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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.