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Common Medications Used for Infertility

 
Listed below are some common medications you may be asked to take as a surrogate, Gestational Carrier or an egg donor or if you are going through the IVF or IUI process. Please note that although the common dosage is also provided it is pertinent that you follow your own doctors orders. 
 

Infertility Medications

Oral

Clomid, Serophene  (clomiphene citrate)  50 mg tabs

Binds with estrogen receptors, pituitary thinks estrogen level is too low and releases more endogenous FSH to drive the ovaries to make follicles, thus estrogen.

May start on CD 3 or 5

Usual starting dose is 50 mg PO QD for 5 days

Usually increase in 50 mg increments

Max dose is usually 200 mg PO QD

Occasionally taken for greater than 5 days (8-10) especially in PCOS patients who may be resistant to lower doses.

Can cause poor cervical mucus and a thin endometrium

75% of pregnancies occur in the first three cycles. Usually take for 3-6 cycles then move on to injectable gonadotropins.

Metformin  ( glucophage  a biguanide)

Primary action is to reduce hepatic glucose output and increase glucose uptake in peripheral tissues.

Used in PCOS patients who may or may not be insulin resistant

Usually start with 500 mg po QD x 1 wk, then BID x 1 wk, then TID x 1 wk

Many c/o GI disturbances

May be used in conjunction with Clomid/Serophene

Some MDs will discontinue with a positive pregnancy test and others will continue.

OCPs     (monophasic birth control pills)

Used to prime estrogen receptors on the ovaries, prevent or eliminate cysts, time the start of other meds ie. Lupron and synchronize DE cycles

Start day 2 or 3 of period for at least 10 days but usually 21-28 days

Provera  10 mg

Used to induce period (withdrawal bleed) in anovulatory women

Usually 10 mg po for 5-10 days

Usually get LMP within 3-5 days of last provera pill

Need to have adequate E2 level or may not get period

Should check BhCG and P4 levels before giving

Estrace   0.5mg   1 mg   2 mg tablets

Oral estrogen tablet used for FET, DE Recipient and Gestational Carrier cycles to mimic Follicular Phase estrogen priming of the endometrium.

Zithromax   250mg tabs

Broad spectrum antibiotic very often used as a one time prophylactic dose of

1 gram (4 tabs) at start of IVF cycle to eliminate bacteria in reproductive tract

Doxycyline  100 mg

Antibiotic very often used prophylactically to eliminate bacteria in the reproductive tract or to treat an infection

Medrol  4 mg and 16 mg   and Tetracycline 250 mg

Medrol is a steroid and tetracycline is an antibiotic

Most frequently used together in IVF cycles and FET cycles when the embryos will have Assisted Hatching (AH). This involves making a small opening in the outer covering of the embryo which might make it easier to “hatch” and implant in the uterus. These 2 drugs used together are intended to prevent the women’s immune system from recognizing the foreign embryo and reacting to it and to protect the embryo from infection.

PNV   Prenatal Vitamins        lots of different brands

Take one pill a day starting at least 3 months before attempting pregnancy.

The most important component is folic acid which helps to prevent neural tube defects such as spina bifida.

Injectable meds

Gonadotropins

These drugs are the hormones that stimulate the ovaries to make more eggs than they would on their own, normally just one each month. They are the hormone FSH (follicle stimulating hormone) which stimulates the development of follicles containing eggs on the ovaries. Injections are usually given SC in the abdomen or thigh.

Bravelle  (urinary FSH)  75 IU vial    

Must be mixed with diluent each time.

Use 3 cc syringes, SC or IM injection

Follistim AQ cartridge for use with the Follistim Pen 

(recombinant FSH, premixed, prefilled cartridge which is inserted into a pen that resembles a fountain pen, comes with SC needles)

300 IU      600 IU    900 IU cartridges

Gonal-f ® RFF

(recombinant FSH) 

75 IU vials   must be mixed with diluent each time

Use 3 cc syringes with SC needles

Gonal-f® Multidose

Multidose vials containing either 450 IU or 1050 IU

Must be mixed with diluent 1st time, comes with syringes marked in units

SC injection

Gonal- f® RFF Pen

(recombinant FSH in a premixed, prefilled, ready to use pen devise)

300 IU     450 IU     900 IU pens

SC injection

Menopur (highly purified HMG which contains both FSH and LH)

75 IU vials must be mixed with diluent each time

Use 3 cc syringes, can be given SC or IM

Repronex  (urinary HMG which contains both FSH and LH)

75 IU vials must be mixed with diluent each time

Use 3cc syringes, can be given SC or IM

GnRH Agonist

This drug is given to quiet/suppress the pituitary/ovaries before stimulation with gonadotropins usually in IVF cycles. It prevents ovulation (releasing eggs) before egg retrieval. Given as a SC injection every day in the abdomen or thigh.

Lupron (leuprolide acetate)

2 week kit   premixed multidose vial with syringes in units  

Lupron Microdose (leuprolide acetate diluted to specified strength by the pharmacy)

Multidose vial with syringes in units 

GnRH Antagonists

This is another class of drug that prevents ovulation (releasing eggs) before egg retrieval in IVF cycles. Given as a SC injection every day, once started, in the abdomen or thigh.

Cetrotide   0.25 mg or 3 mg vial with diluents and syringe

Ganirelix Acetate   250 mcg prefilled syringe 

Drugs to Induce Egg Maturation/Ovulation

Used in both IUI and IVF cycles to mature the eggs and cause ovulation (release of egg from the follicle) once they are big enough. Ovulation occurs 36 to 40 hours after the injection. In IVF cycles timing is crucial, usually given 34 hours prior to egg retrieval so that eggs mature but do NOT ovulate before egg retrieval.

HCG   Novarel  Pregnyl      (urinary HCG) 10,000 unit vial with diluent

 SC or IM with 3 cc syringe

Ovidrel      (recombinant HCG) 250 mcg prefilled syringe for SC injection

Luteal Phase Support

All of these medications provide progesterone which helps to continue development of the endometrium (lining of the uterus) so that the embryo has a nourishing, receptive environment for implantation and pregnancy support.

Progesterone is very important in early pregnancy to prevent bleeding.

Progesterone in Oil  50 mg/ml 10 ml multidose vial for IM injection with 3cc syringe

Progesterone Vaginal Suppositories   various strengths

Insert in the vagina where the suppository melts and progesterone is absorbed by the vaginal blood vessels

May be QHS, BID or TID

Prometrium Capsules  100 mg can be used orally or vaginally

QHS, BID or TID

Crinone 8% GEL   6 per box  prefilled gel vaginal applicator

May be used QHS, BID or TID

Endometrin   progesterone vaginal insert 100 mg with applicator

May be used QHS, BID or TID

 

OTHERS

 Vivelle or Climara patch  0.05mg or 0.1 mg

Estrogen patches usually used for HRT allow transdermal absorption of estrogen. Can be used in FET, DE Recipient and Gestational Carrier cycles to provide additional estrogen to prepare the uterus for pregnancy

 

Gina Paoletti-Falcone, RN, BSN is the Clinical Services Manager at Freedom Fertility Pharmacy, the leading fertility specialty pharmacy in the US (www.freedomfertility.com). Prior to joining Freedom, Gina worked as a fertility nurse and as a Clinical Services Manager at one of the largest fertility practices in the Boston area for 16 years. Gina developed the Freedom MedTEACH website, an on-line patient educational resource with video instruction for all the injectable fertility medications, because she believes that patients’ anxiety over injectable medication administration can be addressed by giving them control over when and how often they  have the opportunity to review the information, including when they are ready to administer their medication.

 

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