Lupron (GnRH antagonist); Antagon, Cetrotide (GnRH agonists)
When undergoing ovulation induction with FSH for an IVF cycle, it is critical to control the development of the follicles and time ovulation. The eggs must not be ovulated before they are retrieved or the cycle would be lost.
Drugs such as Lupron and Antagon allow the infertility specialist to control ovulation. These drugs are administered using individualized protocols and prevent ovulation from occurring until an injection of hCG or LH is given.
GnRH is produced by the hypothalamus and stimulates the release of LH from the pituitary. Lupron acts as an antagonist by inhibiting GnRH production whereas Antagon and Cetrotide completely block the effects of GnRH. Antagon produces a “more complete” down regulation and more FSH may be required. Since GnRH is inhibited by these drugs, the pancreas cannot be “signaled” to produce the LH surge.
Patients are carefully monitored using ultrasound and estradiol while undergoing FSH ovulation induction with Lupron or Antagon suppression. Once the infertility specialist judges that the eggs are mature, an injection of hCG or LH is given to finally prepare the eggs for ovulation and the egg retrieval is scheduled, usually 36 hours later.
Side effects of these drugs are the same as seen in menopause since they induce a menopause like state.
Parlodel, Bromocriptine Dostinex (cabergoline)
Prolactin is known as the breast milk hormone because rising levels in pregnant women stimulate the production of breast milk. When levels are abnormally high in non pregnant woman a condition know a hyperprolactinemia results. Hyperprolactinemia can lead to irregular or no ovulation.
High prolactin levels may result from a benign tumor on the base of the pituitary which is often treated with Parlodel. In some cases, the infertility specialist may decide that the tumor needs to be removed surgically.
High prolactin levels can also be caused by borderline thyroid disease or as a side effect of some medications. Usually, Parlodel or cabergoline will cause normal ovulation to resume and the major side effect is usually nausea.