Medicine used for in vitro fertilisation treatment

Medicine for down-regulation (GnRH agonists)

Synarela®, Suprecur®, Suprefact®, Zoladex®, Gonapeptyl®, Decapeptyl®
These medicines are so-called GnRH agonists. They influence the secretion of the hormones FSH and LH from the pituitary gland. FSH and LH regulate the maturation of follicles and eggs in the ovaries. These medicines temporarily block the secretion of FSH and LH. In this way, it is possible to control the maturation of oocytes in the ovaries. The GnRH agonists blocks the ovulation signal (LH) that would otherwise be re- leased from the pituitary gland when the ovaries contain mature oocytes. In this way it is prevented that ovulation occurs before the scheduled oocyte pick-up. 

GnRH agonists (for example Suprefact®) may also under certain conditions be used to trigger ovulation. It may be done in women who are not down-regulated. It will not work in the ’long down-regulation’ protocol. 

Synarela® og Suprecur® is a nasal spray that must be taken several times every day. Suprefact og Gonapeptyl® is taken as one daily injection.
Zoladex og Decapeptyl are dopot preparations that only need to be taken once per cycle. 

Side effects: Headache, hot flushes and mood changes. 

GnRH Antagonists

Orgalutran®, Cetrotide® 
GnRH antagonists prevent the pituitary gland from secreting LH, which is the normal ovulation-inducing signal. It is used to avoid ovulation before the oocyte pick-up. We recommend that you take this injection in the morning.
Side effects: Itching and redness at the injection site. 
 

Medicine for stimulation of the ovaries

Gonal-f®, Puregon® 
Contain FSH which stimulates the ovaries to produce follicles containing eggs. This is the natural follicle stimulating hormone.
With the doses used for stimulation for IVF/ICSI, the ovaries will produce more than the one egg that is matured in a normal cycle. These hormones are taken as one daily injection. 

Side effects: Local irritation at the site of injection. Tenderness in the lower abdomen. May cause ovarian hyperstimulation. 

See this  administration guide video on correct use of GONAL-f ^{®
This page is for professionals and  the link is here, because your doctor wants to show the video on how to administer the drug. You can also download written instructions below the videos.}

Menopur®, Pergoveris® 
Contain FHS and LH. FSH is the most important hormone stimulating the ovaries to produce eggs. Et is the natural follicle stimulating hormone. LH is necessary in small amounts to assure an optimal follicle development. Normally there is enough LH present in the body so it is much debated whether it is necessary to add the LH component for ovarian stimulation. 

With the doses used for stimulation for IVF/ICSI, the ovaries will produce more than the one egg that is matured in a normal cycle. These hormones are taken as one daily injection.
Side effects: Local irritation at the site of injection. Tenderness in the lower abdomen. May cause ovarian hyperstimulation. 

See this administration guide video on correct use of Pergoveris^{®
This page is for professionals and  the link is here, because your doctor wants to show the video on how to administer the drug. You can also download written instructions below the videos.}

Elonva® 
Contains a long-acting FSH hormone hat stimulates the ovaries to produce follicles containing eggs. It works in the same way as normal follicle stimulating hormone but the stimulating effect lasts for several days after one injection.
With the doses used for stimulation for IVF/ICSI, the ovaries will produce more than one egg. Elonva® is mostly used for stimulation in the ’short antagonist’ protocol (scheme 4) where it is given as a single injection on cycle day 2-3. 

Side effects: Local irritation at the site of injection. Tenderness in the lower abdomen. May cause ovarian hyperstimulation. 

Pergotime® 
The active ingredient in Pergotime® is clomiphene, which indirectly stimulates the ovaries and thus makes more than one follicle grow. Usually Pergotime® will result in growth of less than 5 follicles. We may use it if traditional stimulation with FSH/LH medicines has not worked well. Pergotime® is taken in the form of tab- lets. 

Side effects: Hot flushes, nausea, blurred vision and headache. However, most women taking Pergotime® will not experience side effects. 

Medicine for induction of final oocyte maturation

Pregnyl®, Ovitrelle® 
These medicines contain hCG and induce final oocyte maturation and initiate the ovulation process. The ovulation will occur approximately 40 hours after the hCG injection. The oocyte pick-up is performed 35-36 hours after the injection. At this time, the oocytes are mature but ovulation has not yet taken place. These medicines are taken as a single injection at a time that is carefully scheduled based on the planned time of the oocyte pick-up. 

Side effects: None – except that it may together with stimulation hormones result in ovarian hyperstimulation if (too) many follicles have developed. 

See this administration guide video on correct use of OVITRELLE^{®.
This page is for professionals and  the link is here, because your doctor wants to show the video on how to administer the drug. You can also download written instructions below the videos.}

Suprefact® (GnRH agonists) 
An alternative to hCG to induce final oocyte maturation is to give a single dose of Suprefact® or another GnRH agonist. This ’agonist triggering’ may be employed if down-regulation has not been given and there- fore it cannot be used in scheme 3. 

Estradiol and progesterone

Estradiol, Progynon®, estradiol-patches 
Estradiol and Progynon® contain the femal sex hormone estradiol. This hormone makes the endometrial lining grow so it reaches a thickness that makes it ready to receive an embryo. Estradiol is a hormone nor- mally produced in the ovaries.
In connection with in vitro fertilisation, estradiol is used to strengthen the endometrium after the oocyte pick-up. For treatment with thawed cryo-preserved embryos in women with a long menstrual cycle and for women receiving donated eggs estradiol is used to stimulate the endometrium to increase in thickness. 
Estradiol can be taken as tablets several times daily or as transdermal patches. 

Lutinus®, Crinone®, Cykclogest® (progesterone) 
Progesterone is a natural hormone that makes the endometrial lining ready to recieve an embryo after the endometrium has been stimulated with estradiol. Progesterone is taken as vaginal pessaries (Lutinus®, Cykclogest®) or as vaginal creme (Crinone®). Progesterone strengthens the endometrium.

Possible side effects: Bloating, diarrea. 

Sedating and pain-relieving medicine

Dormicum® 
A sedative. Is given intravenously at the oocyte pick-up. Side effects: Tiredness, vertigo. 

Rapifen® 
Strong pain-relieving medicine. Related to morphine. Is given intravenously at the oocyte pick-up. Side effects: Nausea, tiredness, vertigo. 

Panodil® (paracetamol) 
Mild pain-relieving medicine. Taken as tablets.
Side effects: None – when the daily dose does not exceed eight tablets (of 500 mg). 

Other types of medicine

Prednisone
Prednisone is a corticosteroid. It has several effects. One effect is to dampen immune responses to some extent. 
We occasionally recommend prednisone in connection with IVF treatment. We may do it in women with repeated miscarriages or in women who have not become pregnant despite several treatments. There is no scientific proof for the effect of prednisone. 

Side effects: With the low doses and the short duration, we use prednisone there are very few side effects. 

Metformin 
Metformin is a type of medicine that is sometimes used for treating type-2 diabetes. It increases the insulin sensitivity of cells.
We sometimes suggest treatment with metformin in women with PCOS because such women may have a degree of ’insulin resistance’. 

Subsidies for medicine 

For patients with Danish social security coverage the medicine is subsidised. If you are a member of the health insurance ’Danmark’ you may have some of the medicine expenses reimbursed from there. 

The public subsidy means that within one ’subsidy-year’ your own payment for medicine is limited to approximately DKK 3075,-. 

You may find additional information on the website of The Danish Health and Medicines Authority (sst.dk)