Ovarian Stimulation with Fertility Medication Starts the IVF Process
This appointment occurs after your birth control pills are finished, and usually after you have had your period. If you are not taking pills, this should occur on cycle day 1, 2 or 3. Before you come to this appointment you will know what FSH you will be taking (you should have received all your IVF meds by now).
In preparation for starting FSH please watch the appropriate injection instruction videos before your suppression check appointment.
***All of your consent forms must be on file at NFC or your cycle cannot begin. ***
At your visit you will experience:
- Blood Draw for Estradiol (E2)
- Ultrasound of your ovaries and uterus
- Meeting with a Nurse Practitioner for a history and physical exam.
- Trial Embryo Transfer
- Meeting with your Nurse to review your stimulation plan.
You will receive a written plan with detailed information about your medications, dosing and timing. Your NFC voicemail box will be set up for you at checkout and you’ll check it the same day to confirm your plan, and then again each day that you have IVF monitoring. Your results and plan will be left in a message for you by 4 pm.
***If you have questions about your plan or your message isn’t clear to you, please call the office as close to 4pm as possible,because our phones switch to night service at 4:30p!***
FSH injections are started to stimulate ovarian follicle growth and egg maturation. FSH is taken for a total of 10-13 days on average. While you are taking FSH you will need to come to our office approximately 3-5 times for “monitoring”. Monitoring includes a vaginal ultrasound to determine the number and size of the follicles and a blood test to determine your estrogen level. Lupron, importantly, prevents ovulation of eggs prior to our being able to retrieve them surgically.
Instead of Lupron, your doctor may recommend that you take take Ganirelix to prevent ovulation. Ganirelix is started after about 5 or 6 days of FSH injections.
Once the ovarian follicles reach 16-18 mm in diameter or more, an hCG injection (Ovidrel) is taken to induce final maturation of the eggs. The egg retrieval procedure is then performed 35-36 hours following the hCG injection.
Patients who respond well to fertility medications usually develop approximately 12-15 follicles. Those who respond excessively may make as many as 30 or more follicles and are at increased risk for Ovarian Hyperstimulation Syndrome (OHSS). Those who respond poorly may develop four or less. In both of these scenarios the physician may recommend cancelling the IVF cycle.
For some poor responders, there may be hope for a better stimulation in another cycle, or the physician may recommend the use of donor eggs. The risk of cancellation for poor response increases with the woman’s age, and ranges from 5-20%.