THE TREATMENT CYCLE
To increase the chance of success and to make management of the treatment cycle easier for both you and us, we use a combination of drugs:
Follicle Stimulating Hormone (FSH) to stimulate the ovaries to mature more eggs than in your natural menstrual cycle. Either Gonadotrophion Releasing Hormone Agonist (Buserelin/Nafarelin) or Gonadotrophin Releasing Hormone Antagonist (Cetrorelix) to control the timing of egg maturation and egg collection.
Human Chronic Gonadotrophin (HCG) which ripens the eggs so that they are capable of being fertilized.
Supply of Drugs
We have our preferred brand of drugs in the hospital pharmacy that supplies all our patients with their drugs. The pharmacy is located within the hospital premises and is open 24 hours from Monday to Sunday.
Please ensure you pay and obtain your drugs in time, before your treatment commences. During the treatment cycle, some women may need more drugs in addition to those prescribed before treatment starts.
Administration of drugs
You can choose to receive your injections in the hospital or we teach you to self administer the injections. This is a simple technique to learn and much easier than having to visit the hospital every day. If you choose not to administer your own injections and wish to go to a clinic near to you, you must make arrangements for this yourself, remembering that some injections have to be given at weekends or late at night. We are happy to teach whoever you wish such as a relative or a friend the injection technique. We will also supply you with the needles and syringes you need.
Care of Drugs
Your drugs must be stored in the fridge or at room temperature away from direct sunlight. Many of the drugs will last several months or more. Before using any of the drugs, you should check their expiry date printed on the label. You should not use any ampoules/bottles that have past their expiry date. Open bottles of Buserelin injection should be disposed of at the end of your treatment cycle and not be kept for subsequent treatment cycle.
If you have any questions about the use or storage of your drugs please contact the nurses.
Cycle Control Drugs
There are two ways we can control your ovaries during stimulation. We can either use gonadotrophin releasing hormone agonists (Buserelin or Nafarelin) or antagonists (Cetrorelix).
Agonists: e.g. Buserelin (Trade name Suprefact), Guserelin (Trade name Zoladex)
These drugs work by "switching off" the woman's ovaries, giving us complete control over the menstrual cycle. Usually you will start your drugs on the 1st day or the 21st day of your period and continue all through the treatment cycle until you have had the HCG injection.
Buserelin is taken as a subcutaneous injection. You must take 0.5mls/50iu subcutaneously once a day. Goserelin is also taken subcutaneously once in 4 weeks (3.6mg dose). It is a slow release (depot) preparation and avoids the burden of daily injection.
Once the ovaries start to "switch off" and the woman's own hormones are suppressed, menopausal symptoms may be experienced such as hot flushes, headaches, forgetfulness and feeling slightly depressed. These are normal, and you should not be concerned if you experience any of these. For headaches, Paracetamol or similar drugs may be taken.
Some women may notice their period is different from normal, or may notice further bleeding after their period is finished. Again this is not a cause for concern and will not affect the treatment.
There are, as yet, no known long-term side effects after Buserelin or Gosereline use. If the IVF treatment is not successful, you may find your periods are irregular for a couple of months before returning to normal.
Antagonists: e.g. Cetrorelix (Trade name Cetrotide)
The main advantage of Cetrorelix is that it will shorten the length of your treatment cycle. Instead of the priming two weeks of Buserelin needed with IVF cycles now, the Cetrorelix is started after the Follicle Stimulating Hormone (FSH, Menogon or Puregon) and then continued until the time of the hCG (Profasi, Pregnyl) injection. This means that the whole cycle is likely to be completed within 28-30 days. It also means less injections (if you were using Buserelin injections before) but is unlikely to mean that you will need less FSH.
At Life Fertility Centre, the initial scan is arranged to be on Saturday. When using Cetrorelix, treatment must start on either Day 2 or Day 3 of a menstrual cycle, and this means the previous cycle must be controlled using the oral contraceptive pill. This means that you cannot conceive on the preceding cycle.
The other consideration is cost: Antagonists (Cetrorelix) are more expensive than agonists (Buserelin).
As with all treatments there can be no guarantee that it will result in the production of healthy eggs or pregnancy. Cetrorelix is given by injection under the skin. This can sometimes cause redness and itching around the injection site.