There are so many IVF injections. They do so many different things. Today, I am going to
discuss the IVF injections which are used to mature the eggs in the ovaries. Stay tuned.
In most adult women, there are hundreds of thousands of eggs resting
in the ovaries. These eggs have not yet developed the ability to be fertilized.
We describe these eggs as being immature. To become fully mature,
the eggs need the help of certain hormones. During natural ovulation, these hormones, called
FSH and LH, come from the pituitary gland. The body regulates these hormones so that typically,
only one egg becomes fully mature and is released through the process of ovulation.
Part of the reason that IVF is such a successful fertility treatment
is the use of fertility medications to mature many eggs at the same time. These
medications contain the same hormones as the pituitary gland or ones that are very similar.
The hormone which is needed to start the egg maturation process is FSH or
follicle stimulating hormone. Some fertility medications contain FSH alone. Examples include
Follistim and Gonal F. Other brands of medication contain a mixture of FSH and other hormones.
One common brand is called Menopur. Whether given alone or as part of a mixture, it is primarily the
FSH in the medications that can start the eggs on their journey toward maturation.
Remember that each egg is located inside a small cyst called a follicle.
As the eggs mature, the follicles grow larger. This can be seen and measured on
ultrasound. It is how your doctor monitors how you are responding to the medication.
The hormones work by attaching to receptors on the outside of the follicle cells.
As the eggs mature, the hormones that they need to keep maturing are changing.
The need for FSH is decreasing and the need for the other pituitary hormone,
LH, is increasing. When your doctor sees that the follicles have started to grow,
it is important to start changing the medications from ones containing FSH to medications containing
LH. There are a few options for doing this. If you are already using a combination medication,
like Menopur, your doctor may simply increase the dose. If you were using a medication that
only contains FSH, then your doctor may decrease the dose of FSH and start you
on a new medication which contains LH called Luveris. Luveris is very expensive however.
For this reason, it is not very commonly used. A 3rd option is to use a medication called hCG.
There are several brands of hCG available in the US. Some common ones are
Pregnyl or Profasi. The hCG hormone is very similar to LH. Because of this similarity,
hCG is able to attach to the same receptors in the follicle as LH does. During IVF cycles,
using hCG injections has a couple of big advantages over using LH injections. First,
hCG is very sturdy, so it lasts in the body for a long time instead of being broken down. This
makes it a very reliable way to stimulate the LH receptors. Second, it is about six
times more potent than LH so a little goes a long way. Third, it is a lot less expensive.
You may have heard about two other IVF injections that are used to stimulate the eggs to mature.
These two medications are primarily used for women who don’t respond very well to fertility
medications. One medication, Lupron, is mostly used to keep ovulation from happening too soon.
I talked about Lupron in part 1 of this series last week. The other medication
growth hormone, I covered in this episode.
A question that I am asked frequently is whether one type of medication gives a higher chance for
pregnancy than another. Studies comparing IVF medications are very difficult to do. Although
there are theoretical reasons why one type of medication may work better for some IVF patients,
as of now, the studies that have been published have not shown conclusively that one type of
medication or one brand of medication gives a higher chance for pregnancy than another.
This episode is part of a 3 part series on IVF injections. Check out this playlist for all the
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