What is Lupron and how does it work?
Lupron is the brand name for leuprolide acetate. It belongs to a group of drugs called GnRH agonists. GnRH, gonadotropin-releasing hormone, is the signal the brain sends to the pituitary gland to release the two hormones that drive the ovaries each month.
Given every day, Lupron first stimulates the pituitary for a few days. Then the pituitary stops responding. With the signal switched off, the ovaries go quiet: no follicle grows and no egg is released.
When it is given once, as a single dose, only the first effect happens. The pituitary releases a burst of hormone, and that burst can be used to finish maturing eggs.
That is why Lupron shows up in two very different roles in a surrogacy journey:
- Suppression for the surrogate. Daily injections switch off her own cycle before a frozen embryo transfer, so the clinic controls the timing.
- A trigger for an egg donor. One injection at the end of her stimulation matures her eggs before retrieval.
| Role | Who takes it | Dose form | Timing | Purpose | Main side effects |
|---|---|---|---|---|---|
| Suppression | The surrogate, at clinics that use it | Small daily injection under the skin; dose set by the clinic | About 2 to 3 weeks before estrogen starts, often continued into the transfer cycle | Switch off her own ovulation so estrogen and progesterone can be timed precisely | Hot flashes, headaches, mood changes, injection-site irritation |
| Trigger | An egg donor, in protocols that allow it | A single injection under the skin; dose set by the clinic | About 36 hours before egg retrieval | Finish maturing the eggs, with a much lower risk of OHSS than an hCG trigger | Few; mild bloating or cramping is usually from stimulation and retrieval |
| Lupron Depot | Some surrogates, at some clinics | One long-acting injection into a muscle | Before the transfer cycle, in place of daily shots | Suppression that lasts weeks from one dose | The same as daily Lupron, lasting longer |
How is Lupron used to suppress a surrogate before transfer?
In a medicated frozen embryo transfer (FET), estrogen builds the surrogate's uterine lining and progesterone then makes it receptive. If her own ovaries woke up partway through and released an egg, her natural hormones could shift the lining's timing away from the embryo's age.
Lupron prevents that. At clinics that use it, the surrogate starts daily injections about 2 to 3 weeks before estrogen begins. The injection goes under the skin of the abdomen with a small, short needle. Most surrogates give it to themselves after a clinic nurse shows them how.
A common dose is 10 units (0.1 milliliter) a day, and some protocols use up to 20 units; many clinics reduce the dose once estrogen starts. The clinic sets the dose and the calendar.
A typical sequence:
- Lupron starts, often in the second half of her cycle or while she is finishing a pack of birth control pills.
- Her period comes while she is on Lupron. This withdrawal bleed is expected, and it usually marks the baseline day of the transfer calendar.
- A baseline ultrasound and blood work confirm her ovaries are quiet.
- Estrogen starts. Lupron continues at the same or a lower dose, then stops on the clinic's schedule.
The full medication calendar, from Lupron to the pregnancy test, is on the frozen embryo transfer protocol page.
How is Lupron used as a trigger for an egg donor?
An egg donor takes daily stimulation injections to grow many follicles at once. Stimulation usually lasts about 10 to 12 days. When the follicles reach the right size, she takes a trigger shot. The trigger finishes maturing the eggs so they can be retrieved, and retrieval is scheduled about 36 hours later.
The older standard trigger is hCG. It works well, but it stays in the body for days and keeps stimulating the ovaries after retrieval. In a donor who responded strongly, that raises the risk of ovarian hyperstimulation syndrome (OHSS), a condition in which the ovaries swell and fluid shifts in the body.
A Lupron trigger causes the donor's own pituitary to release a short burst of hormone. The eggs mature, and the stimulation fades quickly. That greatly reduces the risk of OHSS compared with an hCG trigger. You can read more about that risk on the OHSS page.
A Lupron trigger only works in protocols where the donor's pituitary is still responsive, usually protocols that use a different drug, a GnRH antagonist, to prevent early ovulation. Many clinics check a blood test the morning after the trigger to confirm the donor responded. The clinic chooses the trigger. The full donor process is on the egg donation process page.
What are the side effects, and how long do they last?
For a surrogate on daily Lupron, the side effects come from lower estrogen while her ovaries are switched off. Common ones:
- Hot flashes and night sweats.
- Headaches.
- Mood changes, irritability or feeling teary.
- Trouble sleeping and tiredness.
- Redness, itching or a small bump at the injection site.
These usually ease once estrogen starts, and they resolve after the last dose. Lupron's effect is temporary. It does not affect a surrogate's own fertility later.
For an egg donor, a single trigger dose causes few side effects of its own. Bloating and mild cramping around retrieval come mostly from the stimulation and the procedure. Her period follows on its own after retrieval.
Call the clinic for a severe headache, vision changes, a rash or swelling, or any symptom that worries you. A full list across all transfer medications is on the medication side effects page.
Why do some clinics skip Lupron in FET cycles?
Many clinics no longer use Lupron for most surrogates. They start estrogen on day 2 or 3 of her period instead. Estrogen given early in the cycle usually keeps her own follicles from growing, so suppression happens without a separate drug.
Skipping Lupron means weeks fewer injections, no hot flashes from Lupron and a shorter calendar.
Clinics still use Lupron when timing has to be tightly controlled, for example when a surrogate travels a long distance for transfer, when her cycles are irregular, when an earlier estrogen-only cycle saw her ovulate, or when the clinic's own protocol calls for it. Clinics vary. Your clinic decides.
What should a surrogate or donor tell the clinic before starting Lupron?
Before the first dose, tell the clinic nurse about:
- Any chance of pregnancy. Lupron is not given during pregnancy. Clinics often require a negative pregnancy test before starting it.
- Every medication and supplement you take, including birth control.
- Allergies, especially to leuprolide or to past injections.
- Migraines or frequent headaches.
- A history of depression, anxiety or mood changes on hormones.
- Bone health conditions, which matter more with longer courses.
- Upcoming travel, so injections and blood work can be planned around it.
Then keep injections on schedule. If you miss one, call the clinic rather than doubling the next dose.
Lupron Depot vs daily Lupron: what is the difference?
Daily Lupron is a short-acting injection under the skin. It wears off within a day or so, which lets the clinic stop it on a precise date.
Lupron Depot is a long-acting form, given as one injection into a muscle. It releases the drug slowly, so a single shot suppresses the ovaries for weeks. Some clinics use it for a surrogate instead of daily shots, and some use it before transfer in women with endometriosis. The trade-off is control: once given, it cannot be stopped early, and its side effects last as long as the dose does. Lupron Depot is never used as a trigger.
PLS does not prescribe medications. Your clinic writes the protocol, and PLS makes sure the surrogate, her monitoring clinic and you have the same dates. PLS surrogates receive a $500 medication start fee from escrow when injections begin. When Lupron is part of the calendar, progesterone in oil usually follows it, explained on the progesterone in oil page.
This page gives general information. It is not medical advice. Your clinic sets the protocol and every dose. If you have a question about your own calendar, ask your clinic nurse, or send it to SurrogacyHotline, PLS's free sister site, for an expert answer within 24 to 48 hours.
Sources
- ASRM (American Society for Reproductive Medicine), guidance on ovarian stimulation, trigger choice and the prevention of ovarian hyperstimulation syndrome. https://www.asrm.org/
- SART (Society for Assisted Reproductive Technology), patient information on IVF medications. https://www.sart.org/
- ACOG (American College of Obstetricians and Gynecologists), patient information on GnRH agonists.