What medications are prescribed after egg retrieval in an IVF procedure?

Question

Hi doctor,

My wife and I are struggling with fertility and have been through IVF four times. During the last cycle, she had an ovarian torsion. We started the IVF process when my wife was 24 years, not overweight, and had no prior health issues. We have had one viable embryo from our first cycle of IVF and one successful pregnancy. On our first three egg retrievals, my wife was prescribed Provera and Cabergoline to take in the evening after the procedure and days afterward. On the last egg retrieval, she has not prescribed Cabergoline, and they prescribed Provera the day after the procedure, so she was behind a dose. Could not having those medications contributed to her ovarian torsion and loss of ovary? What would be your standard procedure for medications to prescribe after egg retrieval? Is Provera always necessary?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Just having or not having a medication cannot trigger torsion. Cabergoline is used to suppress the VEGF (vascular endothelial growth factor), thereby preventing any risk of OHSS (ovarian hyperstimulation syndrome). I feel the real reason is the frequent hormonal stimulation. I gather from your history that, in one year, she has had four cycles of all the hormones and ovum pickup. With such close stimulation, without giving much rest to the ovaries, her ovaries would have enlarged, increasing their weight. Frequently providing high doses of ovulation induction hormones might have increased the peritoneal fluid levels. Few unruptured enlarged follicles might have made the ovaries float, facilitating a torsion of the ovary. At this young age of 25 years, she should be getting a good number of healthy eggs, enough for at least three to four embryo transfers. Torsion is common in polycystic ovary patients. In that case, she should get 15 to 20 embryos enough for the rest of her life to complete a family. After ovum retrieval, if there is a risk of hyperstimulation, I give Provera, Cabergoline, and GnRH (gonadotrophin releasing hormone) antagonist injections. I have not had a hyperstimulation for almost ten years - many points in your history do not match. I give Cabergoline only in PCOD (polycystic ovarian disorder) with a tendency for ovarian hyperstimulation. But in that case, you will have many eggs and embryos, not just one. If she needed Cabergoline prophylactic dose, having so many close cycles is not advisable.

Consult your specialist doctor, discuss with them, and take medications with their consent.

I hope this information will help you.

Thank you.