Leuprolide acetate (Lupron)
Lupron is used to prevent spontaneous release of luteinizing hormone (LH), which would trigger ovulation. Both the OCP and Lupron are administered together for an additional 4 to 6 days where upon the OCP is withdrawn while daily Lupron injections are continued. Menstruation will usually follow about 6 to 10 days after stopping the OCP. In this way it is possible to accurately plan the onset of menstruation by varying the length of time on the OCP. We are therefore able to schedule each cycle of egg donation to the convenience of the donor and the medical team. Additionally, the combined use of OCP and Lupron reduces the risk of Lupron- induced ovarian cyst formation, thereby largely avoiding the need to delay or cancel the cycle of treatment or having to perform cyst aspiration procedures.
When menstruation begins blood is drawn, and if the plasma E2 concentration is less than 60 pg/ml, the patient is ready to initiate ovarian stimulation with gonadotropins. If the E2 level is greater than 60 pg/ml, Lupron therapy is continued at the same (or at an
Increased) dosage for a few more days, whereupon the E2 concentration is re-measured. Subsequent failure of the E2 to fall below 60 pg/ml is an indication for a pelvic ultrasound for the detection of an ovarian cyst, the presence of which usually mandates the performance of an ovarian cyst needle aspiration.
Lupron injections are typically continued at a reduced daily dosage. On a designated day (usually within a week and a half of the onset of menstruation), a specified regimen of gonadotropins (e.G., Gonal f, Follistim, Menopur) therapy is initiated. Dosage adjustments are sometimes made during the course of the cycle, based upon the patient’s response to medication.
GnRH Antagonist (Cetrotide or Ganirelix)
This is another medication that is used to prevent the LH surge in order to prevent ovulation. It is used instead of Lupron. GnRH
Antagonists are added to the stimulation regimen when follicles measure 12-14 mm in size, typically around day 6 of stimulation. This medication is continued for the remainder of the stimulation.
Commencing five to seven days after the initiation of gonadotropin therapy, the patient starts serial ultrasound and plasma E2 evaluations to monitor her ovarian response. These assessments are aimed at determining the ideal day for administering 10,000 iu HCG to trigger the final maturation of the eggs and the production of progesterone by the ovaries. Lupron or GnRH antagonist and gonadotropin injections are discontinued on this day and the patient is scheduled for egg retrieval approximately 34-36 hours after receiving the intramuscular injection of hcg.