The goal of the medication taken in a donor-assisted IVF cycle or embryo transfer is to
make your uterine lining ready for the embryo transfer in the best way and in the time
frame chosen by you. Normally, it takes 10 to 21 days (average 14 days) to achieve the
desired endometrial thickness.
To prepare the recipients for embryo transfer, the following medication groups are used:
Estrogen and Progesterone (natural or synthetic)
Step 1 of your hormonal treatment usually consists of one cycle of estradiol and
progesterone intake before the actual embryo transfer cycle—this is taken to replicate
the stages of the normal menstrual cycle. That is why it is not a concern whether you do
or do not have your own menstruation.
Estrogen and progesterone help to time menstruation logically for the chosen timing of
the embryo transfer.
They also help to facilitate your uterus’ own skill of building endometrium up and down.
Examples of natural estrogen tablets include Progynova, Progynon, Estradiol, Estrofem,
and Femanest.
Examples of synthetic estrogen+progesterone tablets include Neovletta, Femoden, and
Marvelon.
Down-Regulation
Now we move into Step 2. You will have one injection of a “down-regulating” hormone.
The aim of this is to avoid premature ovulation (as premature ovulation may move your
“implantation window” and considerably decrease the implantation success rate).
Down-regulation switches off your own ovarian activity for just one cycle.
It also helps to avoid premature ovulation and progesterone production because this
would shift your implantation window forward and would result in a decrease in success
rates.
Examples of this type of medication include Procrene Depot (3.75mg – 1 single
injection), alternatively Diphereline Depot, Buserelin Depot, Zoladex, Decapeptyl Depot,
or other agonist GnRH.
From time to time patients ask not to include the down-regulation injection (“artificial
menopause”) in their treatment plans for egg donation, or embryo adoption, explaining
this request by their very unpleasant experience with this medication in their previous
own-egg IVF treatments. They note its unfavorable impact on their general state, mood,
and concentration; some of them even say that they had to stay off work and interrupt
their usual daily life for around a month.

However, the way the “artificial menopause” feels in an embryo, or egg donation cycle,
is much milder than the perception of “artificial menopause” in long protocols of own-
egg IVF treatment.
First, before the start of artificial menopause in our treatment plans, the patients take
estrogen and progesterone that counter-balance the effect of the down-regulation
injection.
Secondly, IVF own-egg stimulation protocols usually extend the artificial menopause up
to three weeks. In the case of egg/embryo donation treatment, this period is much
shorter and does not exceed seven days, so the undesired symptoms are highly
unlikely to appear in such a short period.
It’s also good to understand that the refusal of down-regulation may lead to the shift of
the implantation window and to the increase of progesterone. This in turn can lead to
the reduction in implantation rates so that the embryo transfer on the planned date is
not advisable.
Taking all the above factors into consideration, most patients reconcile with the idea of a
short artificial menopause, and as a result, they keep their peace of mind and continue
smoothly, without issues, through their treatment schedule.
Estrogens
Step 3 starts when you stop estradiol and progesterone in your previous cycle (“training
cycle”) and menstruation begins. We then ask you to have your first ultrasound scan at
your local doctor to check the thickness of your endometrium and to make sure that
there are no cysts found.
Your preparation continues with estrogen tablets, cream, and/or patches which help
your lining to gain the optimal thickness needed for the embryo transfer. You will
monitor the growth of your lining again with a second ultrasound at your local doctor to
see how thick it is and whether additional estrogen doses may be required.
Both oral and transdermal forms are used to maintain a stable hormonal level during
and after the donation cycle.
Estrogens grow the endometrium lining in the uterus to prepare it for the embryo
transfer.
Estrogens also sustain the endometrium lining after the embryo transfer so that your
menstruation doesn’t begin before the embryonic placenta picks up the function of
hormonal support in your pregnancy.
Examples of estrogen tablets include Progynova, Progynon, and Estrodiol.
Examples of estrogen patches include Climara, Estradot, Evorel, and Vivelle.
Sometimes patients ask about the amount of estrogen required before the embryo
transfer and also two months after it. They inquire whether it is possibly too high. The
doses that we prescribe are still much lower than the estrogen created by your placenta
in the second and third trimesters. That means that this external estrogen is not

comparable in its level with the regular hormonal balance in a woman’s body during
pregnancy.
Progesterone
We now move into Step 4. Six days before the planned date of your embryo transfer
you will start with progesterone. This time you will need to take two forms of
progesterone at once: vaginal pessaries, or cream and injections. It has been
scientifically proven that such a combination is the best way to prevent an early
miscarriage in pregnancies after egg donation or embryo adoption.
Progesterone prepares the uterine lining for the reception of the embryo.
It also sustains the endometrium lining after the embryo transfer so that your
menstruation doesn’t begin before the embryonic placenta picks up the function of
hormonal support.
Examples of progesterone medication include Crinone vaginal gel and Utrogest vaginal
pessaries.
Other Medication
Vitamins and other medications may be used to improve the blood flow in the uterus
before, during, and after the embryo transfer. Other medications may be used to reduce
the immunity of the potential mother to the embryo. After having thoroughly studied your
medical history, we add the necessary medication to your egg/embryo donation
treatment plan on an individual basis.