What medications will I take & how will they impact me?

What medications will I take & how will they impact me?

There are 4 main types of IVF medications used in IVF treatment, down regulation drugs, stimulation drugs, maturation drugs and luteal support drugs. All of these are synthetic hormones and we will explore each of these in more detail. If you are early in your IVF journey check out our overview to the IVF process to give you a solid understanding of where the drugs fit into the process. For those who prefer video check out our video below.

IVF Down Regulation Drugs Overview

These drugs are not always given however are a common in most IVF cycles not using FET (Frozen embryo transfer) they’re specifically used to take control of your cycle by turning it off. It is quieting down your ovaries, preventing egg production and thinning your endometrial lining. It is often described as a mini menopause.

In simple terms these prevent the release of the hormones FSH and LH from the pituitary gland – which has the effect of preventing spontaneous ovulation. Oestradiol (E12) production also grinds to a halt.  These drugs are known as gonadotrophin-releasing hormone agonists and those commonly used in the UK are: –

  • Suprecur (generic name: buserelin): nasal spray
  • Suprefact (generic name: buserelin): injections
  • Lupron (generic name: leuprolide): injections
  • Synarel (generic name: nafarelin): nasal spray

Each drug has a specific dosage and protocol, so be sure to follow their instructions on administration of these drugs.

IVF Down Regulation Drugs Side Effects

If you read the patient sheet for IVF medications you will see a list as long as your arm for possible side effects of these drugs, try not to let this worry you most of them are extremely uncommon, however if you

do get some of the more concerning rare side effects or anything that you’re concerned about be sure to consult a doctor quickly. We will just look at some of the key side effects which are very common and impact a lot of women.

  • Altered Mood – You are forcing your body into a major hormonal change the reduction of Oestradiol (E12) can cause symptoms associated with hypoestrogenism (oestrogen deficiency) one of the key elements is that you are likely to feel low, irritable, frustrated, moody and all of this is completely normal.
  • Depression and anxiety – This can occur in some women and is a common side effect. Low levels of depression and anxiety are completely normal and by looking after yourself and relaxing and speaking to your support network you can often work through these. However, if it is becoming serious then your clinic should have given you details of how to seek counselling through them, give them a call.
  • Headaches – These are very common; most are dull consistent aches with the occasional migraine. These are nothing to worry about and you can use paracetamol to control these. However, if you get intense head pain that won’t ease then you should speak to a doctor.
  • Nausea and vomiting – These are fairly common, just be sure to stay hydrated and if you are struggling to eat, eat little and often.
  • Increased Thirst – This is another common side effect; just be sure to drink what you need.
  • Hot flushes
  • Tender breasts
  • Bruising at the injection site if administering through injection

IVF Follicular stimulation drugs.

These IVF medications are given in all IVF cycles except for FET and natural IVF. They are designed to put the development and maturation of your follicles into overdrive with the simple fact being more follicles = more eggs = higher chance of 1 or more good quality embryo. Most NHS clinics deem it a successful stimulation if there are 3 or more mature follicles (over 12 – 20mm).

Latest research (link to research article) shows that follicles 12-19mm on the morning of the HCG trigger injection are most likely to yield a mature oocyte. To achieve this, you’ll start injections of either follicle-stimulating hormone (FSH) known as follitropins or a combination of FSH and luteinising hormone (LH) known human menopausal gonadotrophins (hMG). The main ones used in the UK are: –

Follitropins

  • Follistim
  • Gonal-F
  • Pergoveris
  • Bemfola

Human menopausal gonadotrophins

  • Merional
  • Menopur

Follicular Stimulation Drug Side Effects

As with the down regulators, if you read the patient sheet you’ll be presented with a huge list. Also as with the other drugs if you are concerned or get any rare side effects speak to your doctor. Many of the side effects are similar if so I’ll just note them, if they are more or less common then I will note that below The common side effects are:

 

  • Altered mood
  • Depression and anxiety
  • Headaches
  • Nausea and Vomiting – this is slightly more common during stimulation
  • Hot flushes – this is slightly less common than down regulation drugs
  • Tender and sore breast – this is slightly more common than with downregulation drugs
  • OHSS –This is the one to look out for. Mild OHSS affects about 1 in 3 women and moderate to sever affects about 1 in 100 women. Polycystic ovary Syndrome (PCOS) are under 30 and have had OHSS previously are at a higher risk. There is no treatment to revers OHSS, but you can treat the symptoms. For more detailed information see the RCOG
    • Mild OHSS – mild abdominal swelling, pain and nausea this is often treated at home with paracetamol and plenty of fluid
    • Moderate OHSS – Similar to above with increased swelling due to a larger volume of fluid build-up, pain and nausea are often worse. You will need to speak to your clinic and if unable to get hold of them call 111 to see if hospital admission may be required.
    • Severe OHSS – Symptoms of moderate OHSS with extreme thirst and dehydration. You may only pass small amounts of urine which is dark in colour. you may have trouble breathing because of a build-up of fluid in your chest. A serious, but rare, complication is formation of a blood clot (thrombosis) in the legs or lungs. The symptoms of this are a swollen, tender leg or pain in your chest and breathlessness. Sever OHSS will likely require hospital treatment and if you experience any sever symptoms you must call you clinic or attend A&E.

The Human chorionic gonadotropin (hCG) trigger Drug Overview

This is the injection of the hormone which will trigger the final stage of maturation of the egg in the follicle and to ovulate. You must take this injection at a very specific time frame the reason for this is because this drug will cause you to ovulate the egg retrieval must happen before you do. The side effects are very similar to the above, so we won’t do a specific section on these.

Luteal Support Drugs Overview

This class of IVF medications are known as a progestins and contain progesterone. This is prescribed through either a pessary or suppository, which will be inserted vaginally or rectally, usually determined by your clinic. Or through an IM (intramuscular) injection. This is important as during ovarian stimulation can cause a luteal phase deficient – In simple terms this means that the corpus luteum doesn’t produce enough progesterone to sustain early pregnancy. Commonly used progesterone support drugs in the UK are

  • Cyclogest – pessary
  • Crinone – gel
  • Gestone – injection

 Luteal Support Drug Side Effects

There is another long list of side effects as with any hormone treatments the most common are as follows

  • Altered mood
  • Depression and anxiety
  • Headaches
  • Nausea and Vomiting – this is slightly more common than any other of the drugs
  • Hot flushes – this is slightly less common than down regulation drugs
  • Tender and sore breast – this is slightly more common than with downr egulation drugs
  • Changes in your libido – Your sex drive can increase or decrease
  • Cramping
  • With vaginal inserted pessaries you can experience vaginal pain and discharge
  • With rectally inserted pessaries you can experience diarrhoea and flatulence
  • If injecting you can experience some injection site bruising and tenderness

IVF Drug Conclusions and Personal Experience

As you will see a lot of the drugs have similar experiences. One thing I will say is that your journey will be unique to you, some people feel fine on one of the drugs and horrendous on the other. What I will say is don’t underestimate the altered mood, depression and anxiety. There were days where through our treatment I couldn’t stop crying at donkey adverts and then the next day I’d be jubilant with an hour later snapping at my partner for doing something ‘nice’ It was an emotional rollercoaster and yours will likely be so too.

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