An IVF treatment cycle begins with the onset of a menstrual period. A week before the beginning of the next period a medication called Lupron is administered. Lupron prevents premature release of eggs from the ovaries. Lupron is a very small daily subcutaneous injection given just under the skin. Any part of the body can be used for these shots and the woman or her partner can administer them. Lupron is given daily for about three to four weeks. Because estrogen levels are low, side effects may include fluid retention, headaches or hot flashes.
About a week after taking Lupron your period will start. From this point on, Lupron will keep you hormonally “frozen” in that normal egg production is put on hold. A few days to a week from the start of your period, hMG injections will be taken along with the Lupron injections. Follistim, Gonal-F, Fertinex, Perganol, Repronex and Humegon are all collectively known as hMG, but you will only be injecting one of these medications. Lupron puts your ovaries on “hold,” – that is, prevents them from releasing the eggs before we are ready to collect them. At the same time, HMG stimulates development and maturation of multiple eggs in the ovaries. The objective of this medication protocol is to produce as many eggs as possible in a given cycle, and “tell” the ovaries to hold them until we are ready to collect them. On average, about 6 to 12 eggs develop.
Before starting HMG injections, an ultrasound will be made of your ovaries to check that no cysts or large follicles exist. Injections in the form of Follistim, Gonal-F or Fertinex are shallow injections whereas Pergonal, Repronex and Humegon are deeper injections. Some side effects may occur with hMG injections, such as abdominal bloating, weight gain due to fluid retention and pelvic or abdominal discomfort or both. These are signs of ovarian hyperstimulation and usually do not require any treatment. It is rare for a woman to be hospitalized for severe symptoms.
You will be taking Lupron and hMG injections every day for about ten days. During these ten days your progress will be monitored with ultrasound and possibly estradiol blood tests. Since the eggs are microscopic, they cannot be seen on ultrasound. However, we can see when the eggs are mature from the size of the ovarian follicles, or the fluid filled sacs within the ovaries that contain the eggs. These monitoring visits are brief and usually done in the morning
Once the eggs are almost mature you will stop taking the Lupron and hMG. You will then take a single injection of hCG hormone. This medication triggers the final stages of egg maturation. The eggs are nonsurgically removed from the ovaries 36 hours after the hCG injection. You should not have intercourse during the time between the hCG injection and egg retrieval.