IVF Treatment - Drugs

• GnRH Analogues - Synarel (Nafarelin) and Lucrin (Leuprolide)
• FSH (Gonal-F or Puregon)
• hCG (Profasi or Pregnyl)
• Antagonists - Cetrotide (Cetrorelix) and Ganirelix (Orgalutron)

Drugs used and their side effects

Side effects from the medications are relatively uncommon. The following, however, have been reported in the medical literature and couples contemplating treatment should be aware of them.

GnRH Analogues - Synarel (Nafarelin) and Lucrin (Leuprolide)

Synarel and Lucrin are synthetic drugs which are analogues (variants) of a naturally occurring brain substance. Synarel is given by nasal spray morning and night and Lucrin by a daily subcutaneous (just under the skin) injection. They both act the same way and the one chosen usually depends on the women's preference. They are long acting, at first stimulating the pituitary gland at the base of the brain (we call this a flare) but then paradoxically causing a sustained suppression (called down-regulation) allowing us better control over the hormone stimulation. They work for 10 - 18 days after the last dose so they may alter the next cycle in some way, e.g. longer or shorter cycle, lighter or heavier loss.

Reported Side Effects:

1. Headaches
2. Local irritation inside the nose or at the injection site
3. Occasional hot flushes and breast tenderness
4. Muscle weakness and pains, and double vision
5. 1 in 500 women have a slight allergic reaction - shortness of breath, chest pains and rashes. If you have a reaction, stop the medication and call us so we can arrange alternative treatment.

FSH (Gonal-F or Puregon)

This is a synthetic hormone which is exactly like a natural hormone but, being synthetic, it cannot carry any infectious agents. It is used to promote the growth of ovarian follicles and is administered as a subcutaneous (just under the skin) injection.

Reported Side Effects:

1. Headaches, tiredness and lethargy
2. Irritability and tearfulness
3. Breast tenderness
4. Nausea
5. Enlarged tender ovaries
6. Abdominal distension and discomfort
7. Fluid retention
8. OHSS

hCG (Profasi or Pregnyl)

hCG is a sterile human hormone. It has been safely in use for over 30 years. It is given by subcutaneous injection 36 - 38 hours before your egg collection and is used to mature the follicles and to trigger ovulation. It (or progesterone) is also often given in lower doses after the embryo transfer to support the lining of the uterus to allow implantation. It is usually only necessary in hormone stimulated cycles.

Reported Side Effects:

1. Breast enlargement
2. Ovarian tenderness
3. Abdominal distension - bloating
4. Nausea and constipation
5. Pain at the injection site
6. OHSS

Antagonists - Cetrotide (Cetrorelix) and Ganirelix (Orgalutron)

These two drugs, known as GnRH antagonists, specifically and only stop the normal dramatic mid cycle rise of LH, which is the hormone that normally triggers ovulation. By suppressing the LH we can control the day of ovulation to allow more follicular growth. We only use these drugs for a short time around expected ovulation and they eliminate the necessity for ‘down regulation’ using Synarel or Lucrin. They are not used as often because they are more costly and the pregnancy rate is not improved, except in some particular circumstances. They are relatively free of side effects. They come in a 3mg single dose or 0.25 mg multi-dose preparations.