Washington Center for Reproductive Medicine

Fertility Drugs

Lupron, Ganirelex, Cetrotide

Ovulation induction for assisted reproductive technologies, such as IVF, involves the administration of several fertility drugs.  Follicle stimulating hormone (FSH), is given by injections to stimulate the recruitment and development of ovarian follicles, each of which contains one egg.

Once the follicles mature, an injection of hCG (Pregnyl, Ovidrel) is administered and the egg retrieval is scheduled.  The physician must insure that ovulation does not occur before the eggs are ready for retrieval.  Otherwise the cycle would be “lost".

GnRH, or gonadotropin releasing hormone, is the hormone that stimulates the production of FSH, LH, and other hormones by the pituitary.  When Lupron is given it produces a state known as “down regulation” and since Lupron inhibits the release of GnRH (GnRH agonist), injections of gonadotropins (FSH) are necessary to cause follicular development.

In an unstimulated, “normal”, menstrual cycle, a surge of LH occurs once the follicles mature thus simulating ovulation. Lupron allows the physician to precisely time ovulation since ovulation cannot occur until an injection of hCG or LH (the body responds to hCG in the same manner as LH) is given. Follicular development is monitored via vaginal ultrasound and measurements of estrogen levels.

Lupron is administered by injection according to patient specific protocols and the dose is adjusted during the stimulation cycle. Sometimes it is started in the cycle prior to ovulation induction.  Since Lupron chemically induces a “menopausal state” its side effects can include hot flashes, mood swings, and others normally associated with the menopause.

Ganirelex (ganirelex acetate), Cetrotide (cetrorelix acetate)

This class of drugs is known as GnRH antagonist. They produce the same “down regulated” state as Lupron albeit by a different mechanism. Spontaneous ovulation cannot occur while these products are taken.

While Lupron inhibits GnRH production, Ganirelex, and Cetrotide block its production at the pituitary. These products cause a much quicker and “stronger” blockage of FSH and LH hormone production. Because of this, they can be given in smaller doses and for a shorter period of time.

Some reproductive endocrinologists favor Ganirelex and Cetrotide because of patient convenience (shorter course of administration) and greater control over FSH and LH production. Since these products induce a “menopausal state” they produce menopausal side effects similar to Lupron.






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