The following information is intended to give you an overview of the IVF process at Wisconsin Fertility Institute.
Oral contraceptives: These are used to help with the timing of the drugs that will be used during the treatment cycle. They are not necessary, however, unless your cycles are irregular or if you want to try and time your cycle to fit into the busy life schedule that we all have.
Lupron: This drug is a shot, given just underneath the skin in your belly or thigh. There are several reasons Lupron is used:
Ovidrel: These shots, taken just underneath the skin, are used as trigger shots as well.
Follistim/Gonal-F/Bravelle/Menopur: These drugs are used to help grow eggs. They are actually the same hormones that your own body makes to grow eggs. Your own body will secrete a small amount of this hormone during your menstrual cycle, so that you grow one mature egg. We give you very high doses of this hormone in the shot to grow many eggs in a cycle. You usually will take this drug for 9-14 days during your treatment cycle. This drug is also a shot and is injected just underneath the skin in your belly or your thigh.
Ganirelix/Cetrotide: These drugs are also given as shots, just underneath your skin in your belly or thigh. This drug is similar to Lupron, but it is given AFTER you begin the drugs that grow extra eggs (Follistim or similar drugs). You might take the Follistim for a few days and then begin the Ganirelix or Cetrotide. It is usually taken in the morning. This medication is used to stop your eggs from ovulating too early.
Estradiol: This drug is given by mouth and is started the day of your egg retrieval. This drug helps keep the uterine lining thick and helps increase implantation of the embryo. You will continue it until week 11 gestation or until you have a negative pregnancy test.
Progesterone: This drug is also begun the day of the egg retrieval, but this is either a shot that must be given in your bottom 2 times daily or a gel or tablet, taken vaginally 2-3 times daily. If this is taken in the shot form, you might need a partner to help take this shot. This drug also helps keep the uterine lining thick and helps improve implantation of the embryo. You will continue it until week 11 gestation or until you have a negative pregnancy test.
Doxycycline: This is a drug taken by mouth that will stop any infection. You will take it twice a day, beginning the day of the retrieval.
Baby Aspirin: A low dose Aspirin (81 mg) is taken to improve blood flow to your ovaries and uterine lining.
Prednisone: This medicine has the potential to increase implantation rates by slightly suppressing the immune system.
Valium: This medicine is taken at the time of the embryo transfer to help relax the uterine muscle.
On day 1 of your menstrual cycle, you will call the office to set up your baseline visit for day 2. If it is a weekend, call the office and have the doctor paged so we can get you set up for your cycle.
On day 2 of the cycle, you will come in for your baseline visit. At this visit, we will perform 1) a blood test to check your estrogen and progesterone levels and 2) an ultrasound exam of your uterus and ovaries to make sure there are no cysts and that all of the eggs are small. We may also perform a trial transfer procedure. If your estrogen level is low, your ovaries have no large eggs, and your uterus looks ready, you will be instructed, via a phone call from the clinical staff, to start Follistim or Gonal-F later that day.
You will begin taking Follistim or Gonal-F each evening at approximately the same time. After a few days of Follistim/Gonal-F, you will come back for an ultrasound and a blood estrogen level. Based upon the results, we might increase, decrease, or leave the Follistim/Gonal-F dose the same. Over the next few days, you will continue to take your medications and return for repeat testing. Based upon how your eggs grow, you will take Follistim/Gonal-F for 9-14 days total.
At some point during this process, you will be instructed to start your Cetrotide or Ganirelix. This shot, which will be taken in the morning, stops your eggs from ovulating too early. The Cetrotide or Ganirelix is usually taken for 5-7 days total.
When your eggs are mature, (at least two of them measure about 20 x 20 mm average size) you will be told to stop taking the previous drugs. That evening you will take your trigger injection(s): either Ovidrel or Lupron or a combination of both. The trigger will allow the eggs to mature even further.
You will be given a specific time to take this medication—the trigger injection(s) must be given within fifteen minutes of the time you are told to inject!
The next day is the day before your retrieval. It is a shot free day. You may not have anything to eat or drink after midnight the day before the retrieval.
The retrieval is performed 35 hours after you have taken your trigger shot. Again, you should not eat or drink anything after midnight the night before the retrieval. If you usually take medications in the morning, it is ok to do so with a tiny sip of water.
When you come in to the clinic, we will place an intravenous tube into a vein in your arm. You will receive fluids and drugs through this tube. The drugs that you are given during your retrieval will make you slightly sleepy. You should not feel the cramping that is associated with the retrieval. If at any point you are uncomfortable, make sure you tell us, and we will give you more medication so you feel comfortable.
If you are undergoing MicroIVF, then we will use a single intramuscular shot of drugs to make you a bit sleepy and use local shots at the vagina to keep you comfortable. We will not use IV sedation for you, unless you request it ahead of time.
During the retrieval, an ultrasound is placed into your vagina, and we aspirate or extract the eggs by passing a small needle across the vagina and inserting it into the ovary while we watch with the ultrasound. We will remove all of the eggs we find if you are undergoing standard IVF and remove up to five viable eggs if you are undergoing Micro IVF.
All eggs will be passed to the Laboratory Director who will look at each egg, prepared, and place it in a Petri dish. A few hours later, the sperm is either placed next to each egg in a Petri dish or a single sperm is injected into a single egg (via ICSI: Intracytoplasmic Sperm Injection).
The day of the retrieval is also the day you begin Estradiol (pill) and Progesterone (either shots or vaginal gels or tablets).
The Estradiol will be 2 mg tablets taken 3-4 times daily by mouth.
If you are taking progesterone in shot form, it will be injected into the upper/outer area of your bottom. It will be taken two times daily. This shot will be a bit uncomfortable and over time you might notice lingering soreness and swelling in the muscle or even a mass you can feel. This is normal. If this mass becomes hard and tender, or if the skin above the site becomes red, give us a call. It might mean there is an infection that we can easily treat with antibiotics. You might also take a progesterone gel or tablet that is inserted into your vagina 2-3 times daily.
We will look at your embryos under the microscope. Based upon the quality and number of the embryos, you and your doctor will decide whether the transfer will occur on Day 2, Day 3, or Day 5. You will begin the baby aspirin on this day as well.
Your transfer will be performed on day 2, day 3 or day 5. You should come to your appointment with a full bladder. We recommend you drink about 1 quart of water one hour before you are scheduled to come in. Drinking coffee or soda might be helpful as this fills your bladder faster than plain water. Your partner can join you in the transfer room the day of the transfer.
Before the transfer of the embryo(s) is performed, you and your physician will sit together and discuss the quality of the embryos and the medical recommendations for number of embryos to transfer. Remember, however, that this is your decision, and your physician will want your input as to the number of embryos to transfer.
After the transfer, we recommend that for the rest of the day you do something that is fun, relaxing and peaceful. Light activity seems to be associated with higher pregnancy rates, but we would not recommend physical exercise. You may resume sexual intercourse beginning the day after the transfer. You may return to your normal physical exercise routine the second day after the transfer.
Over the next few days as you are waiting for your results, we recommend that you spend lots of time doing the things you enjoy in your life. Low stress levels will lead to higher success rates. If you are using alternative fertility treatments, such as acupuncture or stress reduction techniques, this is the time to utilize those treatments as well.
You will continue the Progesterone, Estradiol, and baby aspirin until week 11 gestation or until you are told to stop. These medications are used to keep the uterine lining thick so it accepts implantation of the embryo(s).
If you have any questions at any time during this process, please feel free to call us. While the physicians may not always be available to answer phone calls, our staff is knowledgeable and happy to help you. We can’t promise a successful outcome for everyone, but we are here with you and for you every step of the way.
The Doctors and Staff of Wisconsin Fertility Institute