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Understanding IVF Once it has been determined that you are a good candidate for IVF, your doctor will match you with a specific IVF protocol that will maximize success for your particular diagnosis. There are three primary IVF protocols: 1. Down Regulation, or Long Lupron Protocol: This cycle is the most common IVF protocol in the US and begins two to four weeks before your period. It includes birth control pills, and later introduces Lupron injections to prevent early ovulation and create a blank slate for stimulating new follicles to grow. 2. Antagonist Protocol: This cycle typically begins with your period and includes the use of antagonist medications which create a blank slate much more rapidly than the Long Lupron protocol. Stimulating drugs are given for a much shorter duration as well, making this an ideal protocol for women at risk of Ovarian Hyperstimulation Syndrome (OHSS). 3. Microdose Lupron, or Lupron Flare Protocol: This protocol uses Lupron, but at a much lower dose than the Long Lupron Protocol so as to not over-suppress the patient’s hormones making stimulation more difficult. The patient is then given very high doses of stimulation drugs for a short period of time to produce the maximum quantity and quality eggs for retrieval. This protocol is best suited for women who have responded poorly to the other protocols. Ovarian Stimulation Once the birth control and Lupron phases of the cycle (if applicable) are completed, the patient will begin the ovarian stimulation phase. You will start fertility drugs based on your individualized treatment protocol. This typically involves injectable fertility drugs that you will administer daily for 8 to 12 days. These medications stimulate the ovaries to begin the growth of multiple healthy eggs. Monitoring While taking fertility drugs, you will visit the fertility clinic every few days for blood tests and trans-vaginal ultrasound monitoring to assess your follicle growth. Trigger Shot Once your ovarian follicles have attained a sufficient size, and your blood level of estrogen is adequate, you will administer an intramuscular injection of hCG, commonly called the "trigger shot." This finishes up the maturation process and ensures your eggs are ripe for retrieval. Egg Retrieval Approximately 12 days after beginning medications and 36 hours after the "trigger shot," the eggs are ready for retrieval. You will receive light anesthesia, and the fertility doctor will use an ultrasound-guided hollow needle, which is inserted through the back wall of the vagina up into the ovaries. The needle is used to aspirate follicles in the ovaries and suction out an egg from each follicle. Egg Fertilization and Embryo Growth Eggs are then fertilized in the lab by washed sperm. In traditional IVF, the sperm and egg are placed together in a neutral solution and allowed to fertilize themselves. Intracytoplasmic Sperm Injection (ICSI) is an advanced procedure where one sperm is injected into each egg. Embryos are then monitored for growth and grading. Embryo Transfer Several days later (typically Day 3 or Day 5) the highest grade embryos are selected for transfer. Any other well-graded, viable embryos are frozen for later use. Approximately one week after transfer, you will return for a blood test, beta hCG, to test for positive pregnancy hormone. Two days later, your fertility doctor will want to retest your hCG level to ensure it has risen appropriately indicating a successful pregnancy.