Leuprolide Acetate

Leuprolide acetate, sold under the brand name Lupron, is one of several gonadotropin-releasing hormone (GnRH) agonists (meaning it simulates the effect of natural GnRH in the body) that are used in fertility treatments, such as in vitro fertilization.

Daily injections of leuprolide acetate overstimulate the pituitary gland, which causes it to produce excessive amounts of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). FSH causes mature follicle to develop in the ovaries, while LH causes an egg to be released (ovulation). The pituitary, sensing there is too much of each hormone in your body, shuts down production and ovulation then ceases. This is called "down regulation" or "suppression." Approximately 10 days of injections are usually necessary to halt ovulation.

This suppression allows doctors to predict and control precisely when you ovulate and time your fertility treatments accordingly to increase the likelihood of achieving pregnancy. Once follicles are mature and your doctor is ready for you to ovulate, he or she will inject you with an ovulation-stimulating medication, such as synthetic hCG or LH, and one or more eggs can be retrieved 35 hours later.

When Lupron is first administered and production of LH and FSH spikes, some women may develop ovarian cysts, although this is a fairly rare occurrence. After this flare stage, when the pituitary has been fully suppressed, some women get a period. Your doctor will put you on Lupron for a few weeks before scheduling any ART procedure to make sure you are past this flare stage and your pituitary is fully suppressed.

Side effects of using Lupron resemble those associated with menopause, including:

• Hot flashes
• Mood swings
• Vaginal dryness
• Decreased libido
• Increased LDL cholesterol
• Decreased HDL cholesterol
• Insomnia
• Headaches
• Breast tenderness
• Nausea/vomiting

Ovarian hyperstimulation syndrome (OHSS) is potentially the most serious complication that can arise from the use of fertility medications. Ovarian hyperstimulation syndrome is a condition that can usually be predicted before it occurs, but it sometimes occurs when only minimal risk factors exist. The following risk factors increase the risk for ovarian hyperstimulation syndrome:

• Women with polycystic ovarian syndrome.
• Women with high Estradiol levels.
• A previous history of ovarian hyperstimulation.

Symptoms of ovarian hyperstimulation include abdominal pain or discomfort, abdominal distension, nausea, dizziness, increased thirst, decreased urinary output, or shortness of breath.

In order to reduce the risk of OHSS, your doctor will monitor your blood daily and perform daily transvaginal ultrasounds around ovulation to check the number and size of developing follicles. Enlarged follicles usually subside once the medication is stopped; rarely, hospitalization may be necessary.

The development of ovarian cysts may be avoided in two ways:

• The Lupron can be started after ovulation has occurred. Ovulation would be confirmed with a blood test and Lupron begun between the 18th and 25th day of your cycle.


• Your doctor may start you on birth control pills before introducing Lupron. You must take the Pill for at least 10 days before Lupron is started, although you may begin injecting Lupron any time after the fifth day. Once you have started Lupron, you would continue taking the Pill for five more days and then discontinue them.

Although Lupron does not appear to cause birth defects, ovulation and pregnancy that occurs with the start of Lupron therapy may be associated with a higher risk of miscarriage. For a few weeks, a newly fertilized egg depends on secretion of the hormones LH and FSH by the pituitary gland. Lupron suppresses these hormones, so the egg may have trouble developing. However, after a few weeks, the developing placenta produces enough of the hormone hCG to support the developing embryo, so after that point, Lupron would have minimal effect.