Lupron – The Drug With Many Uses!
Traditionally, Leuprolide has been used to treat advanced prostate cancer, endometriosis, uterine fibroids, and premature puberty. With Assisted Reproductive Technology (ART), it is used a little differently. The dosage, strengths, shelf life, and how it is supplied will change depending on the type of IVF treatment prescribed.
Microdose Flare Lupron is generally used for patients who may respond poorly to IVF stimulation Medications (low responders or advanced maternal age). The idea is to use Lupron at a much lower dose, causing a release of FSH in the body. That, in addition to the FSH stimulation medications, will work directly on the ovaries to increase the number of eggs in the cycle. Because Microdose Lupron is compounded (made to order in the pharmacy), it has a very short shelf life, anywhere from 9 days to 30 days. Microdose Lupron starts on day 2 of menstrual cycle, and is an injection once in the morning, and again in the evening.
Our most common protocol utilizes Lupron as a trigger instead of hCG to mature follicles prior to egg collection. The use of Lupron has effectively eliminated the risk of OHSS (Ovarian Hyperstimulation Syndrome). An LH surge is initiated in response to the Lupron injection, but is short-lived. The LH surge will induce maturation of the eggs for IVF. However, it is cleared from the body relatively quickly which diminishes the long-term stimulation of the ovaries that occurs with an hCG trigger which lingers in the body.
The Lupron trigger also causes a rapid drop-in estradiol and progesterone levels, thus, decreasing luteal phase support, so we cryopreserve all embryos created. Our patients undergo a frozen embryo transfer cycle the following month. This protocol results in no cases of OHSS, and increases the rate of success because many couples also choose to genetically test the embryos prior to transfer.
Lupron is also used with frozen embryo transfer cycles. During a frozen embryo transfer cycle, hormones are used (estradiol and progesterone) to prepare the uterine lining for the embryo transfer. Using Lupron during the luteal phase of the cycle before is the first step, as it will suppress the ovaries and reduce the risk of ovulation during the frozen embryo transfer cycle. Lupron usually continues throughout frozen embryo transfer (FET) cycle until 1 week before progesterone supplements start. The goal is to mimic a woman’s menstrual cycle using supplemental hormones. Estradiol thickens the uterine lining, and once ready, progesterone is added in to further mature the lining and prepare for implantation.
Many medications can be utilized in a number of different ways, to achieve different outcomes.
Many medications can be utilized in a number of different ways, to achieve different outcomes. This is dependent on what medication is given and the dose prescribed, among other medical factors. As you can see with Lupron, we use it in several different ways, for several different reasons. So, don’t be surprised if you see Lupron used during different types of cycles. If you are ever unsure of the reason for a medication, reach out to the nurses – we are all well versed in these medications, and are always happy to answer any questions you may have.
- Natalie Sofia, BSN, RN & Samantha Smith, BSN, RN