The role of medications in an IVF or egg freezing cycle

29 January 2024

Dr Montse Amodeo

The role of medications in an IVF or egg freezing cycle

If you’re new to IVF or egg freezing, taking hormonal medication can be extremely overwhelming, particularly when you’re injecting yourself.

So we asked Dr Montse Amodeo to write a blog to break down the purpose of each type of medication typically used during an IVF cycle, so you can understand the purpose of each medication and help you feel more informed and confident throughout your IVF or egg freezing journey.

Why is medication used in IVF or egg freezing?

Medication plays a pivotal role in the processes of IVF (In Vitro Fertilization) and egg freezing. These medications are instrumental in stimulating the ovaries to produce multiple eggs, a process known as ovarian stimulation.

Typically, the body naturally matures only one egg per menstrual cycle, but fertility drugs can prompt the production of several eggs to increase the chances of successful fertilisation.

These medications are essential for controlling the timing of egg maturation and optimising the harvest of mature eggs, thereby increasing the chances of success in IVF treatments and egg freezing procedures.

Why might I be using a different medication to someone else I know who’s had treatment?

Thanks to Google, social media and various fertility forums, we often get patients comparing their treatment plans with someone else who may have had success.

But it’s important to understand why your plan is different to someone else’s. Each person’s treatment protocol should be tailored to their individual needs, medical history, and, if relevant, their response to previous treatment. Therefore, not every patient will require all of these medications, and some may need additional medication.

Which is why we only believe in personalised treatment plans at The Evewell, because every body is different, right?

And then before you even start your IVF or egg freezing cycle at The Evewell, every single patient will have a face-to-face nurse consultation.

In this meeting, the nurse will go through every single medication and demonstrate exactly how to use the different types, as well as explain why you are taking these, when to take them and if there are any specific storage details you need to be aware of.

If you aren’t having treatment at The Evewell, we recommend you speak to your doctor and ask both why these medications have been prescribed to you, and advice on how to take the medication, as each one listed below has a very different application method.

Let’s take a look at the typical medications used in an IVF or egg freezing cycle.

Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists:

GnRH agonists, such as Buserelin are used to suppress the pituitary gland to prevent premature ovulation. This allows the fertility specialist to control the timing of egg retrieval and ensures that the eggs don’t release too early.

If you are using these fertility drugs, you are most likely having a “Long Down Regulated Protocol” or a “Long Protocol”.

On the other hand, GnRH antagonists like Fyramadel and Cetrotide act rapidly to prevent premature ovulation but without the initial flare effect seen with agonists. They’re usually started later in the stimulation phase on Short Protocols.

A lot of clinics use this medication to align their patients with their internal timings, so they can time egg collections and theatre operating schedules. At The Evewell, we don’t believe in outing you on unnecessary medication, and unless there is a specific medical or timing reason why, you will generally go on a short protocol and miss this stage.

This means extra work for us, and sometimes egg collections or embryo transfers on a weekend, but it’s better for you – and when your body is going under enough during an IVF or egg freezing cycle, why add more stress?

Follicle-Stimulating Hormone (FSH) and Luteinising Hormone (LH)

FSH (e.g., Gonal-F, Menopur, Fostimon, Bemfola) and LH (e.g.: Luveris) or a combination of both, as found in Pergoveris, are used to stimulate the ovaries to produce multiple eggs, enhancing the chances of successful fertilisation. These hormones mimic the body’s natural processes but on a more potent scale.

You may have been prescribed a few different medications to inject yourself during this time. Don’t be afraid to ask your doctor why this is the case and if you have any questions, including when to take the medication, and how much – again: always check and make sure you understand the instructions.

During this stage of IVF or egg freezing, you can expect to be injecting yourself for between 10-12 days, and during this time you will need to attend the clinic every 2-3 days for an ultrasound scan to check on how your follicles are responding to the medication.

At The Evewell, we sometimes take a blood test at this appointment, and once your results have been analysed by the whole team on our daily “All Hands” meeting, you’ll get a phone call before 7pm if there are any changes to your medication, such as increased or reduced dosage.

Human Chorionic Gonadotropin (hCG)

Once the eggs have matured, you’ll be given an injection of hCG (brands include Ovitrelle and Gonasi). This “trigger shot” initiates the final maturation of the eggs and loosens them from the follicle walls, preparing them for retrieval.

hCG is indeed a pregnancy hormone, and this can be a bit confusing for some patients as to why are they using them in an IVF or egg freezing cycle, but this hormone mimics the LH surge that happens when you ovulate.

The reason why we closely monitor you during your treatment cycle is so we can identify the optimum time for egg collection. You’ll be given an exact time to take this injection, and the timing is important as the egg retrieval will happen 36 hours afterward. If you delay the injection, and the procedure takes time at the time it was planned, you may not get any mature eggs.

Any delay in taking this medication can also mean delays to other patient’s egg collection, meaning they may also miss their slot. So when the nurse gives you your time, you must check you a) have the right amount of medication, b) understand how to use it and c) set the alarm!

Progesterone

After the eggs have been retrieved, and before the embryos are transferred, progesterone is administered in preparation for a fresh or frozen embryo transfer. This hormone prepares the lining of the uterus for implantation and supports early pregnancy until the placenta can produce its own progesterone.

After natural ovulation, the follicle that releases the egg will start producing progesterone, at this time the ovulatory follicle is called Corpus Luteum (yellow body). As the content inside the ovulatory follicle is aspirated at egg collection, the production of progesterone will be compromised and therefore is externally supported.

During a frozen embryo transfer we often suppress ovulation and therefore Progesterone will be required as well.

You may be prescribed different application methods of progesterone, for both a fresh and a frozen embryo transfer, depending on what your personal fertility history and natural hormone levels are. If you’re in cycle at The Evewell, these levels will be checked at various stages leading up to your embryo transfer, and in some cases, in the first few weeks of pregnancy.

Here are some of the more common progesterone medications you may be prescribed for the first 12 weeks of your pregnancy.

• Cyclogest is administered as a pessary, either vaginally or rectally. We recommend you speak to your doctor who can advise the best application method for your lifestyle.
• Lubion is administered subcutaneously, as an injection, into your stomach every day.

Estradiol

Estradiol (E2) is the primary form of oestrogen in your body during your reproductive years. It’s the most potent form of oestrogen and it helps to grow and maintain your uterine lining and sustain a pregnancy. It also helps your placenta function, boosts blood flow to your uterus and primes your body for breastfeeding.

Estradiol is found in medications such as Progynova and is used to help prepare the uterine lining for implantation, or during the frozen embryo transfer cycle to coordinate the timing of transfer.

Similar to Progesterone, you may be asked to continue taking Estradiol up until around 12 weeks of your pregnancy, then taper off.

Note: This blog post is for informational purposes only and should not be considered medical advice. For personalised guidance, please consult with a doctor.