IVF treatment is one of the treatments that assist pregnancy. In the treatment, male and female cells are combined in a laboratory environment and the resulting embryo is transferred to the woman's uterus. The goal of this treatment is to obtain a sufficient number of healthy embryos. The woman's age, egg reserve in her ovaries, and hormone levels play an important role in determining the drugs to be used in IVF treatment. The dose and method of use of the drugs are determined as a result of the tests performed. A special treatment is applied to each patient. In IVF treatment, the drugs are started to be used on the second or third day of the woman's period.
However, in some patients, it can be started on the 21st day of the menstrual period. If the dosage of the drugs used is not adjusted well, if the patient is given a high dose of drugs, OHSS, an overstimulation disorder of the ovaries, may occur. Therefore, the use of drugs in treatment is very important. In line with technological developments, new and effective drugs are being developed. The purpose of using drugs in treatment is to increase the pregnancy rate by ensuring that the ovaries reach sufficient size and sufficient follicle development. The drugs used during in vitro fertilization treatment are applied during the egg stimulation and collection phase.
Drugs used to suppress egg production and physiology
GnRH Analogs (Lucrin and Decapepty): The purpose of these drugs is to prevent premature ovulation and suppress normal physiology. It is a synthetic form of the hormone released from the hypothalamus in the brain. It can be given to patients by nasal spray or injection.
Stimulating injections (Menogon, Puregon, Merional, Menopur, Fostimon, Gonal-F): Women normally produce only one egg during the menstrual period. However, a large number of eggs are needed for successful in vitro fertilization treatment. After the drugs used to suppress physiology, stimulating injections are administered to obtain a large number of eggs. The effectiveness and reliability of the drugs used are quite similar. Stimulating injections can be administered to the patient under the skin or into the muscle. However, it is generally preferred to be administered subcutaneously. If an intramuscular injection is to be made, the upper outer part of the hip is preferred, and when a subcutaneous injection is made, the arm, the front part of the thigh and the anterior abdominal wall are preferred.
The drugs used in the treatment should be stored in the refrigerator at +4 degrees. However, even drugs kept at room temperature can be stored for a long time. In order not to decrease the effectiveness of the drugs to be used, they should not be kept at room temperature in the summer months. In order to start drug treatment, ultrasound and blood estrogen levels are measured on the 2nd-4th day of the menstrual period. The stimulating injections to be administered to the woman should be done at the same time every day. Since the dosage of the drugs is determined daily in patients, these doses should be followed.
What are the side effects of the drugs used to stimulate the ovaries in IVF treatment?
There are no serious side effects of the drugs used to stimulate the ovaries during treatment. The most important side effect of the drugs is the development of ovarian hyperstimulation syndrome (OHSS) in women with many eggs due to excessive stimulation of the ovaries. In this problem, excessive water retention occurs in the body and weight gain occurs. OHSS development occurs after embryo transfer. If the following effects are observed, the patient should contact their doctor immediately.
Excessive swelling in the abdomen
Some bloating, pain and tension in the abdomen are normal. However, if these effects are excessive, a doctor should be informed.
Gaining weight suddenly and rapidly during the day
If there is a noticeable increase or decrease in urine output
If loss of appetite and severe nausea occur
If you experience shortness of breath, you should definitely see a doctor.
Medicines used to mature and crack eggs
GnRH Antagonists (Cetrotide, Orgalutran): These drugs are used to prevent premature ovulation.
Egg cracking needle – HCG (Pregnyl, Ovitrelle): In order for the eggs needed for treatment to reach maturity, their diameter must be approximately greater than 15 mm. In the treatment, HCG is applied when 3 or more eggs exceed 17 mm and mature or when the E2 level exceeds 500 pg/ml. The purpose of the cracking needles is not to ensure that the eggs crack. The needles are only applied for the eggs to reach their final maturity. The eggs must be collected from the patient before they crack. The egg collection phase begins 36 hours after the HCG is applied. It is very important to pay attention to and comply with this period.
Pregnyl: This drug used in treatment consists of 5000 units of powder and solvent water. There is 1 powder and 1 water in the box. The drug is usually used in the form of 2 doses of powder and 1 dose of water, applied intramuscularly and from the hip. Ovitrelle is administered subcutaneously by mixing 1 dose of powder containing 250 mg and 1 dose of water. Although these drugs can be stored at room temperature for a certain period of time, they should be kept in the refrigerator at +4 degrees in the summer to maintain their full effectiveness.
Drugs used to desensitize the ovaries
Femara: These drugs are used in patients who are expected to have very weak ovaries. Drugs are preferred to make the ovaries more sensitive.
Medicines used to prepare the uterine wall
Progesterone (Crinone, Proluton): Progesterone hormone is released from the ovaries and prepares the uterine wall for the embryos to attach. When IVF treatment is applied, external progesterone hormone supplementation must be provided. The administration of this hormone begins the day after the egg collection procedure. Hormone supplementation continues until the 10th week of pregnancy, with the establishment of pregnancy. Crinone in gel form is applied vaginally once a day in the morning. It is applied in the evening on the day of embryo transfer. The woman does not need to lie down for a long time during these applications. In addition, this application has no side effects on pregnancy. It may only cause a small amount of vaginal discharge in the patient. Proluton is applied intramuscularly as half an ampoule in 4-day periods. The remaining half ampoule of the drug is not used again. The use of progesterone hormone can cause slight weight gain and mood swings in women. If pregnancy is not achieved at the end of the treatment, the woman's menstrual periods may be delayed due to the use of progesterone hormone.
Drug protocols used during IVF treatment
After examining the patients, the necessary information is given about the method of use and dosage of the drugs. The drug protocols used in IVF treatment are generally as follows.
Long protocol (Luteal Long Lucrin Protocol): This drug protocol starts with Lucrin on the 21st day of the menstrual period. Ovarian stimulating treatment is applied to the patient on the 2nd-4th day of the menstrual period. When stimulating injections are started, the Lucrin dose is reduced. Lucrin is continued until the ovulation injection is used.
Birth control pill long protocol (Oral contraceptive OC – Luteal Long Lucrin Protocol): This drug protocol is applied to patients with excessive ovarian stimulation. Drugs are started on the 3rd day of menstruation with the use of birth control pills. Lucrin is started on the 15th day of the drug. Ovarian stimulating treatment is started on the 2nd-4th day of the menstrual period. The injections should be given to the patients at the same time every day.
Diluted Lucrin Protocol (OC Microdose Protocol): This drug protocol is applied to patients with poor ovarian response. It is considered the most powerful stimulation protocol in the ovaries. In order to use birth control pills, patients over the age of 35 should not have high blood pressure problems and should not have a smoking habit.
Short Protocol (Antagonist Protocol): This drug protocol is started with an ultrasound and blood estrogen levels checked on the 1st-3rd day of the menstrual cycle, and with ovum stimulating injections administered at the same time each day. Patients are kept under surveillance until they start using the cracking injections.
Ovarian Sensitizing Protocol (Femara Protocol): This drug treatment is started with ovarian stimulation treatment on the 1st-2nd day of menstruation. The patient is kept under constant surveillance and the treatment is continued until the trigger shot is used.
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