Drugs used in ART (Assisted Reproductive Techniques)

Clomiphene citrate

It is structurally similar to estrogens. It binds to estrogen receptors in the hypothalamus (part of the brain that takes part in the regulation of the menstrual cycle) and thus continues the secretion of GnRH from the hypothalamus, which in turn stimulates the pituitary gland to protect the FSH and LH. These two hormones participate in the stimulation of the growth and maturation of the follicles in the ovaries.
Clomiphene citrate is taken orally (by mouth) in the form of tablets of 50 mg. The therapy starts from 3-7 days of the cycle. The dose is individual, taking into account the body weight index, the response of the ovaries.
The effect of stimulation is followed by ultrasound-folliculometry, ie, the number and size of the growing follicles is monitored.

Gonadotropins

These are hormones that normally emerge from the anterior part of the pituitary gland and include FSH (follicle-stimulating hormone) and LH (luteinizing hormone).

In the ART process these hormones are applied in the form of injections that are administered subcutaneously.

Induction to ovulation usually begins with low doses (50-75 IU / day) and gradually the dose can be increased if there is no good response from the ovaries. Each stimulation requires the ultrasound of the number and size of the follicles to be monitored because there is a risk of ovarian hyper stimulation.

GnRH analogues

Drugs used to desensitize the pituitary, that is, serve to prevent premature leap of LH in the process of controlled ovarian hyperstimulation (COH)

These include:

GnRH agonists

Leuprolide acetate - this drug binds to GnRH receptors and leads to the release of substances that stimulate secretion of FSH and LH. Continuous administration of this medication initially leads to increased secretion of the above hormones, and then to desensitization of the pituitary and fall in the production of FSH and LH, thereby preventing the LH leap in the stimulation phase. Such drugs are used in the so-called. long protocols of stimulation.

GnRH antagonists

Unlike GnRX agonists whose action requires 2-3 weeks, GnRH antagonists act immediately, within a few hours they perform desensitization of the pituitary, with subsequent reduction of FSH, LH and estradiol. Short stimulation protocols.

HCG - (Human Chorionic Gonadotropin)

It is a polypeptide hormone that is synthesized in the placenta (placenta). It consists of one alpha and one beta subunit. The alpha subunit is identical to the alpha subunit of LH, FSH and TSH. This medication serves to prepare the puncture follicles. After receiving the injection with HCG, ovulation occurs at the 40th hour. This is a key point because puncturing eggs should be performed before ovulation occurs, ie, at 34-36 h after administration of the medicine.

Progesterone

It is a hormone that is produced from the ovaries, the yellow body after ovulation and the placenta. It is important for the preparation of the mucous membrane of the uterus for implantation of the fertilized egg. Progesterone preparations are in the form of vaginal or injection with a depot (prolonged) effect. Progesterone therapy starts from the day of ET (embryo transver) or insemination until the 10-12 gestation week when the placenta is already developed and can produce it on its own.