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 When
assisted reproductive technology patients undergo an ovulation
induction cycle, it is necessary to control when hormones,
such as FSH, estrogen, and luteinizing hormone are released.
Lupron also blocks estrogen production, which is why it
is effective in treating endometriosis. Endometrial tissue
depends upon estrogen for growth.
Lupron is a gonadotropin releasing hormone
agonist, which blocks the production of GnRH at the hypothalamus.
When GnRH is blocked it cannot signal the pituitary to produce
FSH or LH. FSH is administered by injection until the follicles
are judged to be mature. Ovulation cannot occur while a
patient is receiving Lupron unless an injection of LH or
hCG is given. This prevents the premature ovulation of follicles
during an ART cycle. If ovulation occurred prior to retrieval,
the ART cycle would be "lost".
The dosage and administration of Lupron is
patient specific and based upon protocols. Some patients
start Lupron in the cycle prior to the stimulation and others
start during the stimulation cycle.
Ganirelix and Cetrotide produce similar clinical
results except that they are GnRH Ganirelixists. These products
completely block the production of FSH and LH at the pituitary
causing profound down regulation. In some cases, down regulation
with Ganirelix and Cetrotide may increase the FSH requirement
and therefore cost. This is because there is essentially
no endogenous FSH to augment the stimulation. Some physicians
feel a minute quantity of LH is necessary and may prescribe
a product such as Repronex or Luveris.
Given Ganirelix's and Cetrotide's clinical profiles,
the total dosage required for down regulation is lower than
that of Lupron. This means fewer injections and possibly
(dependent upon the dose) lower cost.
Products in this category produce side
effects that mimic the menopause. This is because they lower
endogenous hormone levels to those seen in menopausal women.
These side effects include hot flashes, vaginal drying,
emotional disturbances, and nausea. Please see the manufacturers
Web site for a complete discussion of side effects.
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