Fertility Education

Frequently Asked Questions (FAQ's)

Acronyms Frequently Used in Fertility
To assist you in better understanding the terms used in fertility, below is a list of the more commonly used acronyms.

Some commonly used terms:

Assisted Reproductive Technology (ART):

Providing assistance in achieving pregnancy. This may include super-ovulation, intrauterine insemination, or in-vitro fertilization.

Superovulation Therapy or
Controlled Ovarian Hyperstimulation:

The use of injectable drugs to stimulate the ovaries to recruit and develop numerous follicles/eggs.

Ovarian monitoring:

The use of ultrasound and/or blood or urine tests to monitor ovarian follicle development and hormone production.

Intrauterine Insemination (IUI):

The special preparation of sperm that is introduced into the uterus (womb).

Egg retrieval (also called oocyte retrieval):

A procedure for collecting the eggs contained in the ovarian follicles. This is done with a needle through the vagina under anesthesia.

Intracytoplasmic Sperm Injection (ICSI):

A procedure in which a single sperm is injected directly into an egg for fertilization.

Embryo transfer (AH):

Placement of embryos into a woman's uterus through the cervix several days after in vitro fertilization (IVF).

Cryopreservation:

A technique for freezing extra embryos to preserve for use at a later date. Cryopreserved embryos are referred to as frozen embryos.

Assisted Hatching (AH):

A small incision is made in the shell surrounding the embryo just prior to transfer of the embryo into the uterus.

Blastocyst Culture:

Extended or prolonged growth of embryos in the laboratory to select the best for transfer.

Medications:

There are a number of medications that you may use during your IVF cycle. The section below lists and describes the medications that we currently use at our center. From time to time new medications are introduced. We will try to keep you informed about such medications as we begin to use them in our program. If you have any questions regarding any of the medications you are using, please ask a member of our clinical staff.

Oral Contraceptives:

Oral contraceptives (OCPs, birth control pills) contain both synthetic estrogen and progesterone-like compounds. OCPs are sometimes used to enhance your response to the gonadotropins and to provide us with some flexibility in scheduling and starting your IVF cycle. There are a variety of oral contraceptives on the market, many of which can be used for our purposes. If you have previously taken an oral contraceptive that you tolerated well, let us know so we can consider prescribing it for you. The length of time you will be on the OCPs may be different from other IVF patients depending upon your history and when you enter the program to start your ART cycle.

Some common side effects of the hormones in birth control pills include nausea, breast tenderness, increased appetite and weight gain, acne, increased breast size, and headaches. Though low, there are also risks associated with OCP's. These risks include stroke, deep vein thrombosis, and pulmonary emboli. If you are over 35 years of age and smoke, if you are a heavy smoker at any age or have serious heart disease you may be at increased risk for these complications. If you smoke or just recently (less than 6 months) discontinued, you should not take oral contraceptive pills.

Luteal Estrace:

Estrace a synthetic estrogen tablet may be used during the luteal phase (last 7-10 days) of your menstrual cycle. This tablet (2 mg) is taken orally twice per day, and is used as an alternative to OCP's to enhance the ovarian response to gonadotropins and create flexibility in your IVF schedule.

Gonadotropin-Releasing hormone (GnRH) Agonist and Antagonists:

GnRH agonists have been used in IVF since the 1980's to increase the number of eggs we retrieve from your ovaries and to prevent premature ovulation. GnRH antagonists have been used in IVF since late 1990's/2000. Both work to prevent premature ovulation. The agonists are typically started 7-14 days prior to starting the fertility (gonadotropin) injections, while the antagonists typically are started after 5-8 days of being on the fertility injections. Different clinical scenarios will dicate if you are prescribed the agoinst or antagonist. All patients will be on one or the other.

Lupron

is a GnRH agonist that may be administered by subcutaneous injection once or twice daily. It is usually started prior to gonadotropins, and continued until you are ready for retrieval. Risks and Side Effects of Lupron: hot flashes, vaginal dryness, mood swings, vaginal bleeding/spotting, headaches or insomnia. All are short term and usually disappear after you start your gonadotropins. Women who use Lupron for more than 6 months may have loss of some of the density of their bones. However, you will be on Lupron less than 30 days.

Ganirelix or Cetrotide

are GnRH antagonists and are also administered subcuatneously. They are used like Lupron to prevent ovulation, but are only started after gonadotropin therapy has already begun. Your individualized protocol will inform you when to start these medications. Risks and Side Effects of Ganirelix/Cetrotide: abdominal pain, headaches, vaginal bleeding or spotting, nausea and irritation at the injection site. All are uncommon, short term and generally disappear after you stop taking the drug.

Gonadotropins ("fertility shots")

are hormones secreted by the pituitary gland and include FSH and LH. FSH is responsible for the selection and growth of developing eggs and follicles on your ovaries. LH plays an important role in the final maturation of the eggs and also causes ovulation to occur during a natural menstrual cycle.

All gonadotropins can be injected subcutaneously. Some come as a powder that must be mixed with sterile saline or water prior to their use, others come pre-mixed. Your physician will select the drug and dosages that are most appropriate for you and our clinical staff will provide you with instructions on how to use them.

Follistim Pen

utilizes premixed cartridges of Follicle Stimulating Hormone (FSH) and a reusable pen delivery system.

Gonal-F Pen

utilizes premixed cartridges of FSH and a disposable pen delivery system.

Bravelle (FSH) and Menopur (FSH + Leutinizing Hormone) powder must be reconstituted prior to being injected with a syringe.

Monitoring:

During the course of your IVF cycle we will be closely monitoring the status of your ovarian response to these medications using both ultrasound images and blood hormone levels (estradiol, progesterone). We may alter the dose of medication you are taking or cancel a cycle that is not producing a reasonable number of follicles. You will be given specific instructions regarding when to take the various medications you will be using, what doses of medication to take, and in some instances what time to take your medication.

Adverse Reactions/Side Effects: Occasionally you may experience one or more of the following reactions to the gonadotropins you are taking:
Local irritation at the injection site
Dizziness, nausea, headache, mood swings, irritability, hot flashes
Ovarian enlargement and twisting of the ovary (torsion, which is rare)
Ovarian Hyperstimulation Syndrome (OHSS) is an excessive enlargement of the ovaries and accumulation of fluid in the abdomen.

Some of the risks associated with OHSS include:
Deep vein thrombosis (clots)
Pulmonary embolism
Stroke

OHSS ranges from very mild symptoms (pelvic discomfort) to severe (pain, clotting problems, electrolyte imbalance) which may require hospitalization. The specific cause of OHSS is unknown but appears to be related to high estrogen levels. Often women who develop OHSS are also pregnant from their IVF cycle, but this is not always the case. The more severe forms of OHSS are fortunately quite rare in IVF (less than 1 % of patients who develop OHSS). Some symptoms to watch for are weight gain, bloating, nausea, diarrhea and shortness of breath.

Monitoring:

is the hormone associated with pregnancy and its actions in the body are identical to LH. There are two main categories of hCG used for ART cycles, urinary and recombinant. Urinary gonadotropins, as the name implies are isolated form the urine of postmenopausal women using special processes to ensure their safety and potency. hCG medications that are urinary gonadotropins include Profasi, Pregnyl and Novarel. These medications are injected intramuscularly (IM). Recombinant hCG is a product of DNA technology and contains only pure hCG. Ovidrel is a recombinant hCG product used in some IVF cycles, but more commonly for Intrauterine Insemination (IUI) cycles. Ovidrel is a subcutaneous injection.

hCG is used in an ART cycle to mimic the normal midcycle LH surge, which is necessary to facilitate the final maturation process of the egg. The timing between your administering of hCG and the egg retrieval is carefully planned so you do not ovulate prior to us collecting your eggs at the retrieval. Your egg retrieval is done before you ovulate your eggs. Our clinical staff will instruct you on both the date and time you are to take your hCG.

Your treatment protocol may also include dilute or low dose hCG to add a small steady dose of LH during the growth and maturation of your follicles and eggs. Dilute hCG is administered subcutaneously using an insulin syringe and should be kept refrigerated.

Progesterone (P4)

is a steroid hormone that is normally produced by the corpus luteum (that portion of an egg follicle that remains on the ovary after ovulation). Progesterone is important in transforming the uterine lining from one that is growing into one that is preparing for embryo implantation. Progesterone is administered by vaginal suppository or intramuscular injection each night, starting the night of your oocyte retrieval and continuing until your first pregnancy test, approximately two weeks after your egg retrieval. If pregnant, you must continue progesterone support.

Adverse Reactions/Side Effects include breast tenderness, bloating, and nausea. Because we only use natural progesterone, there are no increased risks to the fetus for birth defects, miscarriage, etc. We no longer use forms of progesterone that are dissolved in peanut oil. Rather, we use ethyl oleate, leading to much less of a risk of allergic reaction. Please alert our clinical staff, however, if you feel that you are experiencing an adverse reaction so that we may adjust your treatment protocol accordingly.

Estrogen

is also a steroid hormone that plays an integral role in reproduction. It is produced by growing follicles, the corpus luteum and the placenta. Estrogen supplementation is begun after your embryo transfer and is delivered in the form of transcutaneous patches. The risks and side effects of estrogen are discussed earlier in this section.

Drugs Used For Micromanipulation and Embryo Transfer

In addition to your retrieval and embryo transfer, you may require the use of micromanipulation on your eggs, embryos or sperm as part of your ART cycle. The two most common forms of micromanipulation used in IVF are Intracytoplasmic sperm injection (ICSI) and assisted hatching (AH). Preimplantation genetic diagnosis (PGD) of embryos is being used more frequently in ART cycles as the technology becomes appropriate for select groups of IVF patients. Micromanipulation procedures are detailed later on in this pamphlet. Antibiotics are used to minimize infection and augment implantation. These include:

Antibiotic (Z-pack, doxycycline, other)

are given to patients for several reasons during an ART cycle. During micromanipulation procedures, a small hole is made in the outer covering of the egg (zona pellucida) and the antibiotics prevent bacterial contamination of the manipulated egg or embryo.

Risks and Side Effects:

gastrointestinal upset, nausea, vomiting, diarrhea, photoxicity (allergic reaction to sunlight), and allergic reaction (rash, itching, asthma). Alert our clinical staff if you have a know allergy to a specific type of antibiotic that you have been prescribed in the past so that we may avoid its usage during your IVF treatment.

Preparing for Pregnancy
Fertility Services

Last updated: July 22, 2008
Author: Dr. Arlene J. Morales

 

 

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