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Short Protocol
Each fertility clinic differs in the protocol and medication used in IVF.
Here is a sample of a general short protocol:
Day 1 Call clinic on first day of your menstrual cycle(spotting does not count).
Day 13 Start of Phase 0 Preparation stage
1) Start birth control pills. Most patients will stay on the pills between 9 and 28 days. (Check with your
nurse for the exact number of days.) The pills have several purposes but mainly help us time the events of your IVF cycle.
Your menses should begin a few days after stopping the birth control pills.
2) Call clinic when menses arrive (spotting does not count).
At this point, we will a time for you to come in for a baseline ultrasound and blood work to make sure your eggs are “quiet,”
meaning your ovaries are not actively developing eggs.
Stimulation Start of Phase I Egg Growth
Phase I typically takes 10 to 14 days and ends when enough eggs are fully grown
1) Day 1 If your ovaries are quiet, you will begin to take gonadotropins. Gonadotropins are hormones which cause eggs to grow. Many different brands are available, (Menopur, GonalF etc) The dose and brand will be selected by your physician prior to your treatment. Given in high doses, gonadotropins will cause multiple eggs to grow at the same time.
2) Day 6 Most patients will return on this date for their first ultrasound to check how big the follicles are getting.
As directed by the physicians, you will return to clinic intermittently to monitor follicle growth.
Generally by day 7, your follicles are big enough and your estrogen is high enough that you could spontaneously ovulate. If
this happened, we would have to cancel the cycle. To prevent ovulation, the antagonist is begun and continued until the day of hCG.
hCG Day
When an adequate group of eggs has reached maturity (usually 2 follicles measuring > 18mm), you will be instructed to take an hCG injection. The brands of hCG include Ovidrel, Pregnyl etc. hCG will complete the maturation process of the egg and promote ovulation. THIS IS AN IMPORTANT INJECTION AND YOU WILL BE ADVISED TO TAKE A JAB (USUALLY AT THE CLINIC) AT A SPECIFIC TIME, BASED ON YOUR EGG RETRIEVAL TIMING.
It is important that you do not trigger the shot earlier or later than the specified timing.
On this day you will stop taking the antagonist and gonadotropins.
Egg Retrieval
36 hours
after hCG You will get an egg retrieval. This is a minor surgical procedure which requires minimal intravenous (IV) sedation. After you arecomfortably sedated, a needle will be inserted into each ovary. We use an ultrasound to guide the needle. We will aspirate the fluid from the follicles to obtain eggs. Not every follicle will release an egg and it is not always possible to aspirate every follicle. Therefore, sometimes the number of eggs retrieved does not equal the number of follicles that we can see on ultrasound.
You will know this day how many eggs we have retrieved. These eggs will be fertilized in the lab with the sperm provided by your partner. Ideally, your partner will provide a fresh sample on the day of your retrieval.
Fertilization and Embryo Development
Day after retrieval
On this day you will learn how many of your eggs fertilized normally and be told when to expect an embryo transfer.You will also begin taking progesterone on this day. Progesterone prevents menses from arriving prematurely. The IVF process can cause some women to produce inadequate amounts of progesterone. You will take progesterone on a daily basis (e.g. Crinone inserts, duphasthon etc). Progesterone comes several ways: as an intramuscular injection, as a vaginal cream or vaginal suppository.
After retrieval
Over the next few days, the fertilized eggs turn into embryos. Our embryologists will carefully cultivate your embryos to maximize the chance that they progress through critical developmental stages. Embryos advance through several stages: zygote (fertilized egg) to cleavage stage (an embryo with more than one cell) to morula (a dense ball of small cells) to blastocyst (an embryo with a fluid filled cavity).
At what stage and what day the embryos are placed back into the uterus depends on how many embryos you now have and how well they are dividing. On the third day after retrieval, the embryos are still at cleavage stage. Blastocyst transfers have the highest pregnancy rate per embryo (implantation rate). Because not all good embryos will tolerate culture for 5 days, unless you have ample numbers of good quality embryos on day 3, most doctors usually won’t recommend blastocyst transfer.
14 days after retrieval
You will get a pregnancy test (blood test for hCG level). If pregnant,
continue on progesterone. If you are not pregnant you will discontinue
progesterone.