Egg freezing is a medical process in which a woman’s ovarian follicles are stimulated to allow for multiple eggs to be produced in one cycle so that they may be retrieved and used for fertility preservation. While the specific medication protocol is personalized to the patient, you can become familiar with the most common medications used and how they work.
The most common medications used in an egg freeze cycle are:
Oral contraceptive pills (OCPs), or birth control pills, are used at the start of the menstrual cycle, prior to starting the ovarian stimulation process with medications. The egg freezing cycle begins shortly after stopping OCPs. OCPs are used to manipulate the timing of the egg freezing cycle to better fit the patient’s or clinic’s schedule. Ultimately, whether or not a woman is on OCPs during egg freezing does not impact the final outcome of an egg freezing cycle.
Lupron is a medication that is used frequently and in a variety of doses at different times during the egg freezing cycle. For example, some patients might start Lupron a week before their menses starts, while others may overlap it with OCPs before stimulation. Some patients might start it with their stimulation medications at the same time or use it to trigger prior to their egg retrieval. Lupron is most often injected to either cause a natural surge in the LH or FSH hormone which stimulates the follicles to grow, or to shut down the LH or FSH hormone and temporarily put the ovaries at rest. This, in effect, synchronizes the follicles to grow during stimulation with the fertility drugs and prevents ovulation or release of eggs prior to the retrieval.
Gonadotropins are made of FSH (follicle stimulating hormone) and LH (luteinizing hormone). FSH is used to help the follicles in the ovary grow, and the most common formulations on the market are Follistim and Gonal-F. Menopur has FSH in it and also LH. These are daily injections self-administered by the patient, usually for 9-12 days. The number of days and dosages are adjusted depending on patient response to the medications, determined by regular pelvic ultrasounds and hormone levels in the blood.
Gonadotropin releasing hormone (GRH) antagonists are used to prevent early ovulation. Cetrotide and Ganirelix are the most common injectable medications. These are started 4 to 6 days after the start of FSH medications and continue until the day of trigger.
hCG is the most common medication used to trigger the follicles for egg retrieval 34 to 36 hours after injection. It is timed specifically so that the eggs mature and do not release prior to when egg retrieval is performed. The hCG medication mimics an LH surge, which typically occurs in the middle of the menstrual cycle prior to ovulation. This is the hormone that can lead to ovarian hyperstimulation syndrome, or OHSS for some women. Learn more about OHSS.
Keep in mind that variations in medication protocols can make it challenging for patients when they compare their experience from physician to physician or patient to patient. Not all egg freeze cycles are the same, even though there is a common end goal of obtaining a good number of mature eggs to freeze so that one day they will be thawed, inseminated with sperm to create embryos, and transferred back into the uterus for implantation. Physician practice and training will influence what hormone testing and medication protocols patients will use to grow the most eggs with the best yield in the safest way possible per treatment cycle. If a patient chooses to do more than one cycle, their experience during a previous cycle will dictate if the physician uses the same protocol or makes modifications since there are a variety of fertility medications and protocols to choose from.
Dr. Alison Peck, M.D., F.A.C.O.G., Southern California native and practicing since 2006, is board certified in both obstetrics/gynecology and reproductive endocrinology/infertility (REI). Dr.Peck is also fluent in Spanish and Hebrew and has a special interest in Genetic Screening of Embryos and Fertility Preservation in Young Reproductive Age Women. Dr. Peck completed her specialty training in obstetrics and gynecology at the University of Southern California and her fellowship in reproductive endocrinology and infertility at the Albert Einstein College of Medicine, New York.
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