The Purpose of Fertility Medications
Women usually mature only one egg each month. To obtain multiple eggs for donation, women are given a series of fertility medications to stimulate more egg maturation. In egg donation cycles, it is also essential to synchronize the egg maturation with the maturing of the recipient's endometrial (uterine) lining (the recipient is the woman to whom the eventual embryo will be transferred).
Fertility Medication Timeline
Once the donor has been medically cleared after “Donor Day,” the IVF Clinic you are working with will create a cycle schedule for you. This explicitly explains the sequence, dosage, and schedule of your medication. Your Signature coordinator will continue to handle all appointments and travel bookings, walk you through medication administration, and do anything else necessary to set you up for a great retrieval.
A full donation schedule usually takes 2-3 weeks of daily hormone injections. While on medications, you may attend local monitoring appointments for blood work and ultrasounds.
1. Birth Control Pills
The use of birth control pills is one of the primary ways we synchronize egg maturation in egg donors with the uterine lining maturation of the recipient. The donor will start birth control pills, usually on Day 3 of her menstrual cycle, and may take them for 21 to 35 days total, depending on where the recipient is at in her cycle. Of course, the donor will be initially evaluated on “Donor Day” to make sure she has no medical reasons why she cannot take birth control pills and will be advised of minor side effects such as spotting, breast tenderness, or headaches. If the donor has an IUD or arm implant, these will likely be removed on the “Donor Day” as well.
2. Lupron
Approximately 14 days after beginning the birth control medication, donors will begin taking a medication called Lupron (Leuprolide acetate). Lupron is known as a gonadotropin-releasing hormone (GnRH) agonist, which means that the medication acts similarly to the body's natural GnRH hormone.
This is to ensure that the body's own LH is not activated too quickly, leading to premature ovulation that would interfere with the stimulation and egg recovery process. Approximately 7-10 days after starting Lupron, there will be a drop in the body's estrogen level. This will, in turn, lead to 'withdrawal bleeding' (vaginal bleeding). The birth control pills will be discontinued at this point, but the donor will stay on Lupron until two days before the egg retrieval procedure.
3. Gonadotropins
In conjunction with Lupron, donors will begin taking a type of medication known as Gonadotropins, which stimulate the egg follicles to produce multiple eggs. These medications, which include Follistim, Menopur, and Gonal-F, all contain an active form of FSH, the primary hormone responsible for producing mature eggs in the ovaries.
4. Human Chorionic Gonadotropin (hCG)
Throughout the Gonadotropin treatment, donors will be monitored by ultrasound and blood testing to assess egg follicle growth. When monitoring indicates that follicles have developed sufficiently, an egg retrieval procedure will be scheduled, and donors will receive one injection of a medication called Human Chorionic Gonadotropin (hCG). This hormone is produced by the placenta, the human organ responsible for nourishing the fetus.
This hormone fully matures the eggs so that they are ready for retrieval. hCG triggers the release of the egg (ovulation). Because ovulation usually occurs 34-42 hours after the hCG injection, patients are instructed to receive the injection precisely 36 hours before the scheduled egg retrieval.
Your eggs are ready for harvest when your leading follicles reach 18 - 20 mm (average diameter) in size and the estradiol hormone (E2) level increases. Your eggs will mature after about two weeks of hormones.
Once this happens, you'll return to your doctor's office for the egg retrieval procedure. You can read more about the retrieval in our next post, “What to Expect Before, During, and After Egg Retrieval.”
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