Step 1:
One week before period due |
Make an appointment:
Call the clinic to make an appointment for your orientation visit for one week before your period is due. At your orientation visit, the nurses will explain the treatment cycle to you, the medications you need to take and the times you will be required to visit the clinic for blood and ultrasound tests. Call the clinic on the first day of your period to arrange your next visit.
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Step 2:
Day 2 of your cycle |
Blood test:
On day 2 of your cycle, you will attend the clinic for a blood test. Provided all your natural hormone levels are low (which they normally are at this stage of your cycle) you will start the FSH (Gonal-F or Puregon) injections that day.
How FSH injections work:
The Follicle Stimulating Hormone (FSH) injections work by stimulating the ovaries to produce more than one follicle (egg). Naturally there will be a number of follicles that a receptive to grow every month but only one reaches maturity. By giving a higher dose of FSH than is naturally produced each month, we are able to recruit some of those follicles that wouldn't normally grow to maturity. IVF treatment does not use up your supply of eggs and you will not reach menopause any earlier than normal.
When to give injections:
We recommend you give injections at the same time each day. We normally suggest the evening is a better time to do this, so that when we do blood test and ultrasounds in the morning, if we need to change the dose then this can be done so that same day.
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Step 3:
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Starting Antagonist:
After four days of injections you start a second injection (the antagonist, either Cetrotide or Orgalutron) to switch off your own hormones and prevent premature release of the eggs.
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Step 4:
Day 6 |
Blood test:
Normally on day 6 of your cycle you will have another blood test to check your hormone levels. If your oestrogen levels are starting to rise, this is an indication that follicles are starting to grow.
The nurses will phone you the afternoon following your blood test with the results to let you know that it is time to start the antagonist injection (Cetrotide or Orgalutran) as well as the FSH (Gonal-F or Puregon) injections. The antagonist injection will stop the eggs from being released naturally so that they can be collected later.
If you have your FSH injections at home please do not have one on the morning of these blood test and/or ultrasound.
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Day 5:
Day 8 of your cycle |
Treatment monitoring:
On day 8 you will have an ultrasound and blood test. You will continue with the FSH and antagonist injections until the trigger injection.
Regular blood and ultrasound monitoring:
We will continue to closely monitor you will blood tests and ultrasounds until you have an optimum number and size of developed follicles. To do this you will be required to come to the clinic every couple of days.
Ultrasound scans:
Ultrasounds show us how many follicles are growing in the ovaries. We can't see the eggs on the ultrasound however we know that when a follicle reaches approximately 18mm it will contain a mature egg. There is not a set time in which the follicles will reach this size. There is a 3-4 day window when your eggs reach maturity allowing us adequate time to collect them.
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Day 6:
Approx day 12 of your cycle |
Trigger injection:
Once we know you are ready, we will advise you when to have your hCG trigger injection and we will schedule the egg collection for usually 36 hours later.
The exact time for the trigger injection:
The trigger injection is the only injection we specify the time that it is given. The timing is very important as it relates to when we actually collect the eggs. It is normally given in the evening and the egg collection will occur approximately 36 hours later. Once you have the trigger injection you stop the FSH injections and the antagonist injection.
How the trigger injection works:
The hCG trigger injection is the same hormone that is produced in pregnancy, but it has the effect of maturing the egg so that it is ready to be collected. For example, if you had a trigger and waited 48 hours your body would naturally release the egg on its own ready for fertilisation.
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Day 7:
Approx day 12 of your cycle |
Egg and sperm collection:
Egg collection is undertaken in a day surgery/hospital under a light general anaesthetic and takes around 30 minutes. You will be at the hospital for about 4 hours and need someone to drive you home afterwards (don't plan to work that day). The procedure is performed using ultrasound guided probe (similar to the scans conducted in the clinic). Attached to the ultrasound probe is a needle, which pierces the folllicle and draws the fluid (and egg) out.
On the morning of your egg collection your partner will need to provide a fresh semen (sperm) sample so we can immediately fertilise your eggs after collection.
After egg collection your progesterone level will be supplemented by inserting one application of Crinone vaginal gel every night until your pregnancy test 2 weeks later - this is to prepare your uterus for embryo transfer by supporting the lining of the womb ready for a preganncy.
Before going home we will give you an instruction leaflet. We can provide medical certificates (which do not mention the type of treatment you are having or have any IVFAustralia addresses).
You may feel a bit sore after your egg collection - abdominal cramping is normal - you may take Panadol or Panadeine and use a hot pack to ease the discomfort. If you find this is not sufficient then please contact the clinic for advice. It is not recommended to take Aspirin, Nurofen or Naprogesic unless specified by your doctor as these may interfere with implantation. You can expect some light red or dark brown bleeding for a few days, which come from the puncture sites in the vaginal wall. if you experience heavy bleeding contact the clinic.
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Step 8:
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Egg Fertilisation:
Your egg and sperm will be taken directly to the laboratory where they will be prepared for fertilisation.
If you are having IVF, the egg and sperm will be placed in a dish allowing fertilisation to occur naturally.
If you are having ICSI, an embryologist will insert one single sperm directly into the egg, allowing fertilisation to occur.
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Step 9:
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Embryo Development:
The day after egg collection the scientists will call (usually between 10am and 2pm) to let you know how many eggs have actually fertilised. The scientists will keep you informed on how the embryos are growing and will let you know the date and time of your embryo transfer. Your embryos will develop for 2-5 days in the laboratory. |
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Embryo transfer / freeze:
We transfer the embryos back into the uterus in a simple procedure, similar to a pap smear. You can go about your daily activities after this procedure and the embryo will not fall out. Any extra suitable, healthy looking embryos are usually frozen at this time if that is your wish.
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Pregancy test:
Continue with the progesterone medication until your pregnancy test, two weeks after egg collection. You can expect to hear from the nurses throughout this period, however if you have any worries or concern pelase is contact the nurses.
You will need to visit the clinic for a pregnancy blood test whether or not you have a period. The nurses will call you the same day following treatment with the results of your pregnancy test.
Following a positive pregnancy test, we will organise for you to attend the clinic for an ultrasound normally at around 7 weeks - this will confirm the number of sacs (that is number of babies) and heartbeat. Your GP or fertility specialist can refer you to a local obstetrician, if you do not already have one.
Should you not be pregnant, we recommend you attend a follow up appointment with a fertility specialist for a review of your cycle.
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Support throughout your cycle:
The counsellors are available for support at any time throughout your treatment cycle. We recommend all patients access these services. Counselling sessions are free while on cycle and one counselling session post treatment.
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