Hormone medication in fertility treatments: what is it used for?
Hormone medication in fertility treatments plays a crucial role in improving reproductive outcomes. Compared to other mammals, humans are relatively inefficient from a reproductive standpoint. The probability of achieving a natural pregnancy is 23% per month or per woman’s ovulatory cycle. In a couple with fertility problems, this probability is even lower: generally 3% or less.
In a natural cycle, the ovary recruits and selects (ovulates) a single oocyte, occasionally two, from a cohort of a variable number of eggs. The other oocytes not selected for ovulation will undergo a process of death or atresia. This will occur every month, causing a decrease in a woman’s ovarian reserve year after year.
The aim of most medications used during fertility treatment, whether artificial insemination or in vitro fertilisation, is to improve the effectiveness and efficiency of assisted reproduction techniques.
Examples of hormone medication in fertility treatments
Here are several examples of hormone medication in fertility treatments used in assisted reproduction, and the reason for each one.
The use of the contraceptive pill, or oral oestrogens, before starting a stimulation cycle in IVF, aims to regulate and synchronise the development and growth of the follicles in the ovary. In patients with low ovarian response, prior treatment with androgens may be indicated, which would improve the ovary’s response to stimulation.
The injectable medication used to stimulate the ovary (Gonal, Puregon, Bemfola, Fostipur, Elonva, Pergoveris, Menopur, Meriofert, etc.) is used to achieve multiple follicular development. In an IVF cycle, this will enable a greater number of mature oocytes to be obtained, which will allow more embryos to be developed so that the best ones can be selected for transfer to the uterus, thus improving the chances of pregnancy.
In specific cases, there are also oral medications that stimulate ovulation, such as clomiphene citrate (Omifin). In the case of artificial insemination, ovarian stimulation aims to ensure proper ovulation. In IVF, during ovarian stimulation there is a risk of premature ovulation. To avoid this, drugs such as GnRH agonists and antagonists are used, which prevent premature maturation and ovulation and, since their introduction, have reduced the number of treatments cancelled for this reason.
At the end of stimulation, once optimal follicular development has been achieved (when they exceed 18 mm in diameter with appropriate levels of oestradiol and progesterone in the blood), the extraction and recovery of the oocytes is scheduled by means of ovarian puncture. To trigger this final maturation, the hormone hCG (Ovitrelle) is generally used 36 hours before the procedure.
After artificial insemination or ovarian puncture, in the case of IVF, progesterone is prescribed to ensure proper ‘maturation’ of the endometrium, which is necessary for normal embryo implantation.
Are all medications equally effective?
In general, all the hormones we control in an IVF cycle, and which are used to stimulate the ovaries, are equally effective.
The use of one or the other will depend on each patient, their diagnosis and the experience of each doctor.
We understand that the subject of medication is complicated and always a source of doubts and concerns. That is why, at URE Centro Gutenberg, we have prepared a guide to frequently asked questions, which we will answer here. However, we want you to take away one very important idea that dispels one of the great myths about fertility treatments: this hormonal medication is very safe, and its aim is always to improve the efficiency of assisted reproduction treatment.
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