The following is our most frequently used treatment plan. This type of medication regime is called a ‘long suppression’ cycle and has been demonstrated to produce better quality embryos and a higher pregnancy rate than other regimes that have been in common usage in the past. However, it may be individualised for your particular case. Therefore, please use the information sheet given to you at the start of the cycle. It is helpful if you can bring it with you to each clinic visit. The days are flexible, where possible, to allow minimal disruption to your usual routine.
STEP 1 – Day 1 to 5 of Menstrual Bleeding
Ring the nursing staff (02 9586 3311) on a weekday after 10am to arrange your first blood test. This will be done between day 20 and 23 of the menstrual cycle.
STEP 2 – Day 20 to 23
Attend for your prearranged blood test, collect your Lucrin or Synarel and pay any ‘Out-of-Pocket’ expenses. The nursing staff will contact you in the afternoon to finalise the date to start the Lucrin or Synarel.
STEP 3 – 10 to 14 days After Starting Gonadotrophin Injections
Attend for a blood test and ultrasound scan. It is likely that your period will have started prior to the appointment. The blood test is to ensure you are ‘down-regulated’ (i.e. the hormones that normally occur in your cycle at this point are blocked). We don’t want them interfering with egg development. The vaginal scan is to check there are no ovarian cysts or follicles present, that could interfere with your treatment.
It is possible that you might still be bleeding from your period. It will not interfere with your scan, but you may want to bring a change of pad or tampon. You will be given enough drugs to cover the first 8 days of gonadotrophin injections used to stimulate your ovaries. The nursing staff will contact you in the afternoon to start the injections.
STEP 4 – 9 Days After Starting Gonadotrophin Injections
Attend for a blood test and ultrasound scan. On this day we will assess how many eggs are growing and can usually predict the day of egg collection the following week. You might need a follow-up blood test and scan within a few days to confirm the exact day. You will be given any injections you will need until the next visit. It is possible that on this day we might recommend cancelling the treatment cycle, if the ovaries are over or under responding. The nursing staff will contact you in the afternoon to confirm the morning’s instructions.
STEP 5 – ‘Triggering’
10 to 14 days after your first injection, when the blood test and scan indicate the eggs are ready to be collected, you will have an injection of hCG (Pregnyl or Profasi). It will complete the maturation of the eggs. It is crucial that the injection is given at the time requested and is given into the muscle, not under the skin. The injection is given 35 to 36 hours before the time of the egg collection. This might mean it is given very late at night, depending upon the theatre time available for the eggs to be collected. If the injection is given too early, you might ovulate and lose some or all of your eggs before we get to theatre. If the injection is too late, the eggs might be less mature and more difficult to collect, reducing the number available for treatment. You will stop all Synarel, Lucrin and gonadotrophin injections once this injection is given.
Ensure that your hospital admission form has been given to the reception staff by this time. It enables your admission to be streamlined when the time comes.
STEP 6 – Egg Collection
25 to 36 hours after the ‘triggering’ injection. Requires an early to mid-morning hospital admission, depending upon the operation time. Bring your hospital insurance book, cheque book or credit card, and Medicare card with you, as all hospital fees are payable on admission. Please leave valuables at home and remove make-up and nail polish before arriving. Sperm will be required around the time of egg collection.
STEP 7 – Embryo Transfer
Occurs 2-3 days after the egg collection. You will be notified the day before of the number of eggs that have fertilised and the timing of the embryo transfer.
STEP 8 – Pregnancy Test
8 to 9 days after the last hCG injection or after 14 days of progesterone pessaries, we will do a pregnancy test. Even if you have started bleeding, we might wish to do the test to exclude an early tubal pregnancy.
On day 1 to 5 of your period, counting the first day of menstrual bleeding as day 1, ring the nursing staff (02 9586 3311) on a weekday after 10am to arrange your first blood test. This will be done between day 20 and 23. If you live outside Sydney area it may be more convenient to see the nursing staff earlier than that date and have your blood test locally on the correct day. You can collect your drugs, pay your account and be taught injection techniques at the earlier time. If you have had treatment before, you may prefer to have your drugs mailed. You should discuss this with the nursing staff at least a week before your blood test is due. If you don’t have regular periods, alternative steps and instructions will be given.