Clomiphene (Clomid, Serophene…)
This is a medication that will not be available in Canada beyond summer of 2017. It is interesting to know that it was the first medication approved for induction of ovulation. And since its introduction in the middle of the twentieth century, is has proven itself in helping many hundreds of thousands, may be millions of women ovulate and get pregnant. It is in pill form, and usually taken in the early part of the period to cause internal (natural) FHS to rise, and this leads to ovaries producing one, may be two eggs or so. It is a safe medication, with minimal side effects. It has a multiple pregnancy rate in the 7-8% range. Its main issue is that it sometimes is associated with a thin uterine lining, and this may be a factor of why not all women will get pregnant with it.
Letrezole is a medication that is mainly used to prevent recurrence of cancer breast. As such, it is not approved for use for induction of ovulation. Having said that, it has proven itself as a very effective medication, in pill form, for use for induction of ovulation, to the extent that, nearly all fertility centers will use it for induction of ovulation. The fact that clomiphene will not be available in the Canadian market soon has added to the ubiquitous use of Letrezole. It has a safety profile very similar to clomiphene, if not safer. Recent studies have actually shown it is associated with less congenital malformations than clomiphene. It can still be associated with increased risk of twins, like clomiphene, but has better profile in relation to uterine wall thickening. Like all similar medications, it may be associated with some side effects like headaches, skin rashes, hot flashes, rarely visual changes, seeing spots, etc. Please inform your physician if any of these develop. Also associated with increased incidence of twins. Please read ectopic pregnancy.
Letrezole is typically used on days 3-7 of the cycle.
Letrezole (and clomiphene) are usually used for induction of ovulation as first agents, and when the intervention planned is may be cycle monitoring or IUI. If we need to perform IVF, or if pills have not been successful in induction of ovulation, we will then need to use FSH shots.
They come in different names, brands, combinations, strengths, etc. Names include Puregon, Gonal F, Menopure, Repronex, and the list goes on. Some trade names may be different in different areas of the world. Some come in Pens of different strengths (ready to use form) and some will come in vials with powder and solvent that need to be mixed.
FSH shots will induce ovulation. As long as the ovary has a reserve of eggs, they will make the ovary produce eggs. The more FSH you use, the more eggs your ovary will produce. As they are ‘strong’ medications, they need strict follow up, usually by both ultrasound and blood tests.
To prevent your body from causing a natural ‘trigger’ of ovulation, you will be given another medication with the FSH, either Orgalutran, or Lupron (or similar).
You will usually need some training of how to use the medication.
When you are using FSH medications, if you see any other type of physician outside the Fertility field, please make sure that you make them aware of the FSH shots you are receiving as this will affect how your ovaries will appear on Ultrasound, as well as the fact that OHSS is a possibility.
Shots to -Release of Eggs
In a natural cycle, and with the changes of your hormones, your body knows how to trigger the release of an egg on its own. It does this by release of LH hormone. When we are interfering with nature and controlling how your cycle is going, we may need to also control when your eggs are to be released. For that reason, we give you these types of shots that make you release eggs. The medication used is usually hCG type of medication. It may come in different trade names, Human Chorionic Gonadotropin, Pregnyl, Ovidrel, etc.
Depending on what you are doing that cycle, the timing of the next action is related to the time of the shot. So, for IUI or natural cycle (timed intercourse), we usually advise to have that done on the following day of after the shot.
If you are doing IVF and got the shot for timing of Ovum Pick Up, you usually will be instructed to take the shot on the evening of one day, and come to the center “the day after tomorrow” in a certain hour. It is very important to follow that timing protocol (usually about 35 hours time line).
Sometimes, if you are doing IVF and you are on FSH type shots, and you are at risk of OHSS, or have PCO, (or other conditions) AND you are taking Orgalutran or other ANTAGONIST, you may be told to get LUPRON as a trigger shot. This is known to prevent OHSS. You must NOT be on Short or Long Lupron (or Zoladex, or Superfact) protocol, you must be on Orgalutran for Lupron trigger to work. We usually would like to avoid a fresh transfer that cycle.
LHRH type of medications (Lupron, Superfact, Zoladex)
These are medications that are used to prevent your body from triggering the release of eggs. They are typically used in IVF cycles when the plan is to try to recruit as many follicles as we need, and at the same time, prevent those eggs from triggering (ovulation) before we are able to pick them up or harvest them. These medications are particularly useful in patients with PCO to control how many eggs you may have as well as an effort to prevent OHSS. Typically we start these medications on day 21 of one cycle and start the FSH medications day 2 or 3 of the following cycle (LONG LUPTON PRTOCOL)
Interestingly, these medications can also be used in older patients, or those who have shown less than optimal response to pervious FSH induction to try to boost their response. In this case, they are used day 1 or 2 of a cycle and FSH medications are started day 2 or 3 of the same cycle (SHORT LUPRON PROTOCOL).
This is another type of medication that may be used to prevent ovulation. They are typically started during the induction cycle, around day 8 or so (the actual point of need is the stage of egg development, so results of ultrasound and blood work are important). This is a daily shot given alongside FSH shots until your eggs are ready, and then you get a trigger shot. If you are on Orgalutran, you may trigger ovulation by either HCG or Lupron. Doses and timing are different. Please make sure you have clear instructions from your nurse.