What to Expect: The IVF Timeline

Jan 18 2011 in IVF, Trying to Conceive by Nancy

We know that your first IVF will be filled with questions, concerns and excitement and thought the following information would help you through your first cycle.

Just like a woman’s monthly cycle,¬† no two women will have the exact same IVF protocols, tests, medications or results. The timeline and information we give to you is a typical IVF cycle and you will find that your own will vary to some degree.

First Up: Birth Control Pills
You’ll be on birth control pills from 14 to 21 days. Taking these may seem counterproductive, however they do an important thing. They help get your hormones under some kind of exact control in the cycle just before your actual IVF cycle. Using them has proved to also reduce your chances of Ovarian Hyperstimulation and ovarian cysts, therefore increasing your chances for a successful IVF.¬† As mentioned before, not all women will be given birth control pills.¬† An example would be a patient with a lower ovarian reserve (fewer eggs).

Lupron/Antagon/Cetrotide
You can expect to be on Lupron for about 12 to 15 days at the start of your IVF Cycle. With Antagon/Cetrotide, your time is likely to be much shorter. These medications work to shut down or control the ovaries temporarily and prevent premature ovulation. They also help insure that  the follicles, when stimulated will all ripen at approximately the same time. Antagon/Cetrotide is becoming increasingly more popular than Lupron.

Baseline Ultrasound
Your first of many ultrasounds begin once your period arrives. The ultrasound is used to check the size of your ovaries, and look for ovarian cysts. It may also be used to measure the lining of your uterus.

Stimulation
Your doctor has several options for stimulating your ovaries for your IVF cycle.  Depending on your treatment protocol, this may mean anywhere from one to four shots every day, for about a week to 12 days.

During this phase of your cycle, your doctor will monitor the growth and development of the follicles your ovaries are currently producing. At first, this may include blood work every few days, to monitor your estradiol levels, and ultrasounds. Monitoring the cycle is important, as it helps your doctor decide whether or not the medications need to be increased or decreased in dosage. Gonal-F,Follistim and Repronex are three very popular drugs used in this key portion of the cycle.

Once your largest follicle is 16 to 18mm in size, your clinic will probably want to see you daily.

Trigger Shot

The hCG trigger injection is a crucial point in your IVF.  Timing this is an important part of  success with IVF.  The hCG injection induces the final step of maturation of your eggs. It loosens the eggs attachments from the follicle wall and allows for proper timing of your egg retrieval. Usually, the hCG injection is given when four or more follicles have grown to be 18 to 20mm in size and your estradiol levels are greater than 2,000pg/ML.

It is at this point that your doctor may elect to cancel the remainder of your cycle. If he sees that the eggs are not maturing properly or if he feels that you have too many follicles maturing (which can lead to Ovarian Hyperstimulation and can be dangerous.) Cancellation at this point typically runs from 10% to 20%.

Egg Retrieval
Typically 34 to 37 hours after your hCG trigger shot, your egg retrieval will be performed.  Doctors understand that you will be nervous at this point and will likely give you some kind of sedative or anesthesia.  (Be sure to let the anesthesiologist know if you have had any prior reactions to sedatives or anesthesia.) Once they are sure you are relaxed and comfortable, a trans-vaginal ultrasound will be used to  guide a needle through the back wall of your vagina, up to your ovaries.  Ths needle is used to remove the fluid and the egg from the follicle.  One egg per follicle.

The  fluid with the eggs are then is passed to the embryology lab where the eggs are identified, rinsed in culture media, and placed in small drops in plastic culture dishes. The dishes with the eggs are then kept in specialized IVF incubators under carefully controlled environmental conditions. Sperm and eggs are put together in the lab (in-vitro) about 4 hours after egg retrieval. Your doctor may have elected to use ICSI for your cycle in which case the sperm are then injected individually into eggs.

The average number of eggs per cycle is from 8 to 15.¬† Fertilization of these eggs must occur within the next 12 to 24 hours. You can be sure they are closely being watched by the clinic’s embryologist.

Embryo Transfer
After the eggs and sperm (now called embryos) have been watched and cultured in the IVF lab for 3 to 5 days, one or more will be placed back in the uterus. At day 5, your embryos are now called Blastocysts. This is one of the the final steps in your IVF cycle. Proper placement is CRUCIAL here and is key in your success. Typically your doctor will perform this transfer guided by ultrasound imagery.

Once the transfer has occurred, a nurse will have you lay back and relax for a couple of hours. Be sure to bring a book, iPod and company to help pass the time.

If you have had an abundance of good quality embryos, you may elect to have some frozen for a future cycle. Speak to your clinic beforehand about your options so that you eliminate the need for any stressful decisions at this point.

Progesterone Support
Since you have been on medications that control your hormones so heavily during an IVF cycle, it is very unlikely that your body will be producing enough progesterone to support a pregnancy.  Your doctor will prescribe a progesterone supplement to take care of this for you.

Progesterone supplements typically begin on the day of your retrieval and before the transfer.¬† Progesterone can be administered¬†either through intramuscular injections (Progesterone in Oil), which is the most¬†frequently used method, or through pills, vaginal gels and suppositories. It’s not uncommon to have more than one means of progesterone support used in¬†one cycle.

You’ll be using progesterone supplements for at least 2 weeks.

Pregnancy Test
The last and final step of your IVF cycle is the pregnancy test. Home urine pregnancy tests are not advised here as they may pick up remnants of your hCG trigger shot and give you false positive results.

Your clinic will have you come in for a blood pregnancy test somewhere between 9 and 14 days after your transfer. They will also likely check your progesterone levels as well.

If your results are positive, your doctor will have you continue your progesterone supplements and closely monitor you with additional blood work and ultrasounds for the next few weeks.

If your results are negative, your doctor will have you stop your progesterone dosage so that your period can arrive.

We understand how disappointing a negative result is for anyone involved. Even for your doctor. Have faith though that your doctor has collected quiet a large amount of information during this IVF cycle and will consult with you on ways to improve chances for success should you decide to do another IVF.

If you’d like to figure out the important dates in your upcoming IVF Cycle, try using our IVF Calculator and Calendar!

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