IVF Drugs and Scratch Test
Drugs are an integral part of over 99% of IVF treatments in the USA. The stimulation they provide doesn’t increase the number of eggs in the last ovaries in a particular cycle, as each cycle started several months before (see eggs and follicles). The stimulation increases the number of mature eggs that can be collected from a “batch” of large follicles, in comparison to just one egg being released each cycle from a “dominant” follicle. However, stimulation isn’t possible when women have:
- High follicle-stimulating hormone (FSH) levels.
- Cysts on the ovaries.
- Fluid in the pelvic cavity (due to an increased risk of infection).
1. Gonadotropin-releasing hormone drugs
The hypothalamus makes Gonadotropin-releasing hormone (GnRH), which controls the menstrual cycle by initiating the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. These two hormones directly stimulate the ovaries to grow eggs and follicles.
Fertility clinics use GnRH drugs to control the timing of cycles and are taken before or alongside other fertility drugs. They are available as a nasal spray, daily injections, or monthly injections. There are two classes of GnRH drugs:
- GnRH agonists work by constantly stimulating the pituitary to produce LH and FSH. They create an initial increase in pituitary activity for ten days, but LH and FSH fall after this. Trade names include Synarel, Suprefact, Lupron and Zoladex.
- GnRH antagonists work by suppressing LH and FSH production from the pituitary. Their advantage is an immediate impact on the pituitary function but are less effective in promoting egg and follicle development than the agonists. Trade names include Ganirelix and Cetrorelix.
The possible side effects of these drugs are hot flushes and night sweats, headaches, mood swings, vaginal dryness, changes in breast size, acne, muscle soreness and osteoporosis with extended use.
2. Follicle-stimulating hormone (FSH)
Follicle-stimulating hormone stimulates the development of many eggs in the ovaries. It comes from two sources; either synthetically manufactured or refined from human sources:
- Synthetically manufactured FSH. The trade names include Follistim AQ, Cartridge, Gonal-F, Gonal-f RFF and Gonal-f RFF Pen.
- Human refined menotropins (hMG) (menotrophin means a fertility-altering substance; in this case, LH and FSH). Trade names include Menogon, Pergonal, Menopur, and Repronex.
The hormones are collected from the urine of postmenopausal women and are often more effective than synthetic FSH, but they’re also more expensive.
Possible side effects of FSH injections include Ovarian Hyper-Stimulation Syndrome (OHSS), which affects about 2% of women. OHSS is severe and possibly life-threatening and involves a sudden fluid build-up in the stomach or chest area. If the following symptoms are experienced, avoid sex and call a doctor:
- Severe pain in the lower abdomen.
- Nausea, vomiting, diarrhoea, bloating.
- Feeling short of breath.
- Swelling in the hands or legs.
- Sudden weight gain.
- Urinating less than usual.
3. Human chorionic gonadotropin (hCG)
The human placenta produces human chorionic gonadotropin, and it’s what pregnancy tests detect. In IVF, it’s used to stimulate the final maturing of the eggs in the follicles. It’s collected from the urine of pregnant women, and the trade name is usually Pregnyl. The possible side effects of hCG include:
- Allergic reactions include hives, breathing difficulties, swelling of the face, lips, tongue or throat. Stop the hCG and seek emergency medical help if these are experienced.
- Blood clotting is possible, so if pain, warmth, redness, numbness or tingling in an arm or leg, confusion, extreme dizziness, or severe headache are experienced, it’s wise to seek immediate medical help.
- Ovarian hyper-stimulation syndrome (OHSS) is also possible with hCG injections (see FSH medication).
The procedure involves a “scratch” or rubbing of the womb lining with a plastic catheter in the month before a transfer. Changes to the womb lining increase IVF implantation rates by 1.75x (almost double). It also provides an opportunity for a thorough examination of the uterus before transfer (issues affect 28% of patients). ii iii