Lupron (leuprolide acetate)

Lupron (leuprolide acetate) is often prescribed for endometriosis because it dramatically lowers estrogen levels by "down regulating" the bodies production of FSH and LH. Endometrial tissue is highly dependent upon estrogen for growth.

Lupron is given in IVF cycles according to patient specific protocols usually the "luteal Lupron" or "flare" protocols. Initially, Lupron stimulates the pituitary to release FSH (flare effect) within 7-10 days, however, Lupron will inhibit the production of gonadotropin releasing hormone. Since GnRH is required to cause the pituitary to produce FSH and LH, Lupron essentially "shuts down" the bodies reproductive hormone system.

While down regulated, IVF patients receive externally administered FSH (Gonal-F, Follistim) to cause the recruitment and development of follicles. Dosages of FSH are adjusted based upon each patient's response and it is continued until the follicles are mature.

Ovulation cannot occur naturally while on Lupron because LH, which triggers ovulation, is suppressed. This prevents a premature surge of LH before the retrieval, which could cause loss of the cycle. Once the eggs are mature, an injection of hCG or LH is given to stimulate ovulation and retrieval is scheduled 35 hours later.

When a patient is on the "luteal Lupron" protocol she usually starts Lupron 7 days prior to her next menstrual cycle. Dosages are adjusted based upon each patient's individual response. The "flare protocol" is usually used in poor responders. When Lupron is first administered there is a characteristic initial increase in FSH for several days followed by suppression. Lupron is administered on day 2 on the menstrual cycle and FSH is added to take advantage of this initial surge in FSH.

Ganirelix Acetate and Cetrotide (cetrorelix acetate)

Ganirelix Acetate (ganirelix acetate) and Cetrotide (cetrorelix acetate) also suppress FSH and LH production; however, the suppression is more complete than with Lupron. These fertility drugs are GnRH agonists meaning they block the action of GnRH at the pituitary virtually stopping FSH and LH production. Because the suppression is so complete these drugs can be used in IVF for shorter periods of time and the dosage of FSH that must be given is sometimes higher.

Other Fertility Medications

• Fertility Drugs-Overview
• Clomid for ovulation induction (Clomid Web Site).
• Gonal-F, Follistim, Bravelle, Menopur, Repronex for ovulation induction.
• Glucophage (metformin) is used in the management of polycystic ovarian syndrome.
• Parlodel for hyperprolactinemia
• hCG or Luveris will be used to stimulate ovulation 36 hours prior to egg retrieval in ART procedures or 36 hours prior to insemination in IUI cycles. Luveris may also be prescribed for women with hypogonadotropic hypogonadism, which is extremely low levels of FSH and LH.
• Birth Control pills may be prescribe to insure there are no "leftover follicles" from previous cycles.
• Antibiotics will be used to treat infections in the male and female.