Medications Used in Assisted Reproductive Technology
Medications Used in ART
Letrozole
Works as an aromatase inhibitor and increases chances of Ovulation.
Causes a reduction in oestrogen levels which then enhances the release of Follicle Stimulating Hormone (FSH) from the pituitary gland in the base of the brain, stimulating the growth of ovarian follicles which contain eggs.
Is the preferred option, when used with FSH, in IUI cycles.
In Australia, Letrozole is most commonly used to reduce the likelihood of breast cancer recurring in women with the diagnosis. Many breast cancers are oestrogen dependant and Letrozole produces a fall in oestrogen levels. It is not a chemotherapy drug. The half life of letrozole is 45 hours, meaning that it essentially disappears from the system after 9 days.
In Europe, the United States and most Australian clinics, Letrozole is used in 5-day courses to induce ovulation as well as in IVF cycles.
Letrozole is the preferred drug for use in Ovulation induction, and preparation for frozen embryo cycles at Ballarat IVF.
BENEFIT: It reduces side effects of nausea, hot flushes and, rarely, headaches (compared to clomiphene).
BENEFIT: It achieves comparable pregnancy rates to other drugs.
BENEFIT: When used in conjunction with FSH, it can be useful in improving pregnancy outcomes in women who do not produce a high number of eggs in ART cycles.
Clomiphene Citrate (Clomid, Serophene)
A synthetic hormone that causes the pituitary gland to produce more Follicle Stimulating Hormone (FSH) than in the natural cycle. We don’t routinely use Clomiphene, as there are too many side effects.
MOST COMMON SIDE EFFECTS
Ovarian Hyperstimulation Syndrome (OHSS) is uncommon and potentially serious. Most women notice no side effects. There are no long-term adverse effects. Some women have unpleasant menopause-type symptoms during the 5 days when taking the drug, and sometimes for a few days following, such as hot flushes, mood swings, breast tenderness, irritability and headaches.
Rare symptom –visual symptoms of flashing lights and halos around objects. There have been many studies to see whether there is a link between this drug and birth defects. No link has been found.
Gn RH Agonists (Synarel, Decapeptyl)
- Has been used long-term for IVF treatment in Australia.
- Works at the level of the pituitary gland to prevent the release of the hormones that bring about ovulation.
- Is most commonly used as a “trigger” injection when the woman is at risk of OHSS in “antagonist” cycles.
- Synarel is a nasal spray and is administered by inhalation.
MOST COMMON SIDE EFFECTS
Most women notice no side effects. Some women notice hot flushes, headaches and nausea.
GnRh Antagonists (Cetrotide, Orgalutran)
Used to prevent natural ovulation during IVF stimulation cycles.
Allows for a shorter treatment cycle.
Reduces the risk of OHSS.
Gonadotrophins (Bemfola, Menopur, Puregon Gonal-F, Ovaleap, Rekovelle)
A highly purified synthetic FSH, except Menopur , which is human derived, and can provide additional benefits in some situations.
Administered as a subcutaneous (just under the skin) injection.
Used to increase the amount of FSH in the woman’s circulation so that follicles in her ovary develop to the stage of ovulation or egg collection.
MOST COMMON SIDE EFFECTS
Ovarian Hyperstimulation Syndrome (OHSS) is common and potentially serious. Some women notice pain at the injection site.
Rare symptom – an itch and a generalised drug reaction rash at the injection site.
hCG – Human Chorionic Gonadotrophin (Ovidrel or Choriomon)
A hormone that occurs naturally from a developing pregnancy – used as an ovulation trigger.
hCG causes eggs to be released from the ovaries.
hCG causes the production of progesterone from the follicle that has released its egg.
Sometimes used in low doses after embryo transfer.
Sometimes used in low doses to improve egg quality during treatment.
MOST COMMON SIDE EFFECTS
Some women notice breast enlargement and ovarian tenderness.
Progestagens (Provera, Primolut)
Induces similar effects to the body’s own progesterone.
Used to control the cycle and timing of egg pick up.
This drug or the pill is used worldwide during pre-treatment to plan the woman’s stimulated cycle.
Can be used to block natural ovulation in IVF cycles instead of GnRH antagonists in some situations.
MOST COMMON SIDE EFFECTS
Side effects are rare because of the low dosage we use and the short duration of treatment. Some women notice breast tenderness, bloating and mood swings.
Oestradiol Valerate (Progynova)
Oestrogen like hormone
Used to stimulate growth of the endometrium before addition of progesterone in preparation for embryo transfer.
MOST COMMON SIDE EFFECTS
Some women notice nausea and tender breasts (similar to early pregnancy symptoms.)
Oral Contraceptive Pill (Microgynon, Levelen)
Used to regulate a woman’s menstrual periods.
Used in combination with the stimulation drugs to ensure the timing of egg pick up is predictable – to help us plan your treatment cycle.
Used widely by women to control their fertility.
Women over 37 years who smoke or who have high blood pressure may not be able to take the pill.
Women with a history of liver problems or thrombosis should avoid taking it.
MOST COMMON SIDE EFFECTS
Some women notice nausea, bloating, weight gain and mood swings.
Progesterone Supplements (Progesterone Pessaries , Utrogestan Endometrin, Crinone Gel, Prontogest, Prolutex)
Used following embryo transfer.
Used to overcome the problem of a short cycle in the second half (or luteal phase).
Used until the 10th week of pregnancy – once the placenta develops the pessaries are no longer needed, and can be reduced in usage.
MOST COMMON SIDE EFFECTS
Some women notice cramps, headaches, breast tenderness and mood swings.