I. Leuprolide acetate (Lupron) or Nafarelin acetate (Synarel)

Leuprolide acetate (Lupron) and Nafarelin acetate (Synarel) are known as gonadotropin releasing hormone (GnRH) agonists. This means that the drugs have a similar action to the natural hormone GnRH. In the natural reproductive cycle, GnRH is produced by the hypothalamus, which is a specialized area in the brain. GnRH stimulates the pituitary to produce two natural hormones known as gonadotropins: luteinizing hormone (LH) and follicular stimulating hormone (FSH). FSH is responsible for the development of mature follicles that contain healthy eggs and for the production by the follicles of estrogen necessary to build the uterine lining. LH is released at low concentration throughout the cycle, but at the time of ovulation, there is a rapid increase (a surge) in its blood concentration. The LH surge causes the release of the egg to occur (ovulation) and this is followed by the conversion of the follicle to a yellow body (the corpus luteum), which produces progesterone and estrogen. The progesterone further favors growth of the uterine lining so as to support implantation of the embryo and early maturation of the developing fetus. The administration of GnRH agonist (Lupron or Synarel) affects the pituitary gland in such a way to eventually reduce LH and FSH production. The resultant drop in estrogen levels will contribute to withdrawal bleeding (vaginal bleeding) about seven (7) to ten (10) days after starting Lupron or Synarel injections (this will coincide with stopping the birth control pills). The treatment requires that you receive Lupron or Synarel for a period of about three (3) weeks, at which time the oocyte (egg) retrieval is scheduled. This approach is aimed at achieving a more uniform and predictable response to gonadotropin therapy and at minimizing the likelihood that the treatment cycle might have to be canceled (while in process) due to premature ovulation. We will closely monitor your treatment and you will be provided with printed instructions, so as to ensure that you receive the proper medications and tests at the proper time.

Extensive studies on non-human primates, as well as limited human evaluations, strongly suggest that Lupron or Synarel are harmless. The drugs are rapidly (within hours) eliminated from the body upon discontinuing its administration. We discontinue Lupron or Synarel therapy at least 3 days prior to transferring the embryo(s) into the woman's uterus. By that time, Lupron or Synarel has disappeared from the system. This fact aside, Lupron or Synarel are very close in structure to the natural hormone GnRH and accordingly, are very unlikely to endanger the developing fetus.

SIDE EFFECTS: The administration of Lupron or Synarel is rarely associated with significant side effects. Some women experience temporary fluctuations in mood, hot flashes, nausea, headache and symptoms not vastly dissimilar from PMS. No serious long-lasting side effects have been reported.

II. Gonadotropins

Gonal-f and Follistim are recombinant DNA preparations of pure human FSH made from special genetically engineered cells. Gonal-f and Follistim are identical drugs made by two different manufacturers. Repronex and Menopur are purified gonadotropins obtained from human urine. They are thoroughly screened for infectious agents.

Gonadotropins are administered for nine or more days and produce ovarian follicular growth. Treatment with Gonadotropins, in most instances, results only in follicular growth and maturation. In order to fully mature the eggs, hCG (Human Chorionic Gonadotropin) must be given when clinical assessment of the patient indicates that sufficient follicular growth has occurred.

SIDE EFFECTS: Side effects of Gonadotropins include Ovarian Hyperstimulation Syndrome (OHSS). In order to minimize OHSS symptoms, we try to use the lowest dose of Gonadotropins possible. We expect all IVF patients to have some mild to moderate version of OHSS, which may be accompanied by abdominal distention and/or abdominal pain. This generally regresses without treatment within a few days.

Severe OHSS is characterized by more significant ovarian enlargement accompanied by pooling of fluid in your abdomen, possible shortness of breath and possible decreased urination. Treatment may require hospitalization. The incidence of severe OHSS is approximately 1-2%.

Other side effects include pregnancy, including multiple births. The donor is therefore advised to not be sexually active during a treatment cycle, from one week prior to retrieval procedure to onset of menses.

III. Human Chorionic Gonadotropin

Human chorionic gonadotropin (hCG) is a polypeptide hormone produced by the human placenta. Chorionic Gonadotropin is a water-soluble glycoprotein derived from human pregnancy urine. When reconstituted the solution should be refrigerated and should be used within 60 days.

The action of hCG is virtually identical to that of pituitary LH. It stimulates production of steroid hormones by stimulating the corpus luteum of the ovary to produce progesterone. During a normal pregnancy, hCG secreted by the placenta maintains the corpus luteum after LH secretion decreases, supporting continued secretion of estrogen and progesterone and preventing menstruation.

SIDE EFFECTS: Headache, irritability, restlessness, depression, fatigue, edema, pain at the site of injection.

IV. Use Of Medications

Egg donors use the same medication as all other fertility patients undergoing IVF. The sequence, dose and schedule of administration for each egg donor will be carefully planned by the nurse coordinator and a specific calendar will be set up to guide the egg donor throughout the process.