For in vitro fertilization to be successful, a sufficient number of eggs is required. For example, according to some data, to get one embryo, a woman under the age of 35 needs on average 9 germ cells, after 35 years - 12, after 37 years - 16.
However, during natural ovulation, only one follicle with an oocyte matures. To get more, you need stimulation with hormonal drugs.
You can, of course, do without hormones - carry out IVF in a natural cycle. But the chances of pregnancy will be very small.
Depending on the drug administration regimen, there are two main IVF protocols - long and short. Their duration is, respectively, about 6 and 4 weeks. Women often ask fertility doctors: which protocol is better?
Apparently, if one of them was ideal in all respects, then only it would be used in clinics. But in fact, each scheme has its own nuances, advantages and disadvantages. Let's figure it out.
Pharmacological properties of the drug Decapeptil
Pharmacodynamics. The active ingredient of the drug Decapeptyl is triptorelin (D-Tri-6-gonadorelin) - a synthetic analogue of gonadotropin-releasing hormone (GnRH). The result of replacing the 6th amino acid residue in the natural releasing molecule was: a more pronounced affinity for GnRH receptors and a longer half-life than the natural molecule. The initial effect of administering the drug Decapeptyl is stimulation of the pituitary gland's secretion of FSH and LH. After prolonged stimulation and in the presence of a constant concentration of triptorelin in the blood, the pituitary gland becomes insensitive to the action of GnRH, which leads to a decrease in the level of gonadotropins in the blood. As a result, the level of sex hormones in the blood decreases to post-castration or menopausal levels. The described effects are reversible. Animal studies did not reveal teratogenic or mutagenic effects. Pharmacokinetics . In the first hours after intramuscular administration of the drug Decapeptyl Depot, the maximum level of triptorelin concentration in the blood plasma is recorded. Further, the concentration of triptorelin decreases noticeably within 24 hours. On the 4th day after injection, the concentration of triptorelin in the blood reaches a second maximum, after which the concentration decreases in a bioexponential order to undetectable values within 44 days. After subcutaneous administration, the decrease in the concentration of triptorelin in the blood occurs more slowly; the duration of the decrease in concentration to undetectable values is 65 days. Repeated injections of Decapeptil Depot with an interval of 28 days do not lead to an increase in the concentration of the drug in the blood. Metabolism/excretion . Elimination of triptorelin acetate occurs through excretion of metabolic products in the urine.
Composition and mechanism of action
The active substance of Decapeptyl is triptorelin. The drug comes with a solvent - water for injection or sodium chloride.
Triptorelin is a GnRH agonist analogue. Under natural conditions, GnRH stimulates the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), gonadotropins involved in follicle maturation.
In women entering an IVF protocol, the administration of Decapeptyl causes gonadotropic stimulation. At the end of the first phase, due to decreased sensitivity to the drug, hormone production is suppressed. Thus, the main task of Decapeptyl is to control ovarian function when stimulating superovulation. It suppresses the LH surge and thereby prevents spontaneous ovulation. In addition, the drug makes it possible to monitor ovarian activity in patients undergoing cryopreservation of embryos or in egg donors. This allows the uterine mucosa to optimally prepare for implantation of the embryo.
Use of the drug Decapeptyl
Treatment regimens for infertility in women using IVF:
- From the 21st day of the menstrual cycle preceding the start of treatment, Decapeptyl 0.1 mg 1 ml is administered daily subcutaneously until the introduction of human chorionic gonadotropin. In this case, from the 3rd day of the therapeutic menstrual cycle, a drug of human menopausal gonadotropin (hMG), for example menopur, is administered. The drug human chorionic gonadotropin (hCG) is administered 34–36 hours before the planned puncture of the follicles.
- Decapeptyl 0.5 mg is administered subcutaneously 1 ml daily from the 21st day of the menstrual cycle preceding the start of treatment (until the 3rd day of the treatment cycle). Decapeptyl 0.1 mg - 1 ml daily subcutaneously from the 3rd day of the treatment cycle until the moment of administration of the hCG drug. In this case, from the 3rd day of the treatment cycle, an hMG drug (for example, Menopur) is administered. The hCG drug is administered 34–36 hours before the planned puncture of the follicles.
- Decapeptyl 0.1 mg is administered subcutaneously from the 1st day of the treatment cycle until the hCG drug is administered. In this case, from the 2nd day of the therapeutic menstrual cycle, an hMG drug (for example, Menopur) is administered. The hCG drug is administered 34–36 hours before the planned puncture of the follicles.
Uterine fibroids, endometriosis, prostate carcinoma At the beginning of the course of treatment for 7 days, 1 ml of Decapeptyl 0.5 mg (1 injection) is administered subcutaneously once a day. Starting from the 8th day of treatment, in order to obtain a therapeutic effect, it is necessary to administer the drug Decapeptyl 0.1 ml daily. The injection site should be changed. For a long course of treatment, it is recommended to use the drug Decapeptyl Depot 3.75 mg triptorelin in delayed-release microcapsules - 1 injection every 28 days. Use of the drug Decapeptyl Depot: the contents of the syringe with the drug Decapeptyl Depot, after pre-mixing with the attached suspending reagent, are injected subcutaneously into the anterior abdominal wall or intramuscularly every 28 days. The injection site should be changed. For the treatment of women with Endometriosis : in case of infertility caused by endometriosis, it is advisable to prescribe a course of therapy with Decapeptyl Depot before surgery. Before starting therapy, laparoscopic and histological examination should be performed to confirm the diagnosis. Uterine fibroids: combination therapy with GnRH analogues and surgical treatment is most appropriate. Prescription of the drug Decapeptil Depot leads to a significant reduction in the size of the myomatous uterus, which facilitates surgical intervention. It is recommended to carry out a course of therapy with Decapeptyl Depot for young patients in order to preserve reproductive function, when organ-preserving surgery can be performed using laparoscopic techniques. Due to the possible effect on bone density, the duration of treatment for women with endometriosis or uterine fibroids should not exceed 6 months. Complementary reproductive technologies (IVF): the drug Decapeptil Depot is prescribed to stabilize the level of endogenous sex hormones with the further administration of exogenous gonadotropins to stimulate follicular growth. The use of the drug Decapeptil Depot allows you to avoid premature spontaneous luteinization of stimulated follicles, which increases the effectiveness of the IVF program as a whole. In the scheme for ovulation stimulation under the IVF program, the drug Decapetil Depot is administered once on the 2-3rd or 22nd day of the menstrual cycle. For the treatment of men Symptomatic therapy of late stages of hormone-dependent prostate carcinoma, the so-called pharmacological orchiectomy, as an alternative to surgical castration, as preparation for prostatectomy, postoperative treatment. To study the hormonal dependence of prostate carcinoma, therapy with Decapeptyl Depot is carried out for 3 months. General notes: There is no need to reduce the dose if renal function is impaired.
Contraindications to the use of the drug Decapeptyl
For women: pregnancy and lactation; clinical manifestations or risk of osteoporosis. The drug should be prescribed with particular caution to patients with polycystic ovary syndrome during a program of complementary reproductive technologies (IVF) in cases where the number of follicles determined by ultrasound examination is more than 10. For men: hormone-independent prostate carcinoma, preliminary surgical castration. For children: with precocious puberty of non-central origin, specific therapy should be used to treat the primary disease.
How does the procedure work?
On the day of puncture, an embryologist examines the sperm in a laboratory setting. Before sperm is added to the oocyte medium, it is treated with seminal plasma removers, cleaned, centrifuged, then microscopically examined, sperm quality determined, and sent to an incubator. This is done to obtain full-fledged and motile sperm. The embryologist, together with a reproductive specialist, examines the obtained eggs under a microscope and selects the best ones capable of fertilization, which are then transferred to an incubator with a low oxygen content and optimal conditions for cultivation. They recreate the natural environment in the body of the expectant mother. Embryos are susceptible to pollution at the molecular level, so the cleanliness and quality of air in the laboratory is strictly controlled. For this purpose, a unique filtration system consisting of several stages is used. Due to this, an atmosphere sterile for embryos is achieved.
Fertilization of cells occurs several hours after the puncture. The initial stages of ICSI are carried out like a standard IVF cycle. During ICSI, the embryologist finds sperm (motile sperm with the best morphology are selected), immobilizes them, “sucks them in” and injects them into the egg itself using a microneedle. In this case, the oocyte is fixed in a certain position using a micropipette (holding) on the opposite side. This procedure requires accuracy and attentiveness, and a special micromanipulator is required to carry it out.
This algorithm of actions is repeated separately for each oocyte obtained. The oocyte membrane has elasticity, and the minimal hole from the microneedle quickly closes due to this property of the membrane. Next, the embryos grow in individual drops of a special medium in an incubator. Mandatory daily monitoring of their development is carried out. There are three more important issues that the reproductive specialist and embryologist can decide together: when, how many and what kind of embryos to transfer.
Side effects of the drug Decapeptyl
Side effects during use of the drug are associated with a decrease in the level of sex hormones in the blood. In women : hot flashes, bloody discharge from the genital tract, dryness of the vaginal mucosa and discomfort during sexual intercourse, headache, depression, decreased libido, a slight increase in the level of cholesterol in the blood, paresthesia and visual impairment. Complementary reproductive technologies (IVF): since exogenous gonadotropins are introduced, the absence of sex hormones in the blood lasts only a few days. In order to quickly identify excessive ovarian hyperstimulation, careful observation of the dynamics of follicular growth is necessary. In men : hot flashes, impotence, decreased libido, decreased testicular size, sleep disturbances, depression, loss of appetite, thrombophlebitis. One patient had a pulmonary embolism. In men and women: in some cases, hypersensitivity reactions are noted (itching, skin flushing, fever, anaphylaxis), and sometimes there are complaints of pain at the injection site. All described side effects disappear after completing the course of treatment.
How long does stimulation last for IVF?
The same protocol affects women differently, so the timing always varies. Ideally, a short protocol lasts 4 weeks, and the stimulation itself lasts 10–12 days. In this case, the size of the follicles must be monitored. They should increase by 2 mm daily.
The schedule is drawn up individually
In the presence of ovarian diseases, women require preliminary hormonal treatment. The long protocol provides 30 days of preparatory period and 10 days of active stimulation.
It is worth remembering that hormonal drugs have a strong effect on moral and physical well-being. Severe mood swings, pain in the ovarian area, and increased volume of discharge may occur.
Special instructions for the use of the drug Decapeptyl
The course of treatment with the drug should be carried out under the control of the level of sex hormones in the blood plasma. For women: it is necessary to exclude possible pregnancy at the time of starting therapy. For uterine fibroids and endometriosis, non-hormonal methods of contraception should be used throughout the course of treatment until menstruation appears after its completion. During treatment with the drug, you should not use products containing estrogens (contraceptives, etc.). Treatment of uterine fibroids must be carried out under ultrasound control, since a rapid decrease in the size of the uterus can in isolated cases lead to bleeding and sepsis. In case of regular menstruation during treatment with the drug, you should consult a doctor. For men: the beginning of drug therapy in some patients may be combined with a temporary exacerbation of symptoms of the disease (urinary problems, bone pain, symptoms of spinal cord compression, a feeling of muscle tension, swelling of the lower extremities), which is caused by a short-term increase in the concentration of sex hormones. At the beginning of treatment, antiandrogen drugs can be used as additional therapy to reduce the severity of symptoms of the initial exacerbation of the underlying disease. Special Warning : Allergic and anaphylactic reactions have been reported in adults and children. Both local and systemic manifestations are noted. The pathogenesis of the reactions has not been precisely established. Given the fact that reactions were more often observed in children, it is recommended not to prescribe Decapeptyl Depot to children.
Self-administration of medications
In most cases, women decide to do the injections themselves. The drugs are injected intramuscularly or subcutaneously. The easiest way is to use a special device - an injector pen.
Deviating from medication recommendations can lead to complications
It is important to follow the indicated dosage and give injections strictly at certain intervals. When administering the medicine, you must remember that:
- agents are administered very slowly;
- if you miss the injection time, you must immediately inform your doctor; in this case, the time of taking the medicine must be agreed upon with a fertility specialist;
- you need to monitor the dosage and not change it;
- Before the injection, be sure to disinfect your hands and injection site.
