Drugs

DRUGS COMMONLY USED IN ASSISTED REPRODUCTIVE THERAPY

Important Note: For a more detailed explanation of these drugs please refer to the consumer information leaflet found with each medication when dispensed.

CLOMID

Although it is also sold under the brand name Serophene, Clomiphene is most commonly referred to by its other brand name, Clomid. Used in women with ovulation problems, Clomid is a very common, inexpensive and popular type of fertility treatment. Used to help regulate or induce ovulation, clomiphene assists in increasing follicle production in the ovaries. Clomiphene is taken orally, usually on days 2-6 of the menstrual cycle. In order to regulate ovulation, Clomid sends a message to the pituitary gland, telling it that it needs to start secreting, or needs to secrete more, Follicle Stimulating Hormone (FSH). Because of the higher level of FSH in the body, egg production and ovulation is improved.

Since Clomid helps to increase the number of eggs that are produced, this fertility medication is also used in women who are undergoing assisted reproductive techniques such as IVF and who require multiple eggs to be retrieved.

Dosage and administration

While Clomid can be prescribed for as many as six cycles, many experts agree that, if a pregnancy hasn’t occurred within the first three cycles, it is unlikely to occur at all with this type of treatment. Most women will respond to clomiphene and ovulate within the first four cycles.

Side effects of Clomid

In general, the side effects of Clomid tend to be fairly mild. While there are a number of severe side effects, these tend to mainly be associated with higher doses of the drug. Common Clomid side effects include:

  • Multiple pregnancy
  • OHSS or Ovarian Hyperstimulation Syndrome (very low risk)
  • Hot flushes
  • Mood swings
  • Nausea and vomiting
  • Breast tenderness
  • Abdominal pain
  • Headaches
  • Blurred vision
  • Fatigue
  • Depression
  • Weight gain
  • Ovarian cysts

In the past, there was also thought to be a link between ovarian cancer and Clomid use. However, this link has been disputed and more recent studies have not been able to find a link between the use of fertility drugs and ovarian cancer.

Storage

There are no special storage requirements for Clomiphene.

GnRH AGONIST (SYNAREL / LUCRIN)

IVF and IUI treatments can sometimes be compromised if ovulation does not occur at just the right time. Many women ovulate prematurely which lowers their chances of pregnancy through assisted reproductive therapy. GnRH (Gonadotrophin Releasing Hormone) agonists can help to stop premature ovulation, thus increasing the chances of pregnancy during IVF and IUI treatments.

When ovulation occurs early, eggs tend to be of a lower quality and less useful for use in IVF. GnRH agonists work by essentially ‘shutting down’ the pituitary gland. The pituitary gland is a tiny gland located in the frontal portion of your brain, just behind your nose. It secretes LH and FSH to trigger ovulation. When first commenced, GnRH agonists overstimulate the pituitary, causing it to release more FSH and LH. When it senses this over-stimulation, the pituitary gland then shuts down, preventing ovulation from occurring.

Dosage and administration

GnRH agonists are typically prescribed in combination with ovulation stimulation medications. GnRH agonists are given in the form of injections (Lucrin) or as a nasal spray (Synarel). They are typically given once or twice a day, for several days, after which ovulation stimulators are administered.

Side effects of Synarel and Lucrin

When taken without ovulation stimulators, GnRH agonists cause similar side effects as incurred with menopause. Common side effects include:

  • Hot flushes
  • Mood swings
  • Forgetfulness
  • Insomnia
  • Headaches
  • Decreased libido

Storage

Protect GnRH agonists from light. Store containers in an upright position and do not refrigerate or freeze. Shelf life is around 18 months when stored below 25 degrees.

GnRH ANTAGONISTS (ORGALUTRAN AND CETROTIDE)

Orgalutran and Cetrotide are used to prevent premature ovulation and are used in combination with follicle stimulating hormone (FSH). An antagonist should be injected subcutaneously once daily, preferably starting on day 6 of FSH administration, or when follicles grow to approximately 12-14 mm in size. Treatment is continued daily until the follicles have reached maturity. Alternatively a single injection of these drugs can be used at a higher dose.

Dosage and administration

This medication is administered daily by subcutaneous injections, that work by reducing the body’s release of LH (luteinising hormone) which triggers ovulation. The antagonist’s therapeutic effect is immediate. However, the action is short-lived and daily injections are necessary to maintain their effect. Injections are administered for approximately 2-5 days before egg collection. By using this medication it allows the continued stimulation of follicle growth whilst preventing premature ovulation prior to egg collection.

Side effects of Orgalutran and Cetrotide

Common side effects of antagonists include:

  • Headaches
  • Nausea
  • Swelling or itching
  • Redness at the site of injection Orgalutran may cause abdominal discomfort.

Storage

Store below 25 degrees and protect from light.

FOLLICLE STIMULATING HORMONE (PUREGON AND GONAL F)

Follicle Stimulating Hormone (FSH) is marketed in Australia as either Puregon or Gonal F. They are both delivered as subcutaneous pen injections and are very similar to the natural hormone follicle stimulating hormone (FSH). They are produced by recombinant DNA technology.

FSH stimulates the ovaries to produce more follicles than usual in a natural cycle. This results in super ovulation, so more eggs than could normally be expected can be retrieved.

Dosage and administration

FSH injections are normally administered for 8 to 12 days. This will vary depending on the response of the ovaries. Your IVF doctor will prescribe your dose and if you need more than one treatment cycle, it will be reviewed and sometimes altered in order to achieve the best possible stimulation. FSH injections are most commonly used in combination with an agonist (Synarel or Lucrin), or an antagonist (Orgalutan or Cetrotide). Your IVF nurses will provide lessons on how to prepare and inject the drug so that you can self-administer.

Side effects of Puregon and Gonal F

Most common side effects include:

  • Slight abdominal distension
  • Mild abdominal discomfort
  • Breast tenderness
  • Bruising and irritation at the injection site
  • Tiredness, especially on higher doses
  • Multiple pregnancy

The most severe side effect is:

  • Ovarian hyperstimulation syndrome (OHSS). This is a potentially dangerous condition if not managed appropriately. Refer to information on risks and side effects.

Storage

Store in original box and refrigerate to between 2-8 degrees.

OVIDREL AND PREGNYL (hCG)

Human chorionic gonadotropin (hCG) is produced by the placenta in pregnancy and sets up the cascade of events that causes production of progesterone by the corpus luteum. hCG levels are measured to confirm pregnancy.

Human chorionic gonadotropin (hCG) can be used to trigger ovulation in women undergoing stimulated IUI (intrauterine insemination)and assisted reproductive technology cycles such as IVF. In a normal ovulatory cycle, a surge of LH triggers ovulation and release of the egg(s). The body responds to hCG in the same manner as it does LH, therefore a surge of hCG also initiates ovulation. In most cases, patients receiving GnRH antagonist or agonist therapy and FSH injections can only ovulate when they are given an injection of hCG or LH. Therefore the insemination or egg retrieval can be precisely timed for 36 hours after the hCG injection. Pregnyl is human derived and Ovidrel is a recombinant synthetic product.

Dosage and administration

Ovidrel is delivered as an injection and comes as the standard dose of 250mcg. hCG is also an injection but comes with doses varying between 1500 international units and 10000 international units.

Side effects of Ovidrel and Pregnyl

Common side effects include:

  • Injection site soreness/redness
  • Headaches
  • Tiredness
  • Nausea/vomiting
  • Abdominal pain

Storage

Store in original box and refrigerate at temperature between 2-8 degrees. Do not freeze and protect from light. Product has a shelf life of 3 years and should not be used after the expiry date.

PROGESTERONE (PROGESTERONE AND CRINONE)

Progesterone pessaries and Crinone contain the hormone progesterone, which is normally produced by the ovaries in the second half of the menstrual cycle and during the first weeks of a pregnancy. Progesterone may be prescribed after embryo transfer in a stimulated cycle to ensure the lining of the uterus is optimal for implantation of an embryo. Some women may use progesterone in combination with oestrogen tablets when having frozen embryos replaced or with donor gametes. In these cases if a pregnancy occurs, progesterone has to be continued for approximately 6-12 weeks after the pregnancy test.

Dosage and administration

Progesterone pessaries or Crinone are administered vaginally and are necessary for the preparation and maintenance of the endometrium for pregnancy. Unfortunately the vaginal route of giving the drug is most effective. Progesterone administration is necessary in the first instance for 2 weeks, but if a pregnancy is achieved then a patient may be required to take progesterone for up to 12 weeks.

Note: If a period does not come, you may not necessarily be pregnant as the progesterone may be preventing the bleed.

Side effects of Progesterone

Pessaries can cause vaginal and labial irritation and soreness. As the pessaries melt a small amount will discharge vaginally. A panty liner protects underwear. In rare cases a patient may be allergic to these substances.

Storage

Progesterone pessaries should be refrigerated to maintain effectiveness. Crinone does not require refrigeration.

PROGYNOVA

Progynova is a synthetic hormone replacement for oestrogen. It is used to build up the lining of the uterus in preparation for embryo transfer during a frozen embryo transfer cycle.

Dosage and administration

Progynova is usually taken daily starting on day 1 of the menstrual cycle. You will receive your dosage regime prior to the start of your cycle. The medication is taken until the day of the pregnancy test and if the test confirms pregnancy, the tablets are continued for another six weeks. If the test is negative, the tablets are stopped and a period will start within a few days.

Side effects of Progynova

Side effects are uncommon, but breast tenderness, gastric upset, nausea, headaches and an increase in bodyweight have been reported.

Storage

No special requirements.

 


 

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