Drugs used in

IVF

Prof. Aboubakr

ElnasharBenha university Hospital,

Egypt

ABOUBAKR ELNASHAR

DRUGS

I. Gonadtrophins

II. GnRha

III. GnRhan

IV. Progesatgens

V. Estrogen

VI. Dopamine agonist

VII.Antiestrogen

VIII.Insulin sensitizer

IX. Antioxidants

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Preparation Trade name Route U.pr FSH LH Price Company

HMG Menogon, Pergonal,

Humegon,

IM 95% 75 75 92 FerringSerono

Organon

H.P.HMG Merional

Menopur

SC <5% 75 75 92

165

Ibsa

Ferring

Purified FSH Metrodine SC <5% 75

Urofillotropin

<0.1 Serono

H.P.FSH Fostimon

BravelleMetrodine HP

SC, IM <5% 75

Urofillotropin

<0.001 126 Ibsa

FerringSerono

HCG Pregnyl

Chorionic

gonadotophin

Profasi

IM 95% Organon

Nile

Serono

H.P.HCG Choriomon SC, IM <5% 98 Ibsa

I. Gonadotropins

1. Urinary

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2. Recombinant

Preparation Trade name Route U.pr FSH LH company Price

1. FSH Gonal-f (follitropin)

Gonal-f FbM Pen

Puregon (follitropin)

Puregon pen

Gonapure

SC, IM

SC, IM

-

-

-

-

-

75,150

300,450,9

00

50,100

300,600

75

150

-

-

-

-

Serono

Serono

MSD

MSD

Minapharm

252

119

167

2. HCG OvitrelleChoriogonadotropin

SC - Serono

3. LH Luveris

lutotropin

SC - Serono

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, rFSH Vs other GN (HMG, hp-FSH, p-FSH)

No evidence of difference in LBR or OHSS

• 42 trials, 9606 couples

• Further research on these comparisons is unlikely to

identify substantive differences in effectiveness or safety

(Cochrane Database Syst Rev. 2011, Wely et al)

• Use either u or rec Gnt for ovarian stimulation

(NICE, 2013)

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II. GnRHa

Produced by

Modification of the native GnRH decapeptide at 6 &

10 positions

Therapeutic uses in IVF:

Down regulation

To block LH surge

To prevent premature lutenization

Triggering in antagonist protocol

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Effects of GnRha

Flare effect: Within 12 h and lasting 24-48 h

: 5 fold increase of FSH

10 fold rise in LH &

4 fold elevation in E2.

Continuous administration

: opposite effects:

internalization of the agonist /receptor complex & decrease in the number of receptors (down-regulation).

: paradoxical suppression of the pituitary Gntsynthesis & liberation (desensitization).

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The decreased levels of FSH & LH:

1. Arrest of follicular development

2. Decrease in sex steroid levels to castrate levels.

The pituitary blockade persist during agonist tt but it

is reversible after therapy.

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PricecompanyDoseRoute NamePreparation

7501550 540

Abbot3.75 mg/4w11.25 mg/12 w2.8 ml, 1 ml daily

IM, SC

IM, SCLupronLucrin

Leuprorelin

500Astrazenica3.6 mgSC ZoladexGoserelin

605

53FerringCR: 3.75mg

0.1mg

IM, SCDecapeptylTriptolerin

46Ibsa0.1mgIM, SCTriptofem

Sanofi0.5 mg Nasal, SCsuperfactBuserelin

Pfaizer0.2 mg bidnasalSynarelNafarelin

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III. GnRHan

Produced by

Modification at 6, 10, & 1, 2, 3, 8 positions

Effects

Inhibition of LH & FSH immediately without the initial

flare up effect of the Gnta.

Mechanism of actionCompetitive receptor blockade. The suppression of LH is dose related. Larger doses of antagonist is associated with marked reduction of pregnancy rate in IVF cycles

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PriceCompanyRouteTrade Generic

0.25 mg

3 mg

SeronoSCCetrotideCetrorelix

0.25 mgMSD

MSD

SCGanirelix

Orgalutran

Ganirelix

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Company Price

(LE)

FormMgGeneric

name

Route Trade name

Abbott12060 tab10 DydrogesteroneOralDuphaston

Ibsa12410 amp100 ProgesteronIMProntogestIbsa10830 vag pessaries200 ProgesteronVag or

rectalIbsa14830 vag pessaries400

Actavis9015 vag pessaries 200ProgesteronVag or

rectalCyclogest

Actavis12515 vag pessaries 400

Ferring20021 vag tab 100ProgesteronVagEndometrinSerono236jell15 tube8 %Progesterone VagCrinonOctoper2930 caps 100 ProgesteroneVag or oralUterocarePharco3224 caps100ProgesteroneVag or oralProgestadwia3630 caps200progesteroneOral onlycyclotronGlobe2215 caps200Vag or oralHysterogest

IV. Progestagen

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Therapeutic uses

I. Infertility

1.LPD in infertility

2.LPS in IUI

II. IVF

1.LPS in IVF

2.Endometrial preparation

3.To block LH in COS

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Estrogen

Estradiol valerate: 2 mg

White tab in Cycloprogynova

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Dopamine agonist

PricecompanyformmgRouteTrade name

Novarts20 tab2.5oralParlodelBromocriptin

amoun20 tab2.5oralLactodel

29Ibsa15 sup2.5Vag, rectalBromotemia

93pfizer2 tab0.5oralDostinexCabergolin

44rameda2 tab0.5oralMarvigolin

60Globe2 tab0.5oralAlonda

67Amoun2 tab0.5oralcabergamoun

22Habib2 tab0.5oralNostiffix

Novarts10 tab0.75oralNorprolacQuinagolide

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