Lupron (leuprolide acetate, a GnRH Agonist)

Lupron

(leuprolide acetate) to prevent premature ovulation. Today, Lupron is used primarily for frozen embryo transfer cycles and egg donation cycles.

At IVF 1, we use a different class of medications to prevent premature ovulation. We like to use Cetrotide or Antagon instead of Lupron.

Lupron acts by suppressing the pituitary gland (which is normally responsible for triggering ovulation). However, before suppression occurs, Lupron may briefly stimulate the pituitary causing an increase in the pituitary hormones LH (luteinizing hormone) and FSH (follicle stimulating hormone). This is called the agonist or flare phase (see picture). For this reason, it is usually given for a few weeks before starting the other fertility medications. This allows us to “get past” the stimulation phase and into the suppression or desensitization phase.

During the suppression phase, spontaneous ovulation will not occur. You may hear the staff refer to the patient during this phase as being “down-regulated” or "suppressed". This effect will even persist for a few weeks after the Lupron is stopped.

Because the flare phase can sometimes result in annoying problems like the development of ovarian cysts, we try to minimize he occurrence of those problems by starting the Lupron in one of two ways:

After ovulation

Lupron can be started after ovulation has occurred. If a woman has a 28 day menstrual cycle, she would normally ovulate around Day 14. Lupron would be started by checking a blood test to verify ovulation (progesterone level) between the 18th and 25th day. If ovulation were verified, the Lupron would then be started.

Using birth control pills

The problems with Lupron can also be reduced by first starting a woman on birth control pills. The pills can be given for variable lengths of time but at least for 10 days. The Lupron can be started at any point after the fifth day. Once started, the birth control pills would be continued for five additional days and then stopped.

Once a patient achieves pituitary suppression, she will sometimes get a period, but not always. Therefore, in order to verify pituitary suppression, we will have the patient come to the office for a blood test and ultrasound. We will ask the patient to call us to schedule this appointment if she gets a period while on the Lupron but in any case if she has taken two weeks of Lupron.