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
