
Although anybody can utilize this strategy, it is most often used on women with a low ovarian reserve or who have had a poor response (a low number of eggs recovered) in a previous IVF cycle. People at high risk of OHSS should utilize this regimen with caution.
MINIMAL STIMULATION IVF PROTOCOL
This IVF treatment is virtually identical to the Antagonist protocol with one exception. The dose of gonadotropins utilised is purposefully low. Sometimes, oral fertility drugs are taken alone or in combination with gonadotropins.
This technique is often utilised for persons with a low ovarian reserve or a history of a low number of eggs recovered after utilising high doses of gonadotropins in a previous cycle. In these categories of persons, there is evidence that a purposely low dosage approach leads to just as good outcomes as a high dose strategy.
There are several ways in which different IVF protocols, together with choices for priming and luteal support, might be combined. And new drugs and techniques to prescribe these treatments are continually being created and evaluated. If you are contemplating an IVF cycle, you should chat with your fertility doctor about which option is suitable for you, based on your particular qualities.