Ovulation induction cycles are usually “controlled” by one of the drugs Lupron, Cetrotide, or Ganirelix. Ovulation cannot occur when a patient is receiving one of these products because they all prevent the LH surge, albeit by different mechanisms.
Lupron essentially blocks the production of estrogen by the pituitary which is why it is also an effective treatment for endometriosis. Ganirelix and Cetrotide act more rapidly than Lupron to block FSH/LH production by the pituitary. Ganirelix and Cetrotide can be given in lower doses for shorter periods of time.
An IVF cycle requires that mature eggs develop so that they can be retrieved and fertilized. Lupron/Ganirelix prevents ovulation of the eggs before they can be retrieved. If they are ovulated prematurely, the IVF cycle will be “lost”. This is one reason why careful cycle monitoring, precise manipulation of the various fertility drugs and physician experience are critical to IVF success. Once the eggs are mature, an injection of hCG is given and retrieval is scheduled 36 hours later.
Prolactin is known as “the breast milk hormone” because it causes milk production in pregnant women. Hyperprolactinemia results when prolactin levels are abnormally elevated in a woman who is not pregnant. Hyperprolactinemia can lead to failed or irregular ovulation. Parlodel and Dostinex lower prolactin levels allowing normal ovulation to resume. Sometimes hyperprolactinemia is caused by a small benign tumor at the base of the pituitary. Rarely, surgery is performed to remove the tumor as medication is usually effective.
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