MEDICATIONS A REPRODUCTIVE ENDOCRINOLOGIST MIGHT PRESCRIBE FOR EGG DONOR RECIPIENTS DURING A DONOR EGG CYCLE
A series of medications are prescribed by the fertility specialist to prepare the endometrium of the donor egg recipient for the embryo transfer and to support the uterus during the first trimester of pregnancy. The medication protocol varies somewhat from clinic to clinic, and also from patient to patient, depending on such factors as ovarian function, health concerns such as diabetes or immune disorder, patient body mass index, and other medical issues. Blood tests and ultrasound scans are performed throughout the treatment cycle to ensure that dosing of medications is appropriate and adjustments are made as necessary.
This article provides an overview of the medications that may be prescribed during the IVF process. It is not meant to replace the advice from one's treating physician nor the prescribing information provided by the pharmacist or from the pharmaceutical manufacturer. Please take any questions or concerns to your healthcare provider.
Any questions or concerns to your healthcare provider.
Anticoagulants (low-dose aspirin, heparin, or low molecular weight heparin (Lovenox® or Fragmin®)) are sometimes prescribed for recipients who have had recurrent miscarriages or those who may have problems with their immune system. Also, Lovenox or heparin may be given to women who have had a previous thrombotic event (such as a deep blood clot in the leg). Low-dose aspirin (baby aspirin) may also be prescribed for older women to increase blood flow to the uterus.
Birth Control Pills
Birth control pills or oral contraceptive pills combine a synthetic estrogen and progestin similar to the naturally-produced ovarian hormones, estradiol and progesterone. Birth control pills are often prescribed for egg donor recipients to suppress their ovaries before a cycle as well as to synchronize their uterine cycle with the ovarian cycle of the egg donor. The use of birth control pills is also useful for patients with irregular menstrual cycles, making it possible to properly time the dosing of other medications.
Common side effects associated with birth control pills include headache, weight gain, light menstrual periods, mid-cycle spotting, or elevated blood pressure.
(Some clinics still use this medication for donor recipients. However, this medication is typically used with egg donor patients not recipient patients)
Dexamethasone is used to suppress androgens in women with polycystic ovaries (PCO) and for certain immune problems. For some patients, this may increase the chance of pregnancy after embryo transfer.
Side effects of dexamethasone include weight gain, blurred vision, or increased thirst. Dexamethasone may increase insulin resistance.
Doxycycline is an oral antibiotic that is commonly prescribed for recipients to decrease the risk of infection at the time of embryo transfer. Other classes of antibiotics may be used besides doxycycline.
The most common side effects associated with doxycycline include diarrhea, loss of appetite, nausea, or vomiting.
Estradiol (Climara®; Delestrogen®; Estrace®; Vivelle-Dot®) is the primary form of estrogen that is produced by the ovaries of women with active menstrual cycles. Estrogens promote the growth of the lining of the uterus and increase the production of cervical mucus.
Estradiol is available as a transdermal patch (Climara® and Vivelle-Dot®), a pill that can be taken orally or vaginally (Estrace® or generic estradiol), or as an injection (Delestrogen® or generic estradiol valerate). Most patients use only one of these formulations during their treatment, although some patients will use a combination of two of these products.
A few days after the recipient starts her period, she will begin the estradiol therapy. Estradiol patches are applied to the abdomen or buttocks and changed every other day or weekly, depending on the brand and formulation prescribed. Estradiol pills are taken orally two to three times daily or are used vaginally once or twice a day. Estradiol valerate injections are given intramuscularly every 3-4 days. Usually, the estrogen dose is increased as the donor is stimulated to produce multiple follicles. This rise in estrogen in the recipient mimics the natural rise in estrogen production by the ovary as an egg matures. If the recipient does conceive, the estradiol medication is continued until the tenth to twelfth week of pregnancy. The placenta will make both estradiol and progesterone after Week 10-12.
Side effects of the estradiol may include headache, breast pain or tenderness, irregular vaginal bleeding or spotting, stomach or abdominal cramps and bloating, nausea and vomiting, or hair loss. Some patients may also experience sodium or fluid retention.
Leuprolide (Lupron®) is a GnRH-agonist used to suppress the normal menstrual cycle in recipients. It is important that the recipient’s ovaries do not make progesterone before the egg donor has her retrieval, since this would affect endometrial receptivity. Leuprolide is usually started a few days before the recipient expects her period to start. It often is begun during the last week of taking birth control pills. Leuprolide is continued while the donor and recipient's cycles are synchronized and it is stopped on the day that the recipient begins taking progesterone. Leuprolide is injected subcutaneously once a day. Recipients who are postmenopausal or who do not have functioning ovaries do not usually need to take leuprolide.
Side effects of leuprolide may include headaches, moodiness, hot flashes, or irregular vaginal bleeding. Patients may occasionally experience a redness and discomfort at the injection sight, as is the case with all injections.
Methylprednisolone (Medrol ®) is a steroid that is taken daily for a few days before the embryo transfer and on the day of the embryo transfer to facilitate implantation of the embryo. It is a glucocorticoid that is used therapeutically primarily as an anti-inflammatory agent. Prednisone may be prescribed instead of methylprednisolone.
Side effects associated with methylprednisolone or prednisone may include diarrhea or constipation; dizziness or drowsiness; hives; nausea or vomiting; rash; stomach ache; dry mouth; headache; loss of appetite; or stomach upset.
Nafarelin acetate (Synarel®) is a GnRH analog similar to Lupron® that is administered as a nasal spray twice a day. Like Lupron, nafarelin acetate is used to suppress the normal menstrual cycle in recipients.
Side effects of nafarelin acetate may include moodiness, hot flashes, or irregular vaginal bleeding. Patients may also experience nasal stuffiness.
Progesterone (Progesterone in oil, Crinone® , Endometrin®, Prometrium®) are progesterone products that are used during the IVF cycle and the first trimester of pregnancy. Progesterone is critically important to prepare the lining of the uterus to enable a fertilized egg to implant and grow. Usually, progesterone is started on the day of or the evening of the day before the eggs are retrieved from the donor. Progesterone is continued until the placenta is sufficiently developed to make adequate amounts of progesterone to support the pregnancy, which is usually at approximately 11-12 weeks of gestation.
Although progesterone has historically been administered as an intramuscular injection, other routes of administration are becoming more common, including vaginal gel (Crinone®) used twice daily and tablets (Endometrin®) used 3 times daily. Progesterone in oil (PIO) is natural progesterone suspended in oil and administered as an intramuscular injection. This may be formulated in ethyl oleate, sesame oil, olive oil, peanut oil, or other liquids. Progesterone does not mix with water. Before using progesterone in oil or Prometrium, it is important to inform your doctor if you are allergic to peanuts, sesame or other oils, or if you have had adverse reactions to hormonal injections in the past.
Side effects of progesterone therapy may include bloating, pelvic cramping, constipation or diarrhea, dizziness, drowsiness, headache, nausea, breast pain or swelling. Serious side effects associated with progesterone therapy may include pain, swelling, or redness of an arm or leg at the site of injection; one-sided muscle weakness; vision problems; trouble breathing; fainting; itching; or skin rash. Women taking progesterone during a cycle should be aware that many of the side effects of progesterone mimic the symptoms of pregnancy.
The medical aspects of egg donation.
Egg donor sample calendar with recipient medications from Advanced Fertility Center of Chicago.
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