Egg Donation:
Medications to Produce
Multiple Eggs
The medications you will take in preparation for the egg retrieval are
referred to as the drug “protocol”. Each patient’s protocol is unique, and
determined by Dr. Donahue based on previous medical history. Possible
medications include:
A. LUPRON (Luprolide acetate- 2-week kit)
Lupron acts upon the pituitary gland, in the brain, to alter the
secretion of FSH and LH (the two hormones responsible for egg development
and ovulation). Initially, Lupron will cause increased secretion of the
two hormones, with a subsequent rise in estrogen secretion. Continual
administration of Lupron, however, will lead to a suppression of the
pituitary hormones, with subsequent drop in estrogen production. In ART
stimulations, Lupron will allow the ovaries to “pushed” to full maturity,
without the fear of premature ovulation. Microdose Lupron is a low
dose preparation that has the ability to stimulate rather than suppress
the ovaries. This is used in a protocol for "poor
responders."
Administration: Lupron is taken as a subcutaneous injection, once per
day, beginning on or about cycle day 21 in the month prior to egg
retrieval.
Side effects: headaches, fatigue, mood-swings, hot flashes, delayed
onset of your period, bruising or irritation at the injection sites
B. GONADOTROPINS (Pergonal, Humegon,
Bravelle, Repronex, Gonal-F, Follistim)
These drugs will act upon the ovaries, to cause the oocytes (eggs) to
develop and grow. Pergonal, Humegon, Repronex FSH 75 IU: LH 75 IU
Gonal-f, Follistim FSH 75 IU
Bravelle FSH 75 IU: LH 3%
Administration: Gonadotropins must be administered by
intramuscular injection or subcutaneously once or twice per day, according
to your particular protocol. They are started when baseline tests
(ultrasound and blood test) indicate that the ovaries are in a resting,
non-productive state.
Side effects: mood-swings, discomfort around the ovaries, abdominal
fullness, soreness at the injection sites.
C. HCG (Profasi, Pregnyl, Novarel)
- This hormone is taken once testing indicates the oocytes on the
ovaries are ready to be released. It performs two functions: structural
changes inside the eggs to make them able to be fertilized and expansion
of the fluid inside the follicles (egg sacs) that would eventually lead to
rupture and ovulation. Ovulation normally occurs between 36-42 hours after
HCG administration.
Administration: HCG must be taken as an intramuscular injection.
You will be given a specific time to take this injection- approximately 36
hours before your scheduled time for egg retrieval. The powder is
mixed with 2cc’s ONLY of saline prior to injection.
Side effects: discomfort around the ovaries, soreness at the
injection site.
D. ANTIBIOTIC
(Doxycycline, Tetracycline, Keflex)
- Both the wife and husband will be asked to take a round of
antibiotics, for infection prevention. When performing the procedure to
retrieve the eggs, a needle is placed through the vaginal wall and into
the abdominal space. We want minimize the risk of an infection due to this
puncture, as fevers are not good for developing embryos. Men can have
white blood cells in their semen, indicating some sort of infectious
process, without having any symptoms. These white blood cells can affect
the ability of the sperm to move efficiently. The antibiotic will clear
these away.
Administration: Doxycycline/Tetracycline: 1 tablet twice per
day, by mouth, with meals, for 10 days OR Keflex: 1 tablet three times a
day for 7 days from the time of the HCG shot until the embryo transfer.
The husband will take the antibiotic from the day of HCG until the egg
retrieval.
Side effects: stomach upset, allergic reactions (hives, itching,
swelling) vaginal yeast infections in women.
E. PROGESTERONE
- This hormone will act upon the lining of the uterus (the
endometrium) to keep it very nourished for the potential embryos that will
be growing there. As part of the egg retrieval process,
progesterone-producing cells are removed along with the follicular fluid
and oocytes, making the ovaries unable to produce progesterone
sufficiently. Progesterone is vital for endometrial development and
continued embryo support. It is absorbed by the body most efficiently
through intramuscular injections. Also, intra-vaginal progesterone has
been shown to decrease uterine contractions before embryo transfer and
improve pregnancy rates. Please see the attached protocol.
Administration: Intramuscular injections of 2cc’s daily are
begun one day after retrieval and continue (daily) through the day of the
pregnancy test. Vaginal suppositories are taken at night before you go to
sleep.
Side effects: breast tenderness, soreness at the injection sites,
delayed onset of your period (even in the absence of pregnancy)
F. PRE-NATAL VITAMINS
- Studies have shown that increasing the intake of folic acid prior
to conception helps to decrease the chances of certain spinal-cord-defects
in babies. It is also a good idea from a general health point of view to
be on these multi-vitamins, prior to and throughout pregnancy.
Administration: 1 tablet per day, usually at bedtime
Side effects: stomach upset, nausea, constipation
G. METHYLPREDNISOLONE (Medrol) - This
steroid hormone is taken when the Assisted-Hatch procedure is being done,
in conjunction with the Embryo Transfer. It is taken to suppress any
inflammatory reaction that might occur between the embryo(s) and the
endometrial lining.
Administration: 1 (16mg) tablet, by mouth, once per day, OR 4
(4mg) tablets, by mouth, once per day.
Side effects: fluid retention
H. LOW-DOSE ASPIRIN - A very high
blood level of estrogen, which will result from the gonadotropin drugs,
can have the potential effect of increasing the coagulation factors in the
bloodstream (especially in the small vessels that supply the uterus and
ovaries). Aspirin, in low doses, will decrease the effects of those
clotting factors, and in turn, increase blood flow to the tissue.
Administration: 1 (81mg) tablet, by mouth, per day.
Side effects: stomach upset, prolonged bleeding time
I. Valium (10 mg) - This is taken one
hour before the embryo transfer. This will help to keep you relaxed for
the transfer.
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