IVF Drugs: Use of Different Protocols

Why IVF drugs are used in test tube baby process?


It is the first stage of high stimulation IVF treatment protocol. It is the process of controlling the ovulation and producing the matured eggs. IVF drugs are used to control the hormones of ovulation cycle. Down regulation helps to produce a viable mature eggs from the multiple follicles where the eggs remain in the follicles and then they can be easily harvested.
It helps to grow all the follicles in a same rate thus helps to collect the mature eggs. If downregulation was not used the follicles may grow at different rates in response to superovulation. 
It takes 2.5-4.5 weeks for the down regulation process
After the downregulation stage various medications are used to stimulate the ovaries to produce high number of eggs.
Mainly used in patients with poor ovarian reserve

Components of IVF protocol


Ovarian stimulation
Ovulation induction
Collection of eggs
Fertilization of eggs with sperms
Transfer of the fertilized eggs to the uterus for implantation and maturation

IVF Drugs used in down regulation:


GnRH agonist : 


Lupride, nafarelin, goserelin
GnRH antagonist : 
Cetrorelix , ganirelix
These drugs works together by suppressing the production of hormones triggers the egg development and ovulation which downregulate the function of ovaries

GnRH agonist:


Triggers the production of FSH & LH , ovaries are flooded which stops the production of LH & FSH after 3 weeks
GnRH antagonist :
Binds to the receptor on GnRH and blocks its ability to receive signal immediately stops the production of FSH & LH

After the GnRH injections for particular days or weeks ultrasound helps to see the lining of the uterus and maturation of eggs for harvesting  

Protocols used in IVF


Long protocol 
Antagonist or short protocol
Short flare up
Ultra long protocol
Ultra short protocol

Long protocol:

 It is also known as agonist protocol. The time scale for this process is around 6weeks.
Patients undergo a standard methods of injections  for ovarian stimuation. 
The treatment usually starts around day 21 of the  cycle succeeded  by ovarian stimulation with Follicle stimulating hormones.
The patients needs to monitor regularly for the right follicle size and stage of development for egg collection.

Three stages of long protocol :

Ovarian suppression:


The first process of long protocol is suppressing the ovaries with GnRH drugs are given on day21 of cycle or in day 2 to suppress the LH and FSH hormones where the ovaries do not produce eggs.
Drugs are continued for approximately 10-15days followed by ultrasound and estradiol levels. If the ovarian follicles are around 15mm implies the greater control of ovarian stimulation and shows the even growth of the  follicles and prevents them to ovulate. If  it is not complete the medication may extend for another week.

Ovarian stimulation: 

After ovarian suppression , the ovarian stimulation is done using synthetic FSH drugs which is started when the cycle begins. Initial doses are given for 2 days estradiol levels are checked depending upon the doses are adjusted.  
Ultrasound helps to monitor the ovarian stimulation. Most woman require 8-12 days for the ovaries to get stimulate, drugs for downregulation are continued during this time. 

Follicle triggering:


When the follilces reaches the certain criteria indicating the eggs are matured, Patients are advised to take HCG (Human chorionic synthetic FSH)
Criteria:
Altleast 2 follicles with the diameter atleast 18mm
E2 – 150 to 200pg/ml for each follilces 
Must present before the administration of HCG
Patients are advised to take 5000 to 10000 units of HCG approximately 36 hours before oocyte retrieval. 
The timing of the HCG administration is important.

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