Answer from: Raúl Olivares, MD
In a normal standard IVF, there are four different types of hormones that we are going to use. All these hormones can either be produced as recombinant hormones, so that means there is a culture of cells that produce a hormone that is biologically identical to the ones that the woman produces. Sometimes, there are these hormones that can be obtained from biological products, either the urine of a menopausal woman or the placenta. These tissues are processed, and we obtain these hormones that are used for later stimulation of the ovaries. These are basically the hormones that are used for stimulation and inducing and triggering ovulation.
Other types of drugs that are also used are the GnRH agonist and GnRH antagonist. These are the drugs that are used to block natural ovulation. When we do a normal IVF, we want the patient not to ovulate until we think she’s ready for the egg collection, so we can get a good number of mature eggs. Therefore, for a few days, patients may have to take two different injections at the same time. One injection is going to keep stimulating the ovaries, the other injection is going to block the natural ovulation. These are drugs that are synthetical, artificial, and they are focused on preventing the patient from ovulating.
Then there is a fourth type of drug is progesterone that is usually started after the egg collection. The progesterone that we now work with is natural micronized progesterone, so it is the same as the natural progesterone produced by the ovaries. In this sense, they have no risk, and progesterone is useful because it’s going to prepare the endometrium to allow the implantation of the embryos.
To sum up, we have 4 different types of hormones. Hormones that are going to stimulate the ovaries, recombinant FSH, recombinant hMG, LH, or biological hMG. We are going to use drugs to block the ovulation with a GnRH agonist or antagonist. We are going to use drugs to trigger the ovulation with hCG, usually recombinant hCG, and also progesterone to prepare the endometrium, which is a natural micronized progesterone to prepare the endometrium for the embryo implantation.
Answer from: Harry Karpouzis, MD, MRCOG, DIUE
IVF is a process in which the first stage starts with ovarian stimulation. To stimulate the ovaries, we need hormones so you can understand that hormones play a very important role in IVF.
The basic hormones that are used are FSH and LH, which are called gonadotrophins. These can be either synthetic created in the laboratory or even coming from, for example, urine of menopausal women. They work similarly, mimicking a natural cycle, and they have the same role that FSH and LH have in reproductive medicine. There are other hormones as well, which are called GnRH analogues or GnRH antagonists. Depending on the protocol that we choose, they suppress the ovaries and down-regulate them so that you can then stimulate them, they may stop ovulation, which is very important because, in the old times, there was a lot of premature ovulation that was destroying the cycle. There was a lot of cancellations, but nowadays especially, with the GnRH antagonists, this is something that is prevented, and the ovulation only happens after triggering the follicles to release the eggs. This is another hormone that is used in IVF, it can be a GnRH analogue again, or it can be beta HCG, which actually helps in releasing the eggs, and it acts the same way as LH in a natural cycle.
Finally, before embryo transfer, estrogen and progesterone are very important. Estrogen primes the endometrium so that it can increase the thickness to accept an embryo. Progesterone is a very important hormone as well, because, in a normal spontaneous cycle, it is created and produced by the body. In IVF, there is no corpus luteum to produce this hormone, so we need external administration, so this progesterone can be given either through the vagina or through the mouth subcutaneously or even intramuscularly, all these hormones are very important, and they need to be used at the right doses and the right timings during an IVF. The whole plan behind all this is to mimic reality, to mimic what is happening in a natural cycle.
What hormones are used before, during, and after the IVF, and how they may change my body?
Most of the drugs that are used in IVF mimic the body the same way as if you were to become pregnant naturally. What drugs and hormones are involved in IVF? When are they needed?