In vitro fertilization is a very complicated procedure. She gives the chance to many women suffering from infertility to get pregnant. During IVF, several drugs are used. The most commonly used drug is "Orgalutran". The instruction to it describes in detail the technique of administering the medication and warns of possible consequences.
The composition and form of production
Warns about the need to consult a specialist reproductologist before the introduction of the drug "Orgalutran" instruction. Release form - a 0.5 ml syringe with a solution for subcutaneous injection. It contains about 250 μg of the active substance ganirelix, which is produced in the form of acetate. Among the auxiliary substances involved mannitol, glacial acetic acid, distilled water. Orgalutran medication is packaged in cardboard boxes one or five disposable syringes. Instructions to it are included and describe all the nuances of using the drug.
Pharmacological effect of the drug on the body
The drug "Orgalutran" (the instructions describe in detail how to inject this medicine) refers to gonadotropin-releasing hormone receptor antagonists . Helps track the production of gonadotropins LH and FSH. Slows down the secretion of LH and FSH by the pituitary gland. If the stimulation of these hormones has not been previously performed, then the secretion of the pituitary gland is suppressed almost immediately after the administration of the drug. This effect is maintained throughout the entire therapeutic period.
A study of the drug in female volunteers showed that multiple administration of a 0.25 mg drug reduces the concentration of FSH, estradiol and LH in the blood by 74, 32 and 25 percent, respectively, which is achieved after 4, 8 and 16 hours after the injection. Within two days after the administration of the drug, the hormone index became initial.
The average duration of a therapeutic course with daily injection of Orgalutran in the amount of 0.25 mg / day to track ovulation stimulation is five days. The average rate of LH increase frequency (above 10 IU / L), accompanied by an increase in progesterone content (above 1 ng / ml), is 1.2%, which is proportional to 0.8% for GnRH agonists.
Before the start of treatment with Orgalutran, before the sixth day of ovarian stimulation with gonadotropic drugs in women who had an increased ovarian reaction, an increase in LH occurred. LH production in this category of patients was suppressed almost immediately after the first use of Orgalutran.
Indications for use
Gives a positive result when conducting IVF drug "Orgalutran." Instructions and indications for use recommend the use of this medication to prevent an increase in the indicator of luteinizing hormone (LH) in those women who make traceable ovarian hyperstimulation using additional reproductive technologies.
This also includes special programs for the treatment of infertility, which are often combined with recombinant follicle-stimulating hormone (FSH). In these cases, the hormonal agent “Orgalutran” is used only as prescribed by the doctor. The instructions describe in detail the dosage regimen.
Contraindications
In case of hypersensitivity to the active substance and auxiliary elements, the instruction for use prohibits the administration of injections of the drug "Orgalutran". The medicine is not prescribed for hypersensitivity to gonadotropin-releasing hormone and similar substances. A ban on the use of the medication are diseases of the liver organ and kidneys, which are in a moderate and severe stage of development. Warns that it is not used during pregnancy and lactation medication "Orgalutran", instructions. Contraindications indicate the inadmissibility of the introduction of the drug in childhood.
The medicine "Orgalutran": instructions for use
This drug is authorized to prescribe only a reproductologist with extensive experience. Monitoring ovarian hyperstimulation, which is carried out using FSH, begins on the second or third day of menstruation. 0.25 mg injections are given subcutaneously once a day. They are made starting from the sixth day of using FSH. If there is an increased ovarian reaction to stimulation, then in order to prevent an untimely increase in the LH index, Orgalutran therapy is carried out on the fifth day when using FSH medications. If there is a slow development of follicles, then the introduction of the Orgalutran solution can be carried out later.
FSH and Orgalutran medications should be used at the same time. They can not be mixed together in the same syringe. These injections are placed in different parts of the body. The dosage of FSH is selected individually for each patient. It is affected by the size and number of progressive follicles. It should not take into account the content of estradiol in the blood. Orgalutran is administered until the required number of preovulatory follicles is formed. Their final ripening is achieved by the introduction of preparations of human chorionic gonadotropin.
Paying attention to the period of excretion of the active substance, we note that the interval between injections of the drug "Orgalutran" should be no more than 30 hours, since with an increase in the interval between them, an early peak of LH can occur. Therefore, with the introduction of "Orgalutran" in the morning, it is necessary to continue therapy with this medicine during the time period of using gonadotropin. It is necessary to take into account the day when ovulation initiation occurs. With the introduction of "Orgalutran" in the afternoon, the drug is put the last time after dinner the day before the initiation of ovulation.
This drug is considered completely safe and has sufficient effectiveness for those who have undergone numerous therapeutic cycles. Luteal phase insurance is done according to the technique used in the infertility clinic.
The drug "Orgalutran" is administered only subcutaneously. For injection, it is advisable to select the thigh area. So that lipoatrophy does not occur, the injection site needs to be changed. The medication can be administered independently, but provided that a full briefing is received from the doctor. Before you enter the drug, you need to check the solution. It should have a transparent color and not contain any impurities. After the expiration date and with improper storage, the product can not be used.
Before the injection, you should wash your hands with soap and water, and the skin intended for the injection should be treated with alcohol. The protective cap must be removed from the needle. The skin should be clamped into the fold with the thumb and forefinger, and the needle should be positioned at an angle of 45 ° C to its surface. To check the correct position of the needle, you need to slightly pull the piston toward you and see if blood appears in the syringe. Its appearance indicates a needle entering a blood vessel. In this case, the medicine is prohibited. A needle with a syringe should be removed, and a swab moistened with plenty of alcohol should be applied to the injection area for a couple of minutes. They put the medicine every time with a new syringe. If the needle is positioned correctly, then at a slow pace and with equal effort should be pressed on the piston. This method of administration will not cause skin damage.
After drug administration, the needle is quickly removed, and an alcohol swab is applied to the injection site. The syringe can be used only once. If the injection time of the drug was missed, then an injection should be made as soon as the woman remembered him. You can not enter a double dosage of the drug to compensate for the missed injection. If the delay in administering the drug is more than six hours, and the period between injections is more than thirty hours, then the patient should, at any opportunity, administer the drug and seek the advice of a doctor.
Side effects
Warns that negative reactions may occur at the injection site of the drug "Orgalutran", instructions (photo of this medication can be seen above). As a rule, this is redness, swelling and itching. Adverse reactions occur one hour after the administration of the drug. From time to time, there is general weakness, rashes on the skin, swelling of the face, as well as difficulty breathing. Eczema may worsen, headache, nausea may occur. Some negative symptoms are associated with gonadotropin therapy, which is performed with ovarian hyperstimulation. As a rule, these are pain in the pelvic area, ectopic pregnancy, bloating, ovarian hyperstimulation syndrome.
special instructions
Women prone to allergies should be careful when using the drug "Orgalutran." The instructions and description of the drug warn that with hypersensitivity to the constituent components, a negative reaction appears immediately after the first injection. The packaging of the medicine contains rubber latex, which can provoke an allergic reaction.
The use of the drug "Orgalutran" usually continues until the desired number of preovulatory follicles are formed. Their final ripening is achieved by the use of human chorionic gonadotropin. Paying attention to the half-life of the active substance, we note that the interval between administration of the drug should not be more than 30 hours. This condition applies to the joint administration of Orgalutran and hCG injections. If this rule is not observed, then the peak of LH may occur earlier than the due date. The use of Orgalutran injections in the morning should be continued until the day of hCG administration, including it. With the evening administration of the drug, the last dose is used in the evening, before the day that precedes the use of hCG.
Repeated drug therapy is carried out only after evaluating the effectiveness of treatment and potential risk. During the period of ovulation stimulation, ovarian hyperstimulation syndrome sometimes appears. The possibility of this pathology should always be considered when treating with gonadotropins. If ovarian hyperstimulation syndrome manifests itself in the middle and severe stages of development, then intensive treatment is applied with the introduction of colloidal and electrolyte solutions into the vein, as well as heparin. Such therapy is carried out for several days.
The drug is safe to use, as evidenced by numerous preclinical trials, which were aimed at studying genotoxicity and toxicity. The drug does not show teratogenic qualities. Efficiency, as well as the safety of administering the drug, have not been established in women who have a weight exceeding 90 kg or less than 50 kg.
The probability of manifestation of congenital malformations in the fetus when using assisted reproductive technologies is not much higher than with the usual conception of a child. If malformations arise, then most often they depend on the individual characteristics of the parents. After ART, there is always a risk of multiple pregnancy. There is no direct connection between the likelihood of developmental malformations and the use of GnRH antagonists.
It is important for in vitro fertilization to conduct an ultrasound examination in a timely manner, since in women with fallopian tube pathology, the risk of ectopic pregnancy is quite high. Warns that it is impossible to use after the expiration date, which is two years, the drug "Orgalutran", instructions. Storage of the drug should take place in a dry place, protected from the sun and out of the reach of children. The temperature storage of the solution for injection ranges from 2 to 30 ° C.
Cost
Not in every pharmacy you can find the drug "Orgalutran." The instruction and description of the drug warns that the medicine is the strongest hormone and therefore is dispensed from pharmacies strictly by prescription. The average price of a package of five ampoules varies in the region of 6000-7000 rubles. One ampoule costs about 1700-2200 rubles.
Analogs
Notes that when side effects occur, you must cancel the use of the drug "Orgalutran", instructions. If necessary, analogs can replace it, but they should be selected only by a doctor. There is only one analogue in a medicine - this is Cetrotide. The cost of one syringe is 1200 rubles, seven - 8500-10000 rubles. Produce a substitute in Switzerland.
Patient Reviews
Indicates that the drug "Orgalutran" helps to get pregnant during IVF, instruction. Reviews note that the medicine works wonderfully and pushes the egg out of the follicles. The medication is packaged in a strictly defined dose, has a thin needle, so that the injection is practically not felt, and the procedure for administering the drug dispenses with swelling and bruising, but with the condition that everything was done correctly, according to the instructions.
Among the negative sides of the patient, soreness of the injection site is noted. Not happy that the medicine is difficult to buy in a regular pharmacy, and most often women are offered to buy it in a clinic. In some women, injections caused a decrease in appetite. Most are dissatisfied with the high price of the medication, but they say that it is worth it.