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Rachel Dyer, Nurse Practitioner ACU, talks to an Apricity egg donor about using Buserelin and Ovitrelle in the egg donation process.
The interview was held at the ACU Guy’s & St Thomas’ Hospital, London.
As an egg donor, there are three different medications that need to be given during the cycle. This final injection, and it can be either one, usually called the ‘trigger’ injection is the one that ripens the eggs up ready for fertilisation. The Cetrotide suppresses the hormones which naturally perform this function, so therefore either Buserelin or Ovitrrelle is given 36 hours before the eggs are collected to ripen the eggs ready for collection and is time sensitive.
How Buserelin worksBuserelin (sometimes under the name of Suprecur) is a synthetic form of a naturally occurring hormone called Gonadotrophin-Releasing Hormone or GnRH and acts in the pituitary gland in the same way as natural GnRH.
The pituitary gland produces and stores various hormones, including the sex hormones, Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH). In women, FSH and LH cause the production of oestrogen by the ovaries and help control the menstrual cycle. The amount of LH and FSH released from the pituitary gland is controlled by GnRH. GnRH acts on receptors in the pituitary gland, causing the release of LH and FSH and hence the subsequent production of oestrogen in women.
Buserelin is also used in fertility treatment. In women who are infertile due to problems with their natural ovulation, it is used desensitise the pituitary gland and stop the natural production of FSH and LH. Synthetic FSH, LH and hCG (gonadotrophins) are then administered to artificially stimulate ovulation.
Buserelin is also used to stimulate the final maturation of eggs in the ovaries of egg donors. The eggs will be collected 36 to 40 hours afterwards.
Buserelin can be given by injection under the skin (subcutaneously) or by nasal spray for infertility treatment.
How Ovitrelle worksOvitrelle injections contain the active ingredient Choriogonadotropin alfa, which is a synthetic version of a natural sex hormone called Human Chorionic Gonadotropin (HCG).
The Ovitrelle injection stimulates the final maturation of eggs in the ovaries of egg donors. The eggs will be collected 36 to 40 hours after the Ovitrelle injection, for fertilisation in a laboratory.
>> Nurse Dyer: So, we’ve done the scan, we’ve shown that you’ve got a good number of follicles. That shows you’re ready for the egg collection. Therefore, to prevent or to reduce any risk of you having ovarian hyperstimulation, we tend to use this drug called Buserelin.
There are two drugs you can use: this Buserelin, which induces ovulation, and there’s also this drug, called Ovitrelle, which is prefilled, which also induces ovulation. However though, we have tried more so to use this one, because this sort of drug induces ovulation but also dampens down your hormones and therefore reduces the risk of you having any adverse reactions – namely OHSS, which is ovarian hyper-stimulation.
>> Egg Donor: So, that one has got less side effects than this one?
>> Nurse Dyer: It’s not the drug has got side effects; it will reduce you developing ovarian hyper stimulation.
>> Egg Donor: Do they both give the same results?
>> Nurse Dyer: Usually; usually they do. We know that both of these drugs are timed and when you take it 36 hours later you go for the egg collection. At that time, the follicles are punctured and you should get a good response.Usually we do find that patients, when they take this Buserelin, they recover quicker, if you like, from the stimulation that they’ve had. When you take the Ovitrelle, the trigger… The drug itself contains HCG, and HCG can make your symptoms of your ovaries being enlarged stay longer in your body, if you like.Therefore, it can take you longer to recover, so that’s the tendency because we’re grateful that you’ve done this for us and we don’t want to disrupt your life any further, so basically we’re trying to get you back to normality.
>> Egg Donor: When you say, “This one will take longer to be in your system and longer to recover,” in what sense of recovery is that?
>> Nurse Dyer: In the way that you’re feeling, because once you’ve taken… What these drugs do, it makes your follicles mature and release. In a natural cycle, you’ve only got the one follicle. When you’ve been induced with these drugs, you might be growing 10 follicles, or 12 follicles, or sometimes 15 follicles, even 20, so it just depends on how you respond.If you imagine, your ovaries are going to be quite enlarged. They’re normally quite small, so when you have multiple follicles your ovaries are more enlarged and more uncomfortable. Then a needle has actually gone into each follicle, punctured the follicle to get the fluid out, so that causes bruising on the ovaries.When you take the trigger drug, it exacerbates or it can exacerbate those symptoms, so it can make you feel more bloated, more uncomfortable. We’re trying to reduce that and the way to reduce it, we have found: by taking this Buserelin, it dampens down your hormones a lot sooner and therefore you have less… You’re less likely to have [the actions 0:02:41] with OHSS.
>> Egg Donor: Okay.
>> Nurse Dyer: But again it’s down to the doctor and the clinic to decide which is the best format of treatment for you. Both of the drugs are subcutaneous, as we said earlier. This Ovitrelle is prefilled, so it’s similar to the Gonal-F in that you need to attach a small needle, and again you’d have a small amount of medication in the prefilled pen.In this Buserelin you have to inject yourself with it with a small insulin-type syringe, which again we tend to show you this or how to do it on the day when you come for your scan that we’re saying you’re going to be [set for 0:03:19] the egg collection [in] a couple of days.Whichever medication you have, the Buserelin or the Ovitrelle, it means the egg collection usually occurs 36 hours later, so two days later you come back to the clinic for the actual egg collection.
>> Egg Donor: Okay
>> Nurse Dyer: This just comes as a kit of needles. This is the needle from this bag. This Buserelin, you need to take the cap off. Take the cover off here, take this off. The easiest thing to do is just get some air into your syringe. See, it’s a tiny little needle. Place that through the centre of your seal, invert it up and inject the air inside, then pull down. Again slightly beneath what we need. Flick to get rid of any air bubbles, which should go up to the top, push your surplus out, and then [have your] medication.___[0:04:42] pen – again a similar needle, basically. Peel that off, touch that on, take off that cover. There you see the small needle and then this one again you would do the same thing. The gauge is on zero; you literary twist it to the very end and it should say 250 units in the window.
Written by our group of fertility experts and doctors consultants
Written by our group of fertility experts and doctors consultants
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