IVF injectable medications

Women undergoing infertility treatment are aware of the necessity to deliver injections, whether subcutaneous (below the skin) or intramuscular (within the muscle). Although the regularly used fertility medicine clomiphene (Clomid) is taken as a pill, many of the treatments required for women undergoing infertility treatment require a shot—typically, several shots—over a period of days to week. A woman may use one or more of these injectable reproductive therapies, depending on her specific diagnosis and medical history.

IVF injectable medications

Infertility injectable medicines are all hormonal treatments, with the goal of regulating and stimulating hormone production or triggering ovulation. The medications and their mechanisms of action differ slightly , but they are all used to increase fertility in some way.

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What Are the Top 5 Injectable Fertility Drugs?

Human menopausal gonadotropin (hMG): (Pergonal, Repronex, and Metrodin): This medication is composed of two human hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (LH). Gonadotropins are routinely given to women undergoing assisted reproductive technology treatments in order to stimulate the ovaries to generate several follicles (eggs) in a single cycle. FSH and LH are the hormones that normally govern the ovarian cycle and encourage egg growth and ovulation, and injections of this medicine are commonly administered daily for 7 to 12 days during the first half of the menstrual cycle.

FSH, or follicle stimulating hormone, can also be given alone for the same goal and in the same way as hMG. Follistim, Fertinex, Bravelle, Menopur, and Gonal-F are some of the brand names for FSH.

Human chorionic gonadotropin (hCG) (Pregnyl, Novarel, Ovidrel, and Profasi) is a hormone that stimulates the release of eggs from follicles (ovulation). This is given in conjunction with other fertility medicines that stimulate follicle formation and is given at a certain period during the menstrual cycle based on blood test and ultrasound results. This is the same hormone that the placenta produces during pregnancy and that is tested in pregnancy tests.

Gonadotropin Releasing Hormone Agonists (Lupron, Zoladex, and Synarel) act by inhibiting the body’s production of ovarian hormones such as FSH and LH, reducing oestrogen levels. GnRH is normally produced by the pituitary gland and encourages the ovaries to create hormones. When a GnRH agonist is used as a drug, there is an increase in hormone production at first, followed by a decrease as the body detects that too much hormone is being produced. Turning off the ovaries’ regular hormone production enables for careful control of egg formation throughout a fertility therapy cycle. A woman undergoing IVF, for example, may begin taking this medicine in the second half of her menstrual cycle, prior to the cycle in which she would undertake IVF. Following the cessation of the body’s natural hormone production, gonadotropin medications (see above) will be administered to stimulate follicle production. Another advantage of GnRH agonists is that they inhibit the body’s natural production of LH, which causes ovulation. This means that ovulation cannot occur early and will not occur until the hCG injection (see above) is administered.

GnRH antagonists (Antagon, Ganirelix, and Cetrotide) have a similar action as GnRH agonists, but instead of increasing and later down-regulating ovarian hormone production, GnRH antagonists function by instantly stopping the release of ovarian hormones. Because GnRH antagonists have a higher effect on lowering ovarian hormone production, fewer injections are usually necessary.

Follicle Stimulating Hormone is a hormone that stimulates the ovaries (FSH)

When the pituitary gland produces too much FSH and LH, ovulation problems might result. FSH is present in Gonal-F, Follistim, Bravelle, and Menopur, and it stimulates the ovaries to produce eggs. FSH stimulation is also beneficial in those who do not have normal pituitary function and hence require aid with ovulation. FSH has also been utilised as an empiric therapy to treat regularly ovulating women who have not been pregnant through conventional procedures (combined with intrauterine insemination) (IUI). In this case, FSH stimulation is used in conjunction with IUI to enhance the number of eggs ovulated and, as a result, the likelihood of conception. FSH is also used to induce Controlled Ovarian Hyperstimulation, which results in the formation of more follicles for IVF.

Injectable Fertility Medications’ Success Rates

The success rate of FSH will be determined by the reason for using it. If FSH is used only for patients who are not ovulating but have no additional infertility problems, success rates after 3-6 IUI cycles approach 60-70 percent.

If FSH/IUI is used as an empirical therapy in patients to improve the likelihood of pregnancy, success rates are around 30% after 3-4 cycles. That is, one in every three women who complete three to four cycles of “empiric” FSH/IUI therapy will become pregnant.

Fertility Medication Administration and Monitoring

FSH is a medicine that must be administered subcutaneously (Bravelle, Follistim, Gonal-F and Menopur). Because it is a protein, it cannot be taken orally because it would be processed in the stomach. Your spouse, or the person who will administer your shots, will be taught how to do so during your FSH or IVF class. Injection instructions can be found online.

Because FSH is such a potent ovarian stimulant, you will need to be closely monitored during your FSH stimulation, whether you are performing IUI or IVF. Monitoring will take place in the morning so that laboratory findings are available that afternoon. Two tests will be performed to assess how the FSH stimulation is developing. A vaginal ultrasound and a blood test to determine the serum estradiol level are the two tests. Because FSH stimulates the development of follicles in the ovaries, follicular growth will be monitored using a vaginal ultrasound. Follicles with a diameter of 17-20 mm are ideal. In addition, because mature follicles produce estradiol, blood samples for estradiol will be taken to measure follicular growth.

Process of Ovarian Stimulation

You must begin your FSH injections within 3-5 days of your menstrual period; thus, phone our office on the day of your menstrual period to advise us that you are ready to begin FSH.

Your doctor will decide when you should start taking FSH and how much you should take. Never take more or less FSH than recommended. Typically, you will be given FSH injections for 3-4 days before being followed for the first time. Prior to presenting for monitoring, no special preparation is required. You can eat normally and do not need to have a full bladder. The evening dose of FSH will not be known until 2:30 p.m., when your laboratory values are known and discussed, on the day you report for monitoring.

When monitoring shows that adequate follicular growth has been attained, human chorionic gonadotropin (hCG) will be given to induce ovulation. hCG, like FSH, must be administered intravenously and is not active orally. On the first day of monitoring, you will be given a supply of hCG as well as instructions for use. IUI will be conducted 24-48 hours after hCG. You will need to schedule IUI during a time that is convenient for both you and your spouse.

More information on IUI can be found here. You will be given supplemental progesterone or two supplemental hCG injections following your IUI. These instructions will be given to you at your IUI. These drugs are prescribed because they aid in the luteal phase (the last half of your cycle), which is critical in early pregnancy.

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