What Medications Are Used During An IVF Cycle?

Ask Monica is a Q&A video series hosted by Nurse Practitioner Monica Moore.

In this video:

• Understanding Your IVF Medication Protocol
• IVF Medications: Phase 1 (Suppression)
• IVF Medications: Phase 2 (Stimulation)
• IVF Medications: Phase 3 (Preventing Ovulation)
• IVF Medications: Phase 4 (Maturation)
• IVF Medications: Phase 5 (Embryo Transfer)
• IVF Medication Protocol Additions

Understanding IVF Medication Protocols

Is your head spinning about IVF meds? Let's break down the most commonly used medications for IVF, how they all work, and how we use them to help you find fertility success.

Monica Moore:

Hi, everyone. Monica Moore here, nurse practitioner at Illume Fertility, and today we're going to talk about medications that you use during an IVF cycle.

I feel like the best way to do this is to put them into categories. I'm going to use my whiteboard for this, and we're going to talk about all the different meds that you may encounter during IVF treatment.

IVF Medications: Phase 1 (Suppression) 

The first step is to pause and coordinate before you start an IVF cycle.

What this really means is something called pituitary suppression. The pituitary gland produces hormones that would cause you to ovulate - and we don't want you to ovulate until we're ready for your egg retrieval.

We also don't want all of your follicles (eggs) growing at different rates. We want them to grow at relatively similar rates, so we need to kind of pause and "reset" things in order to make that happen. We do that by using the following:

• Birth control pills (BCPs) 
• Lupron or Estrace (estrogen), in some cases

This allows the follicles to be "paused" at around the same stage/size so that once we get to the next phase, which involves stimulation medications, they will all grow to around the same size, at the same rate.

That's because we don't want what's called follicular disparity (follicles growing at different sizes), which would leave us with, for example, one big follicle, one middle sized follicle, and one small sized follicle. When we remove the eggs from their follicles during your egg retrieval, we want to avoid immature eggs if possible, as they cannot be successfully fertilized.

IVF Medications: Phase 2 (Stimulation)

The next set of medications involves stimulating meds. These medications will act on your ovaries to prompt them to make a certain amount of follicles every month (which are pulled from your ovarian reserve).

Did you know? We actually have the highest amount of follicles (eggs) prior to birth, and the amount we have is finite. We use a little bit of our ovarian reserve each month.

Each month, your ovaries will decide how many follicles (eggs) get pulled from that follicular reserve. Instead of just one follicle becoming dominant and mature, which would happen in natural menstrual cycle, we want to salvage as many of the follicles being pulled from your reserve that month as possible.

We do that by giving you stimulating medications early on in your menstrual cycle, prior to that dominant follicle formation. These medications are known as:

• Follistim AQ (follitropin beta)
• Gonal-F (follitropin alfa)
• Menopur (or low-dose hCG, if your insurance plan doesn't cover Menopur)

Note: Follistim and Gonal-F are essentially the same medication, produced by different drug companies. If you receive one brand or the other, it doesn't mean that one is better. It simply means that your insurance may cover one medication more than the other.

Follistim and Gonal-F are medications that contain a hormone called follicle stimulating hormone (FSH). Menopur and low-dose hCG are medications that contain a hormone called leutinizing hormone (LH). Menopur also contains FSH.

Together, these hormones (FSH and LH) which your body would normally make every month, will give you the best, most robust response in terms of how many follicles (eggs) we're able to salvage that month - so that you don't just make one.

Want to dive deeper?

Each stage of IVF has its own set of side effects. Learn what to expect during the process from an experienced fertility nurse.

IVF Medications: Phase 3 (Preventing Ovulation)

Now that you're making all of these great follicles, we don't want your body to ovulate them too early (prior to your scheduled egg retrieval procedure). So we give you a medication that stops your body from ovulating. This may include the following:

• Lupron
• Ganirelix and/or Cetrotide

Note: Like Follistim and Gonal-F, Ganirelix and Cetrotide are essentially the same medication, just made by two different drug companies. 

Lupron is given prior to you having a dominant follicle, because this medication needs a little bit of time to work (or prevent ovulation). So you take this one longer and for more days.

If you're on a protocol that uses Ganirelix or Cetrotide, those medications work right away. We would start those as soon as you have a follicle that is close to ovulating, which is usually when it measures around 14-15 millimeters.

IVF Medications: Phase 4 (Maturation)

Once you have a dominant follicle, and it seems like your lead follicle(s) are mature, we need to give you a special medication to help complete the maturation process. This so-called "surge" or "trigger" shot induces ovulation in 34-36 hours, so we have to be precise about when you administer this medication and when you have your egg retrieval.

Your egg retrieval should take place about 35 hours after you've taken your "trigger shot," so that your follicles are as mature as possible, but haven't ovulated yet. We want to make sure they haven't left the ovaries yet so that we can access them during your egg retrieval procedure. 

This "trigger" shot medication contains something called human chorionic gonadotropin (hCG). The likely scenario is that if you're doing IVF, you'll get an hCG or hCG derivative. You may receive either of these brands of hCG:

• Pregnyl
• Ovidrel

Remember: Your egg retrieval must be perfectly timed, so it's very important that you take your hCG ("trigger" shot) at the specific time your team instructs you to.

IVF Medications: Phase 5 (Embryo Transfer)

If you get embryos back that cycle, as opposed to freezing them or having preimplantation genetic testing (PGT) performed, you will need to take medications to prepare the lining of your uterus (called the endometrium) for embryo transfer.

With the help of these medications, your uterine lining becomes ready to receive an embryo!

Medications may include:

• Estrace
• Prometrium
• Progesterone in oil
• Endometrin

Prometrium, progesterone in oil, and Endometrin are all progesterone. Estrace is estrogen.

What normally happens during a menstrual cycle is that the optimal combination of estrogen and progesterone make your lining suitable for implantation of an embryo, which is what we hope to replicate with these medications.

If you go on to freeze embryos for future family building or wish to have genetic testing performed on your embryos, you won't do this last step yet. You would wait to start preparing the uterine lining when you are ready to proceed with a frozen embryo transfer (FET) cycle.

IVF Medication Protocol Additions

There are also other medications or supplements that we may give you. One is CoQ10, which can improve something in the cytoplasm called mitochondrial function. Mitochondria is the energy producer in the cell, and cell division is hard work.

If we bolster the energy producer (the mitochondria), that can help make cell division more efficient and decrease the amount of abnormal chromosomes in the cell (called aneuploidy), which is usually one of the main culprits when you are struggling to get pregnant or prevent recurrent pregnancy loss.

The other medication that we have you take is baby aspirin, which you can pick up at your local pharmacy. We have you start baby aspirin when you begin your stimulating medications. Its properties include anti-inflammation, vasodilation (the opening of blood vessels), and inhibition of platelet aggregation (platelets collecting together, which would cause clotting).

All of this helps to increase blood flow to the uterus. As you can imagine, it's important to increase blood flow to the uterus and get the uterus as primed as possible prior to embryo transfer. If your transfer is successful, you won't need to continue the baby aspirin.

If your transfer is not successful, we would have you keep taking baby aspirin to give you the best chance of implantation in the next IVF cycle.

Hope that's helpful! As always, please reach out to us with any questions or concerns. Thanks so much.

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