In most cases, the treatment cycle starts with the patient taking birth control pills. This is for scheduling purposes. By putting the patient on BCPs, we are able to manipulate her menstrual cycle to make it predictable. In this manner we are able to better plan ahead and provide the patient with specific treatment dates that can be set well in advance. The patient will usually take these pills for a period of at least 17 days to up to 5-6 weeks. BCPs will in no way harm the patient’s chances of conceiving, at the contrary, it might help produced a synchronously growing batch of follicles or eggs.
Lupron® or Ganirelex® / Cetrotide®
Roughly 5 days before the last BCP, the patient starts taking daily Lupron® injections. The dose will be indicated on the Calendar. Lupron® will suppress the pituitary-ovarian axis (i.e. it will put the ovaries to “sleep”) so that we can control the ovaries with fertility medications. If Lupron® is not taken, then there is significant risk that the eggs might be released before we are ready to “harvest” them.
Lupron® is administered as a subcutaneous injection (under the skin) with a small needle. The patient will take daily Lupron injections until otherwise indicated. In some patients, based on many different factors, we might use Ganirelex or Cetrotide® to prevent ovulation rather then using Lupron®. These subcutaneous injections are usually taken once a day starting few days before the egg retrieval.
Folic acid is a vitamin that every patient attempting to conceive should take prior to conception along with prenatal vitamins.
The fertility hormones are usually started 10-12 days after the Lupron injections and after a baseline Estradiol blood measurement or ultrasound examination to check for the presence of cysts. These include one or a combination of the following:
- Gonal-f®, Follistim® or Bravelle® (given subcutaneously (SQ) )
- Repronex® (Intramuscular (IM or SQ)) or Menopur® (SQ)
These medications will stimulate the ovaries to produce multiple eggs. The response to these drugs varies according to the patient’s age, her ovarian reserve and the amount of drugs given. The dose should be clearly indicated on the Calendar.
These drugs are given once (usually in the evening) or twice daily (morning and evening). Mixing and injection instructions will be given to the patient prior to treatment initiation. The patient will be told when to stop taking these drugs. If the patient stops taking these medications prematurely, it might lead to the cancellation of the cycle.
These drugs are usually taken for 10 to 14 days prior to egg retrieval. Some patients might need a longer period of time to have a successful stimulation. This is common in older patient or women with elevated FSH levels. A vaginal ultrasound examination will be performed one week after the start of these medications in most patients.
All patients will be given a hormone called Progesterone, at or around the time of embryo transfer. This hormone helps to support the developing zygote.
Occasionally, patients are placed on other medications concomitantly including blood thinners such as Heparin, Lovinox, Baby Aspirin and/or Medrol (steroid) for immunologic problems. These drugs are also started the same day the fertility drugs are started. Further instructions will be given to the patient as to when to discontinue these medications.
Folic acid is a vitamin that every patient attempting to conceive should take prior to conception along with prenatal vitamins. It has been shown to reduce the incidence of serious birth defects (neural tube defects such as spina bifida) when taken during the first 50-70 days after conception. The patient will be placed on Folic acid 1 mg/day or a prenatal vitamin starting the day of stimulation with fertility drugs.
Occasionally, other medications might need to be administered such as Medrol or IVIG. Further instructions will be given to the patient in these cases.