IVF Protocol- or “I’ll Have What She’s Having”

Infertility patients today are not the same as they were 10 years ago. Back then they were more likely to present with sadness and angst and a plea of “please find it, fix it, do something!” Today’s patient, although fraught with the same emotions as her turn-of-the-century counterpart, presents with more confidence, savy,and even a treatment agenda. Websites (such as this one) provide basic information to the patient seeking answers and just about every patient has “a friend who…”. A patient will request a certain medication or medication protocol because someone she knows had success with just that drug or regimen. To some patients the medications seem to take on magical qualities and specific brands are requested. It is important to know, however, that physicians are not choosing between brand vs generic when we recommend gonadotropins (the medications that stimulate the ovarian follicles). There are three companies that manufacture the medications we use and the products from all three companies have demonstrated excellence in efficacy.What makes a doctor select one drug or brand over another may be cost (covered or not by insurance), ease of use (need to reconstitute or not),ease of combining with another medication in the same syringe (pen or vial). The important message here is that one medication does not “produce better eggs” than another medication. In fact the eggs do not have receptors for the gonadotropins at all. It is the ovarian follicles that respond to the injected hormones. Eggs are (genetically and developmentally ) what they are and, unfortunately, we can’t make bad eggs good. What we can do is prescribe the medications responsibly, monitor the patient’s response accurately, and use good judgement when it come to timing the egg retrieval. Our goal is to obtain a few good eggs that, once fertilized, can “go the distance” and procduce embryos with the best developmental potential.