Parlodel (bromocriptine)

Sometimes a condition termed hyperprolactinemia can cause irregular, or no, ovulation.  Hyperprolactinemia is when the levels of the hormone prolactin are abnormally elevated.  Prolactin is the “breast milk hormone” responsible for milk production in pregnant women. One of the symptoms of hyperprolactinemia is breast milk production in the absence of pregnancy.

There are many causes for hyperprolactinemia. One common cause is thyroid disease. In addition, a variety of medications, including those used to control hypertension and depression/ mood disorders, can also cause prolactin elevation. Elevated prolactin levels can also be caused by a benign tumor on the pituitary gland. Rarely, surgery is performed to remove the tumor.

Parlodel (Bromocriptine) and Dostinex (Cabergoline) are often effective in reducing prolactin levels and establishing normal ovulation. Both of these fertility drugs decrease the production of prolactin from the pituitary by stimulating dopamine receptors.

Progesterone

Progesterone is a hormone, which stimulates and supports endometrial development. The endometrium is the layer of tissue lining the uterus where the embryo embeds and implants.  Progesterone is initially produced by the follicular structure leftover after ovulation, known as the corpus luteum. Once pregnancy is established the placenta begins progesterone production.

Inadequate progesterone can lead to a condition known as a luteal phase defect, which is characterized by a poorly developed or “out of phase” endometrium. This defect is diagnosed by either testing your progesterone level after ovulation or by performing an endometrial biopsy where a small section is viewed microscopically.

Progesterone supplementation or ovulation induction with fertility drugs will usually correct a luteal phase defect.  Progesterone is also administered in all IVF cycles because Lupron or Ganirelix interfere with its normal production.  Progesterone is available as an injection, vaginal suppository, vaginal gel, and other forms.

Ovidrel, Pregnyl (hCG)

hCG is known as the “pregnancy hormone” as it is elevated in pregnant patients.  hCG is also used to trigger ovulation in patients undergoing ovulation induction.  Normally, a spike in luteinizing hormone, produced by the pituitary, finalizes egg development and initiates ovulation.  The body responds to a spike in hCG the same as it does to LH; therefore an injection of hCG will cause ovulation of the mature eggs or prepare the eggs for egg retrieval.    If undergoing IVF, the egg retrieval is scheduled 36 hours after the hCG injection, before natural ovulation can occur.

Pregnyl is a “natural” product being derived from the urine of pregnant women. Ovidrel is pure hCG manufactured using genetic recombinant technology in mammalian cells.

Luveris (LH)

Luveris is pure leutinizing hormone (LH) derived using genetic recombinant technology in mammalian cells. It is indicated in women with severe deficiencies of LH caused by a condition known as hypogonadotropic hypogonadism.  Luveris might also be used to trigger ovulation or “sweeten” IVF protocols. 

It seems that there is little, or no, advantage of Luveris compared to hCG preparations and Luveris is more expensive.  Physicians might also add LH to protocols by using Repronex instead of Luveris, which is also less expensive.  The “jury is still out” on the most appropriate uses of Luveris.

Birth Control Pills

Birth control pills are often used in IVF cycles to prevent the formation of ovarian cysts and are given in the cycle prior to the FSH treatment cycle. Another advantage is that they increase the predictability of the menstrual cycle and therefore allow for accurate scheduling of your procedures.  They are also helpful in reducing the level of male hormones and getting all the eggs to a “baseline” state.