Which Hormones Are Used In Ivf

Answer From: Valentina Denisova Md Phd Obstetrician Gynaecologist

Before we start talking about the hormones for IVF, I have to say a few words about the physiology of a females body. The development of follicles and oocytes starts around two previous cycles before menstruation and this part of oocyte development is called Hormonal independent. So, it is going on independently on medicines, which can be used during ovarian stimulation. At the beginning of the menstrual cycle, we have a cohort of follicles who are ready to grow up, but in a natural cycle, only one of them will grow up. FSH is a hormone produced by hypophysis in the head inside the head, and it starts to affect the ovaries and the follicles start to grow up at the beginning of the cycle, and these growing follicles produce estrogens which are necessary to for endometrial growth. And at the middle of the cycle, hypophysis, once again the head produces a high dose of LH and this LH surge will lead to ovulation. Former follicles become corpus luteum and start producing progesterone.

What’s The Success Rate Of Ivf

• 32 per cent if you are under 35
• 28 per cent if you are between 35 and 37
• 21 per cent if you are between 38 and 39
• 14 per cent if you are between 40 and 42
• five per cent if you are between 43 and 44
• two per cent if you are 45 or over

• Reaching a healthy weight for your height before you have treatment. IVF is more likely to be successful if your body mass index is between 19 and 30 .
• Keeping your alcohol consumption to no more than one unit of alcohol per day, as drinking more than this reduces the effectiveness of IVF .
• Stopping smoking Smoking reduces success rates .
• Keeping your caffeine consumption very low. Even low rates of consumption of 2 to 50mg have been linked to lower success rates .

Suppressing The Natural Menstrual Cycle

Youre given a medicine that will suppress your natural menstrual cycle. This can make the medicines used in the next stage of treatment more effective.

The medicine is given either as a daily injection that youll be taught to give yourself, or as a nasal spray. You continue this for about 2 weeks.

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What Do You Do To Prepare For Ivf Treatment

Before starting IVF treatment, youll need a thorough medical exam and fertility tests. Your partner will be examined and tested as well. Some of the preparation youll go through includes:

• IVF consultation .

Many people will return to normal activities right after their egg retrieval procedure. However, you shouldnt drive for 24 hours after having anesthesia. Around nine to 14 days after the embryos are transferred, youll return to the clinic for a pregnancy test using a blood sample.

How Is Infertility Diagnosed

The male partner will have a sperm test. The female partner may have their progesterone level tested in the middle of the luteal phase to see if she is ovulating. She will also have an ultrasound scan to see how many follicles she has in the ovary called the antral follicle count this can indicate how likely she is to respond to the hormones used during the IVF cycle and how likely she is to have a baby after her IVF cycle. A blood test for anti-Müllerian Hormone can provide similar information. An ultrasound scan can also pick up other abnormalities, such as fibroids. A test is usually also carried out to check that the fallopian tubes are healthy and patent such as a Hystero-Salpingo-Gram or Hysterosalpingo Contrast Sonography .

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Medications Used For In Vitro Fertilization

Kiran Panesar, BPharmS , MRPharmS, RPh, CPhFreelance Medical WriterAddis Ababa, Ethiopia

US Pharm. 2016 41:HS8-HS11.

ABSTRACT: In vitro fertilization is a form of assisted reproductive technology in which a womans reproductive system is artificially stimulated to produce oocytes, which are extracted, fertilized in a laboratory, and then implanted in the uterus. This is a multistep process that needs to be carefully controlled with the use of medications. The four main components of IVF include pituitary downregulation, controlled ovarian hyperstimulation, induction of ovulation, and luteal-phase support. Because of the complex interplay of the various drugs used to replicate the different stages of the fertilization process, pharmacists should be an active part of the IVF healthcare team.

In vitro fertilization is a type of assisted reproductive technology in which a womans reproductive system is artificially stimulated to produce oocytes, or eggs, which are extracted, fertilized in a laboratory, and implanted in the uterus. This procedure was developed for use in women with nonfunctional fallopian tubes, but it is now reserved for women in whom reproductive techniques have failed or in women whose infertility is due to male factors, endometriosis, immunologic factors, unexplained infertility, or other causes.1,2

Ovarian Stimulation And Ivf

A menstrual period should begin within 7 to 14 days from starting the Lupron injections. The clinic should be notified when the period starts so that a baseline ultrasound and blood estradiol test can be scheduled. The purpose of these tests is to confirm that the Lupron has successfully suppressed the ovaries to a baseline state.

Suppression means that the ovaries should contain no follicles that are greater than 15 mm in size, and the blood estradiol level should be less than 50 pg/ml. In approximately 10 to 15 percent of patients, one or both of these conditions are not met. Depending upon the results of these tests, the Lupron medication may be extended for another week and the patient may be asked to return for another sonogram and blood estradiol test. Occasionally an ovarian cyst aspiration may be performed for a persistent ovarian cyst.

After ovarian suppression has been achieved, ovarian stimulation using gonadotropin fertility drugs may commence at a scheduled time, which is referred to as the cycle start. These gonadotropin fertility drugs are continued throughout the stimulation phase of the cycle, that is, until hCG is administered.

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Types Of Ivf Medication Overview

• Medication is the primary treatment for women with ovulation disorders and an important part of in vitro fertilization .
• Typically, a patient will start an IVF cycle by taking birth control for a number of days, then injectable medication to stimulate ovaries and produce eggs, followed by a trigger shot and egg removal this process allows the doctor to control the menstrual cycle during treatment.
• IVF medications used to prepare the uterus and to stimulate the ovaries are not known to carry any long-term risks of cancer of the ovary unless there is a family history of ovarian cancer.

Egg Retrieval Side Effects

Keep in mind that the retrieval of eggs is a surgical procedure and will require anesthesia. It has an array of negative side consequences. For the majority of women, they are not severe and will disappear within a few days following the procedure.

• Extremely rare and extremely difficult to diagnose such as rapid weight gain, an increase in abdomen circumference and trouble breathing

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Whats The Success Rate Of Ivf

• 32 per cent if you are under 35
• 28 per cent if you are between 35 and 37
• 21 per cent if you are between 38 and 39
• 14 per cent if you are between 40 and 42
• five per cent if you are between 43 and 44
• two per cent if you are 45 or over

• Reaching a healthy weight for your height before you have treatment. IVF is more likely to be successful if your body mass index is between 19 and 30 .
• Keeping your alcohol consumption to no more than one unit of alcohol per day, as drinking more than this reduces the effectiveness of IVF .
• Stopping smoking Smoking reduces success rates .
• Keeping your caffeine consumption very low. Even low rates of consumption of 2 to 50mg have been linked to lower success rates .

What Are The Steps Of Ivf Treatment

IVF can be broken down into the following steps:

Birth control pills or estrogen

Before you start IVF treatment, your healthcare provider may prescribe birth control pills or estrogen. This is used to stop the development of ovarian cysts and control the timing of your menstrual cycle. It allows your healthcare provider to control your treatment and maximize the number of mature eggs during the egg retrieval procedure. Some people are prescribed combination birth control pills , while others are given just estrogen.

Ovarian stimulation

During each natural cycle in a healthy person of reproductive age, a group of eggs begins to mature each month. Typically, only one egg becomes mature enough to ovulate. The remaining immature eggs in that group disintegrate.

During your IVF cycle, youll take injectable hormone medications to encourage the entire group of that cycles eggs to mature simultaneously and fully. This means, instead of having just one egg , you may have many eggs. The type, dosage and frequency of medications prescribed will be tailored to you as an individual based on your medical history, age, AMH level and your response to ovarian stimulation during previous IVF cycles.

The other steps in the ovarian stimulation process include:

Egg retrieval

Fertilization

On average, 70% of mature eggs will fertilize. For example, if 10 mature eggs are retrieved, about seven will fertilize. If successful, the fertilized egg will become an embryo.

Embryo development

Pregnancy

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Clomiphene Citrate Letrozole And Tamoxifen

If you have ovulation problems you may be prescribed one of these drugs to help regulate or induce ovulation. They increase production of the egg containing follicles. They are all widely used.

Administration

These agents are taken orally, usually on days 2-6 of the menstrual cycle and work by sending a message to the pituitary gland, telling it that it needs to start secreting, or to secrete more, follicle stimulating hormone . With higher levels of FSH in the body, egg production and ovulation are improved.

While Clomiphene Citrate and Letrozole can be prescribed for as many as six cycles, most experts agree that, if you have not become pregnant after three cycles, treatment using these drugs alone will probably not help you. Most women will respond to anti-oestrogens and ovulate within the first three to four cycles.

Clomiphene Citrate, Letrazole or Tamoxifen are also occasionally used for patients having IVF, to help stimulate the growth of many follicles so we can collect a number of eggs ready for insemination.

Your specialist or Nurse Coordinator will advise you on your particular dose and timing.

Side effects of anti-oestrogens

Normally any side effects of anti-oestrogens are mild. Higher doses as might be used in IVF, can produce more severe side effects. Common Clomid side effects include:

• Multiple pregnancy
• OHSS or Ovarian Hyperstimulation Syndrome

There is no link between ovarian cancer and anti-oestrogens.

How Do Ivf Injections Work

During your IVF cycle, youll take injectable hormone medications to encourage the entire group of that cycles eggs to mature simultaneously and fully. Your healthcare provider will determine the type of drug, frequency and dosages you need for your treatment. This is based on your age, medical history, hormone levels and your response to previous IVF cycles if applicable. You can expect to inject fertility medicine for around eight to 14 days.

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How Long Does It Take To Know You Are Pregnant After Ivf

It takes about nine to 14 days to test for pregnancy after embryo transfer. The exact timing may vary depending on the practice or fertility clinic. Your healthcare provider will most likely use a blood test to check for pregnancy. Blood tests measure hCG , which is the hormone produced by the placenta during pregnancy.

Ivf Stimulation Protocols In The Us Generally Involve The Use Of 3 Types Of Drugs:

The ovaries are stimulated with the injectable FSH medications for about 7-12 days until multiple mature size follicles have developed.

What is the goal of a good in vitro fertilization ovarian stimulation?

With ovarian stimulation for in vitro fertilization, the goal is to get approximately 8 to 15 quality eggs at the egg retrieval procedure.

We do not want to have overstimulation of the ovaries which can lead to significant discomfort for the woman and in rare cases can result in ovarian hyperstimulation syndrome, OHSS.

In recent years we have used a Lupron trigger to reduce or eliminate risks for ovarian hyperstimulation syndromeOur 2014 study on using Lupron triggers to maintain high success rates and reduce any risks for hyperstimulationWe also do not want the ovarian stimulation to be insufficient and only give us a few eggs if we might have been able to obtain more by using higher medication doses, etc.

In vitro fertilization can be successful with a very low number of eggs retrieved, but success rates are substantially higher when more eggs are recovered.

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What Hormones Are Used In Ivf

The reproductory system is a complex one it involves various hormones, each of which affects the womans ability to conceive and get pregnant. Hormones like AMH, LH, FSH, progesterone, estrogen, prolactin and TSH play a huge role in female reproductive health and hence, the process of IVF. Lets discuss what hormones are used in IVF in detail.

How Is Ivf Done

Fertility drugsfertility drugsmenstrual cycleendometriosisHormone injectionsfertility drugsside-effectsEgg retrieval and sperm collectiondonated spermFertilisation and embryo transferrisk of miscarriageolder mum-to-bemultiple pregnancyyour agefertility problem40 years or overdonatedRepeated cycles

• you have had previous normal IVF with healthy embryos but they have not implanted
• you are under 40
• you have opted for eSET

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What Hormones Are Important For Ivf

Hormones for IVF are extremely important because they help control the treatment and maximize the patients chance of successful pregnancy. Because the menstrual cycle of the woman receiving treatment must be adjusted for timely egg maturing and egg retrieval, the IVF hormones fertility doctor prescribes help regulate the cycle.

But what hormones do you have to take for IVF success, when should you take them and do you really have to? Keep reading to find out.

Youll Be Left Feeling Like A Teenager

All the hormone shots involved with IVF mean that youll have lots more hormones than normal coursing through your body. That might leave you irritable, bloated, or even turned on.

As youre hormonal, you may feel like you want to have sex, Eyvazzadeh explains. However, during certain points in the IVF process, its important to abstain, so be sure to talk with your doctor about whats okay and what isntand dont be afraid to get creative with other options for adult fun.

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Does Ivf Therapy Influence The Gut Microbiome

The relationship between intestinal microbiota and metabolic health is very topical and of much interest. Changes in the gut microbiota may influence the development of much twenty-first century chronic illness, including diabetes mellitus, cardiovascular disease, and dyslipidemia . The gut microbiota influences chronic inflammatory effects through mediation of leakiness of the gut lining . A useful serum marker for this process is lipopolysaccharide-binding protein , an acute-phase protein. LBP binds bacterial compounds, including lipopolysaccharides , an outer membrane component of gram-negative bacteria that normally reside within the gut and form the microbiota. While strongly correlated with obesity, LBS is also negatively associated with insulin sensitivity . The presence of LPS in the gut is a normal physiological phenomenon, but can become problematic when it crosses over a leaky gut wall into the circulation. Gut wall permeability is likely influenced by stress, including a high fat/energy-dense diet, or use of hormonal therapies. This can result in metabolic endotoxemia . High levels of serum LBP strongly correlate with LPS and associate with insulin resistance, obesity, and T2D .

Ovarian Stimulation Ivf Protocols Medications And Drugs For In Vitro Fertilization

• In order to maximize success rates with in vitro fertilization we want a good number of high quality eggs from the woman. We generally try to get about 10-18 eggs at the egg retrieval procedure.
• IVF success rates correlate with the number of eggs retrieved.
• There are several ovarian stimulation medication protocols that are used to pump up the ovaries to make enough follicles and eggs. Without stimulating medications, the ovaries make and release only 1 mature egg per menstrual cycle .
• The commonly used stimulation regimens include injections of follicle stimulating hormone FSH.

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Growth Hormone For Poor Responders In In Vitro Fertilization

Growth hormone is indicated for the treatment of growth hormone deficiency in both children and adults, as well as for Turner’s Syndrome, chronic renal failure, and children born short for gestational age.

In animal studies, growth hormone has been shown to be important in early antral follicle recruitment, subsequent follicular growth, and oocyte maturation. Together with insulin-like growth factor-1 , growth hormone is essential early on in the recruitment of primordial follicles in the growing pool .

Starting growth hormone prior to stimulation has been studied in one previous publication , and showed that by starting growth hormone on day 21 of the menstrual cycle preceding gonadotropin stimulation, and continuing co-treatment with growth hormone until human chorionic gonadotropin trigger resulted in a significantly higher number of fertilized oocytes when compared to a control group receiving no growth hormone .

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