What medication is needed at each stage of an IVF cycle?
For most patients, there are typically three different times when medication is needed:
- Leading up to a cycle, women take down-regulation medication to regulate their cycle to align with the timing needed to start treatment and help multiple follicles grow instead of just one.
- To promote egg production or support the implantation of a fertilized egg to the uterine wall during an embryo transfer, women take stimulation medication.
- After you have completed a full cycle from stimulation to egg retrieval and possibly even embryo transfer, hormone replacement transfer medications prepare your body to accept implantation of an embryo.
What kinds of IVF meds do most patients take?
For each of the three medication categories - down-regulation, stimulation, hormone replacement transfer - there are many different protocols and medication options that can be taken orally in pill form, inserted vaginally, or injected into the body.
Injections come in two types, subcutaneous and intramuscular. Subcutaneous is injected right under the skin with a short half inch needle. Intramuscular injections go into the muscle, typically in the buttock, and require a 1.5 inch needle.
In general, these are the main types of medications used during IVF:
- Birth control pills: Used in down-regulation; daily oral medication.
- GNRH agonists (Lupron): Used in down-regulation, stimulation, and transfer; typically, a daily subcutaneous injection.
- GNRH antagonists (Ganerlix or Cetrotide): Used in stimulation and occasionally in transfer cycles; daily subcutaneous injection often started halfway through stimulation.
- Gonadotropins (Menopur, Follistim, Gonal F): Used to stimulate the ovaries and in stimulation cycles for an embryo transfer; daily subcutaneous injection.
- Progesterone (Micronized progesterone, Crinone, Endometrin, Progesterone in oil, Prometrium): Used in down-regulation, stimulation and transfer cycles; oral or vaginal medication as well as intramuscular injections typically daily, but some protocols use injectables every few days.
- Trigger (HCG, Novarel, Ovidrel): Used mainly for stimulation cycles but can be used during transfer cycles; one-time subcutaneous or intramuscular injection.
How can IVF meds impact emotions and mood?
Let’s be honest - fertility treatment is an emotional rollercoaster in general. There is so much hope in each cycle that this plays a huge role into how we feel.
Hormonally, our brains love estrogen. As we take medication for IVF our estrogen levels get higher and we feel fantastic!
After an egg retrieval, estrogen levels drop. Around your period, they drop again, which can make some people experience a mood shift and become emotional. You know that feeling when you’re tearing up after reading a greeting card or watching a sappy Olympics commercial? Trust me, we’ve all been there. Luckily, it usually only lasts a few days. Some people don’t notice anything. If you were someone who has emotional changes with their usual menstrual cycles it will be similar but exaggerated.
In simplistic terms, medications that raise our estrogen can make us feel great and medications that keep our hormones low can make us feel down.
Of course, mood can’t always be blamed on medication and hormones. If you put your all into an IVF cycle only to get your period soon after, the grief of a failed cycle will take time to pass.
What do most patients share with you?
Most of my patients do very well with the emotional impact of the treatment. Some patients see a therapist or use acupuncture, meditation, and yoga to help with the emotional impact of treatment. It's important to give yourself some grace during this time. Allow yourself to feel your feelings. Also, permit yourself to skip stressful social events and triggering interactions.
What did you experience personally?
It was an emotional journey for me. I am so grateful for my experiences, but it was hard to go through. The medications themselves, I tolerated well. I used support such as acupuncture to help tolerate treatment.
Dr. Allison Rodgers is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and has been practicing medicine since 2004. She completed her residency at Case Western Reserve-Metrohealth Medical Center/Cleveland Clinic, followed by a fellowship at the University of Texas Health Science Center in San Antonio.
Dr. Rodgers’ personal experiences with both secondary infertility and pregnancy loss have given her a unique insight into reproductive medicine, and she is well-known for her compassionate and individualized patient care. She has published many original research articles in top medical journals on topics such as Endometriosis, Tubal Factor Infertility, In Vitro Fertilization, and Donor Sperm.