Unlike IUI cycles, which take place over the course of one month using gonadotropins to stimulate the ovaries to produce one to three eggs, many IVF cycles take place over a two-month time span. Additional medications may precede ovarian stimulation with higher doses of gonadotropins for a longer period of time in order to obtain a greater number of eggs to be retrieved and exposed to sperm in the ART laboratory to create embryos for transfer to the uterus.
Each fertility center has its own protocols for IVF stimulation and physicians choose the protocol that they believe will optimize ovarian response for each patient based on her individual clinical situation. Patient age, diagnosis and previous response to stimulation are all considered. The following is a general description of a typical ART stimulation protocol. Your doctor or nurse will discuss your protocol with you and give you specific instructions regarding medication dose and schedule. IVF stimulation protocols start with your period. You will need to contact your physician or nurse on the first day of your period for specific instructions. These protocols are used for women doing IVF with their own eggs and for women who are Egg Donors.
Birth Control Pills
Many physicians will use the first month of the IVF cycle to quiet the ovaries in order to have control during the second month of stimulation. This may involve taking birth control pills starting cycle day 3 for 12 to 28 days.
The GnRH agonist, leuprolide acetate or Lupron, is used to suppress the ability of the pituitary gland to release follicle stimulating hormone FSH and leutinizing hormone LH. This means that the ovaries will not be able to make an egg or ovulate without taking gonadotropins. This works well for IVF cycles so that gonadotropins can be given to recruit a good number of follicles containing eggs without the risk that a spontaneous LH surge would cause ovulation before egg retrieval. There are several ways to use leuprolide acetate/Lupron in IVF stimulation protocols. Your physician will choose the protocol that will optimize your response. Protocols include:
Once there are enough mature follicles and a high enough estradiol level, both leuprolide acetate/Lupron and gonadotropins are discontinued and a single injection of HCG is taken on a particular day at a specific time that is determined by the scheduled egg retrieval day and time. HCG injections are generally given 32 to 34 hours before scheduled egg retrieval.
Most women take gonadotropins for 3 to 5 days and then have an ultrasound and blood test to evaluate their response. At this point the dosage may stay the same, increase or decrease and another ultrasound and blood test will be scheduled within 1 to 3 days. Stimulation often takes 10 to 13 days. This process continues until there are enough follicles of a good size and a high enough estradiol level to proceed to egg retrieval. At that time all stimulation protocol medications are discontinued and a single injection of an HCG product (Ovidrel, Novarel, Pregnyl, generic HCG) is given 32 to 34 hours prior to egg retrieval. This injection causes the eggs to mature and be retrieved from the ovaries.
Intended Mothers or Egg Donors should not require any medications after egg retrieval.
Most physicians will prescribe a Progesterone product starting the day of or day after egg retrieval each evening until the pregnancy test. Progesterone may be given orally, vaginally or as an IM injection. Progesterone stimulates the uterine lining (endometrium) to continue to develop so that an embryo that implants will have a thick, supportive environment to nourish it.
Please remember that your clinic may require a different medical protocol for your unique situation and this information is not to take the place of your own physician’s orders. Second Chance Surrogacy does not have the medical knowledge to advise or diagnose medical treatments or medications.