Fertility Treatment Medication
There are many drugs that are used when a couple undergoes a fertility treatment (IVF, insemination, egg donation, etc.). Some are very simple to use and have virtually no side effects and others are more complex and have greater side effects.
We shall now discuss the most commonly used drugs, what they are and their side effects. It should be noted that most medication is hormonal or works on that level, so that side effects in many cases will be similar to those which a woman may generally feel during her cycle or indeed during pregnancy.
Gonadotropins
Are the fertility drug par excellence. They serve to stimulate controlled function of the ovaries so that eggs can then be collected after being developed in them. They are mostly injectable, either intramuscularly or subcutaneously.
The brands of this drug are as follows and you can watch the following videos which outline in a simple way the correct way to administer them:
Rekovelle®
Its active ingredient is follitropin delta, which belongs to the group of hormones known as gonadotrophins. This type of hormone induces the development and growth of numerous ovarian follicles, which is why it is used in women undergoing assisted reproduction treatment.
The drug’s dose in the first ovarian stimulation treatment will be calculated by your doctor based on your blood levels of anti-mullerian hormone (AMH) and your body mass index (BMI). It is therefore necessary to have the AMH values and the woman’s body weight before starting treatment.
The route of administration is subcutaneous. The drug comes in the form of a pre-filled pen.
Prolutex®
Its active substance is progesterone. It is indicated for women who need extra doses of progesterone in the context of assisted reproduction treatment and who cannot use or tolerate vaginal preparations.
Prolutex can be injected either subcutaneously or intramuscularly. In general, it’s usually self-administered (self-administration) subcutaneously.
It is available as vials containing lyophilised powder and vials of liquid solvent. Reconstitution should be carried out at the time of administration.
Meriofert ®
Its active substance is a highly purified human urinary menopausal gonadotropin. It contains both FSH (150 IU) and LH (150 IU).
The aim of this treatment is to obtain multiple and simultaneous follicular development.
Meriofert can be injected either subcutaneously or intramuscularly. In general, administration is usually performed by the patient herself (self-administration) subcutaneously.
It is available as lyophilised powder vials and liquid solvent vials. Reconstitution of the vial with the lyophilised powder should be carried out just at the time when the medication is to be administered.
Ovitrelle®250 µg/0.5 ml
The active principle in Ovitrelle is recombinant hCG human chorionic gonadotropin hormone. This pharmaceutical drug completes oocyte maturation and triggers ovulation around 36 hours after it has been administered. Depending on if we wish to perform artificial insemination (AI) or in vitro fertilisation (IVF), it is used one way or another. It must always be administered at the same time on each occasion. As ovulation approaches, symptoms can resemble the symptoms that women experience over the days prior to menstruation.
This medicine is administered subcutaneously. In other words, it is injected into the skin, generally around the abdomen.
Elonva®
Elonva contains active principle corifollitropin alfa. It is a gonadotropin which is similar to the follicle-stimulating hormone (FSH). Its role consists of stimulating production of the follicles in the ovaries and oestrogen. Their levels increase over the first few days of the cycle (follicular phase).
Therefore, its main aim in assisted reproduction treatment is controlled ovarian stimulation leading to multiple follicle development.
A single 100 mg or 150 mg dose will be recommended depending on your weight and age. Your gynaecologist will advise you about the dose you should take. Seven days after taking the Elonva injection, your doctor may decide to continue the stimulation cycle using another gonadotropin hormone such as recombinant FSH. Stimulation may continue for a few days until there are sufficient follicles of an appropriate size, as confirmed during ultrasound scans.
The medicine is provided in a single pre-filled syringe with an automatic safety system which ensures that patients do not prick themselves with the needle by accident after use.
Elonva must be injected subcutaneously.
Ovaleap®
Contains the active substance follitropin alfa. This molecule contains follicle-stimulating hormone (FSH). In women, it helps follicle growth and development and helps to produce oestrogen secretion. In men, it is needed to encourage spermatogenesis.
The main aim in assisted reproduction treatment is controlled ovarian stimulation leading to multiple follicle development.
The required dose of medication will be indicated by your gynaecologist based on the ultrasound scans and blood tests that have been performed (oestradiol and progesterone levels).
It is administered by means of a subcutaneous injection using a pen device. The device must be filled using the cartridge containing the drug before it is injected.
Pergoveris®
Contains two active substances: follitropin alfa and lutropin alfa. Both belong to the family of hormones called gonadotropins. Follitropin is a molecule that is similar to endogenous FSH (follicle-stimulating hormone). Likewise, lutropin is a molecule that is similar to endogenous LH (luteinising hormone). They complement one another in order to stimulate the growth and development of ovary follicles in women who are embarking on assisted reproduction treatment.
In this case, the vials of powder must be mixed together using the solvent provided immediately before use. Administration is performed via subcutaneous injection.
Your gynaecologist will indicate the dose to be administered. The dose is determined based on each woman’s particular characteristics.
Bemfola®
This drug contains the active substance follitropin alfa. It is almost identical to a natural hormone produced by the body known as follicle-stimulating hormone (FSH). FSH is a gonadotropin, a kind of hormone that plays an important role in human reproduction and fertility. In women, FSH is needed for the growth and development of the ovarian follicles containing the ova. In men, FSH is necessary for spermatozoa production.
This drug has been designed for administration by means of subcutaneous injection using a pre-filled pen device that is for single use only. The device must be discarded following use.
Menopur® 75 & 1200
The active ingredient in both Menopur 75 and Menopur 1200 is highly purified menotrophin which is obtained from the urine of post-menopausal women. This molecule contains both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and its use in assisted reproduction is with a view to controlled ovarian stimulation to encourage the development of multiple follicles. This means we are able to obtain an adequate number of eggs for in vitro fertilisation treatment (IVF/ICSI) which will give us the greatest possible chance of pregnancy, depending on the case in each particular woman/couple.
The dose will be determined by your gynaecologist and may vary depending on ultrasound scan and blood analysis (estradiol and progesterone levels) tests carried out throughout the treatment.
Gonal®
Gonal-f contains a molecule called “follitropin alpha”. Like other gonadotrophins, its function in women is to stimulate the ovary to induce the development of several follicles simultaneously in the context of assisted reproduction techniques.
It must be kept in a refrigerator until the time of administration. After administration of the first dose, it can be kept at room temperature for a maximum period of 28 days, ensuring that the room temperature does not exceed 25 ºC. If in doubt, return the medication to the refrigerator until the next dose.
This medication is available in different forms:
- As a clear, colourless, injectable liquid in the form of a multi-dose pre-filled pen.
- As a lyophilised powder vial and a pre-filled syringe with a solvent. Once the lyophilised powder has been reconstituted, this vial will be multidose, i.e. each daily dose will be drawn up using a graduated syringe provided in the medication container.
It should be administered subcutaneously.
Puregon®
It contains “follitropin beta” as the active substance and, similarly to other gonadotrophins, it is used for the controlled induction of ovarian stimulation in women undergoing fertility treatments and/or assisted reproduction techniques.
The initial dose will be established by the fertility doctor and may be adjusted according to the follicular recruitment observed in the ultrasound and the oestrogen levels measured in the blood.
Regarding storage, the patient has two options:
- Store in a refrigerator (2-8 ºC).
- Store below 25°C for a maximum single period of 3 months.
Once the first dose has been administered, the medication can be stored for a maximum of 28 days.
The medication is presented as a clear, colourless cartridge of injectable solution. The pen or device for loading the cartridge and administering the medication will be provided by the staff of the Reproductive Medicine centre. The administration via is subcutaneous.
Fostipur®
Its active ingredient is urofollitropin. This treatment should be initiated under the supervision of a doctor specialised in the clinical management of fertility problems and assisted reproduction techniques. Its administration produces a controlled ovarian stimulation with the aim of inducing multifollicular development. The treatment will be individually adapted according to the follicular size by ultrasound and/or oestrogen levels in the blood.
It is presented in the form of lyophilised powder vials and solvent for solution for injection, which should be stored at room temperature (below 25°C). The powder vial should be reconstituted immediately before use with the administered solvent.
Fostipur can be administered intramuscularly or subcutaneously. Generally, in order to allow the patient to self-administer the medication, it is administered subcutaneously.
Gonasi Kit 5000 UI
This medicine contains urinary human chorionic gonadotropin. It is the drug responsible for completing oocyte maturation and triggering ovulation approximately 36 hours after administration. Depending on the treatment we want to perform, whether artificial insemination (AI) or in vitro fertilisation (IVF), we will use it in one way or another, always ensuring the correct chronology when administering it. As the time of ovulation approaches, symptoms may be similar to the sensation of previous days before menstruation.
The drug is administered subcutaneously, that is, injected under the skin, usually in the abdominal area.
Oral contraceptives
Are commonly used before a cycle of IVF for various reasons. Among them is to control the cycle and ensure a better response after medication.
Clomiphene citrate (Omifin®)
Is an ovulation inducer. It has been used for many years and today it continues to be used on its own or in combination with other drugs. It is easy to take and has minimal side effects.
GnRH analogues
There are several types of these and they can be administered at different times of the IVF cycle according to the effect desired. They generally serve to better control ovarian stimulation and to create a better response to gonadotropins.
Antagonists
Since their introduction in the management of IVF cycles, they have made monitoring the stimulation process more comfortable, serving to prevent early ovulation and the cancellation of the treatment.
Astarté 0.25mg / 0.5ml
Its active ingredient is ganirelix. It acts as a gonadotrophin-releasing hormone (GnRH) antagonist, joining with its receptor and inhibiting its effect; that is, suppressing the release of the follicle stimulating hormone (FSH), and in particular, the luteinising hormone (LH).
In women undergoing assisted reproduction treatments, on some occasions it is possible for premature ovulation of the oocytes to occur before the ovarian puncture is carried out. This medication, by inhibiting the premature LH surge, prevents this unwanted ovulation from occurring.
This medication comes in pre-filled syringes which contain a single dose. This dose must be injected slowly under the skin; that is, subcutaneously and preferably in the thigh.
Cetrotide®
The active ingredient in Cetroide is cetrorelix acetate which is a gonadotropin-releasing hormone (GnRH) antagonist. Its purpose is to foment the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
An antagonist means that the molecule is able to adjoin onto the GnRH receptor itself, thus blocking it and stopping it from functioning.
Therefore, cetrotide is used in assisted reproduction treatment in order to avoid premature ovulation of eggs (caused by peaks in LH) so that they can be retrieved using ovarian drilling and, in the case of in vitro fertilisation (IVF/ICSI), fertilised later in the laboratory.
Orgalutran®
The active ingredient in orgalutran is ganirelix. This molecule is a gonatropin-releasing hormone (GnRH) antagonist, adjoining onto its receptor (located in the pituitary gland) and replicating its effect. In other words, releasing follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Orgalutran is used, therefore, in in vitro fertilisation treatment, both in IVF and in ICSI with the aim of stopping egg ovulation taking place prior to ovarian drilling.
Progesterone
Typically taken vaginally in the form of an egg. It provides hormonal support in the luteal phase (after ovulation) when there is not enough or when the treatment requires it. Doses are variable and can also be taken orally.
Oestrogens
We use these drugs to prepare the endometrium and make it more receptive to embryo implantation in an egg donation treatment or when transferring vitrified embryos, etc. which in turn will lead to a normal pregnancy. It can be taken orally or transdermally.
In conclusion, the drugs used in fertility treatments can be handled differently depending on the effect that is sought in each case. This will be individualised for each couple, so that the same drug may be used in one way for one couple and in another way for another couple.