Treatment schedule
Your treatment process is determined individually.
This is the schedule:
Sometimes it takes more time to find the causes for infertility, so the treatment will not always start immediately. Each treatment has to be planned carefully. Particularly IVF and ICSI treatments require perfect timing. In order to avoid disappointments and frustration, we recommend planning with a medium-term and long-term framework.
IVF treatment is performed in different phases described in the following sections. Of course, each treatment will be adjusted to your situation. In some cases, schedule deviations may be appropriate.
Preparation phase
Usually, treatment starts in the second half of the menstrual cycle before hormonal stimulation is initiated. A medication with GnRH analogues will temporarily reduce the endogenous fertility hormones. This process is called down regulation. Using this method facilitates the control of the stimulation cycle. It prevents potential premature ovulation. Furthermore, we are able to induce ovulation at the appropriate time. This procedure has been applied internationally for many years and has led to a decrease in cancelled treatment cycles. Depending on your individual situation, however, other promising stimulation procedures may be appropriate. We are definitely going to choose the best treatment for you.
Keep in mind…
After talking to your attending physician, please call our clinic at the beginning of your menstrual cycle to book an appointment for your down regulation. Down regulation usually starts between day 18 and 23 of the preceding cycle (Long Protocol). Alternatively, you can take the pill in the preceding cycle for cycle regulation. Please call our clinic at the beginning of the stimulation cycle, even if your period is absent by the expected date. In order to monitor the success of the down regulation, another ultrasound examination or a hormone analysis might be required.
Stimulation phase
The stimulation of the ovaries with follicle-stimulating hormone (FSH) usually starts on day 3 of the cycle. With the hormonal stimulation, we induce several follicles to grow for the purpose of collecting more eggs. This will increase the chances for a successful treatment. The stimulation lasts app. 11 to 13 days. During stimulation, a hormone will be injected on a daily basis. We use advanced stimulation drugs. If you like, you or your partner can do the injection at home, so you do not need to visit a doctor everyday.
Keep in mind… It is crucial that the injection is given on a daily basis. After 7 to 9 days of stimulation, we will check oocyte maturation via ultrasound and hormone testing in order to find out the best time to collect mature eggs ready to be fertilised.
Instructions for using the Puregon Pens
Instructions for using the Gonal F Pen (video)
Inducing ovulation
Once the examinations show that the appropriate time to induce ovulation has come (usually after 11 to 13 days of stimulation), FSH therapy will be discontinued. Then, ovulation is induced with an injection.
Keep in mind…
The injection to induce ovulation has to be given in the late evening. This injection as well may be administered at home.
Oocyte retrieval
After 35 to 37 hours (the second day after the injection to induce ovulation) the follicles can be obtained transvaginally using ultrasound guidance and a thin needle (follicle puncture). To relieve you from pain or anxiety during the surgery, you will either be given sedatives and pain medication or a short time general anaesthesia.
Keep in mind…
Please come to the clinic on the scheduled day of egg retrieval with your partner. You need to have an empty stomach for the surgery. Both partners need to make sure to bring their ID card, for we are required by law to determine your identity on the day of egg retrieval. The male partner will be asked to provide a semen sample to the laboratory. Talk to us if your partner has any problems in producing the semen sample. We will find a way which is acceptable for your partner. After the puncture, you will stay for 1 or 2 hours in the clinic and then you can go home. On the next day, we will call you to schedule an appointment for the embryo transfer, depending on the results of fertilization.
Embryo transfer
If at least one embryo has developed in the growth medium, a special fluid adapted to the human body, it will be transferred into the uterine cavity through a thin, flexible catheter. This transferral is usually painless. Two (max. three) fertilised eggs will be transferred in one surgery. It should be a mutual decision whether you want your husband/partner to be present when the embryos are transferred.
Luteal phase / Second half of the menstrual cycle
Now you will have to wait, which is usually hard to bear, because it is often a time of inner tension and anxiety. Even though it may be difficult to do, try to stay calm and keep on living a normal life. You should avoid vigorous physical activities and severe increases of temperature or circulatory stress, including saunas, hot baths or intense sun baths and extreme sporting activities. Regarding medication, the second half of the menstrual cycle is usually supported with injections of hCG or suppositories or injections of progesterone. A pregnancy test will be performed two weeks after the embryo transfer. If the pregnancy test result is positive and the period is still absent, an ultrasound will be performed after three weeks to confirm the pregnancy.
