Typical IVF Cycle
Pre-Cycle Day 1 Call with date of onset of menses. This will allow the nursing staff to finalize your schedule.
Pre-Cycle Day 3 Come to the office for baseline hormonal evaluation (bloodwork). You will be instructed to either return on day 21 for bloodwork OR begin birth control pills and instructed on Lupron start date.
Pre-Cycle Day 21 Come in to the office in the early morning to have blood drawn for an estradiol and progesterone level to confirm ovulation. You will be contacted by one of the nurses later that afternoon to confirm that you are ready to start your Lupron. Once you begin your Lupron, you will continue to take a single injection each day until you receive your hCG shot or until told to discontinue the medication by a member of the IVF team. The dose of the medication may be altered (typically reduced when stimulation begins).
Cycle Day 1 Approximately 8 to 14 days after starting your Lupron (it varies from patient to patient and even cycle to cycle), you will have a menstrual cycle. This will be counted as cycle day 1 for the remainder of the stimulation portion of your IVF cycle. Please contact the IVF team and let them know when you begin your cycle so they can tell you exactly when to come in and begin your stimulation (typically cycle day 2 to 4).
Cycle Day 3 Come in to the office in the early morning (between 6:00-7:45 A.M.) for an ultrasound scan and to have your bloodwork done. This will confirm that your hormone levels are low and that your ovaries are ready to be stimulated. The ultrasound confirms that the ovaries have appropriately small follicles which are ready to be stimulated and that the endometrium (lining of the uterus) has shed appropriately and is ready to begin a new development cycle. You will be contacted that afternoon to confirm that you are ready to begin your gonadotropins (Gonal F, Follistim, Fertinex and/or Repronex). The dosing of the medications will also be reviewed at that time. The male partner should begin the Doxycyline at this time. You will be told when to return to the office for your next visit.
Cycle Day 5-? You will be told when to return for blood tests and ultrasounds, typically once every 1-3 days in order to monitor the development of the follicles. Each time you come in, your nurse will contact you in the afternoon with your instructions. If you do not get a call by 7PM, you must have the nurse on call paged for instructions.
Day of hCG Once your follicles have reached an optimal state of maturity, you will be directed to take your hCG (Pregnyl, Profasi) injection. Unlike the other medications you have taken up to this point, the timing of this injection is very specific (plus or minus 15 minutes). You will stop all other injections at this time (Lupron, Follistim, Gonal F, Fertinex, Repronex).
Day after HCG This will be the final morning for ultrasound and bloodwork monitoring. The IVF team will also make sure that you know when you are to arrive at the office for retrieval and will answer any additional questions. You may not eat or drink after midnight on this day in preparation for retrieval.
Retrieval Day Approximately 36 hours after your hCG injection, you will undergo aspiration of your follicles to obtain the eggs. This is done under ultrasound guidance using a specially designed needle. You will need to arrive at our office 1 hour prior to retrieval. During that time, you will be admitted by the nurse into the recovery room. You will also meet with the anesthesiologist who will start an I.V. Your husband will be instructed when to produce his specimen. Generally, this is after the retrieval has been completed and you have been checked back into the recovery room. Following retrieval, you will remain in the recovery room for approximately 1 hour. You will be instructed to begin the Doxycycline and Medrol today. The Progesterone injections begin the day after retrieval. Your husband can stop his Doxycycline at this time. You must have someone to drive you home after the procedure. Please do not bring your children with you today.
Post Retrieval Day 1 Sometime after 3:00 P.M. on the day following retrieval, you will be contacted by the embryologist regarding your fertilization results. Continue taking your medications unless otherwise directed. Begin your Progesterone injection tonight.
Transfer Day 3-6 days after retrieval your embryos will be replaced into the uterus. Embryo transfers are done in the early afternoon and under ultrasound guidance. You will be instructed to drink 4- 6 glasses of water prior to the transfer, as your bladder must be full to be able to visualize the uterine cavity. Following the transfer, you will be asked to remain in the recovery room for 20 minutes before going home.
Post Retrieval Day 7 Return to the office in the early morning for bloodwork. This bloodwork does not tell us whether or not you are pregnant.
Post Retrieval Day 14 Return to the office in the early morning for a serum pregnancy test. (Testing may be done a day earlier or a day later). If you are pregnant, you will be instructed when to return to the office for additional monitoring (bloodwork and ultrasound scans). If you are not pregnant, you should stop all your medications and wait for a menses. This will occur within a few days.
