IVF: What To Expect
The first day your menstrual flow kicks into full force, you'll pick up the phone and call the doctor. On the second or third day of your cycle, you'll be given a baseline blood test and an ultrasound. Assuming all looks good, you'll be told to stop taking your fertility medications.
You'll be placed on gonadotropin medications that contain FSH for a period of 4-5 nights. On the fifth or sixth day of this stimulation medication, you'll come in for another ultrasound and blood test. The doctor will now be on the lookout for signs that the eggs have matured and that you are ready for egg retrieval.
Blocking Ovulation
After the fifth or sixth day of stimulation, GnRH antagonists such as Cetrotide or Antagon will be added to the regimen to block premature ovulation. By day seven or eight, the dose of FSH is lowered and replaced instead with a low dose of hCG.
In most cases, a woman will be ready to receive the injection that will trigger ovulation on the ninth or tenth day of her cycle. Egg retrieval is performed two days later. Antibiotic pills will be administered to cut down your risk of infection and after retrieval you'll be given one more dose of antibiotics.
Progesterone is then administered. Some physicians prefer to give the medication both by intramuscular injection and by vaginal ointment or suppository, as well.
Embryo transfer is done on the fifth day after the eggs have been retrieved. The progesterone is continued and you'll be given a pregnancy test one week after the transfer.
Baffling Procedure
That's the gist of the basics and the scheduling of IVF. However, the procedure can seem baffling to a person who hasn't the benefit of a medical degree. The ultrasound is a good example of a puzzling aspect of IVF. Can it be that the doctor counted 20 eggs during the ultrasound?
Women are often surprised to hear the count during an ultrasound test. But this count doesn't represent the number of eggs that are found. The black circles that are seen on the ultrasound are follicles. These follicles should not be confused with eggs. Follicles are ovarian cysts that contain fluid and the developing eggs.
Swollen Follicles
As the eggs grow to maturity, the follicles begin to produce more and more fluid so that they become much larger. The eggs themselves cannot be seen on an ultrasound, only these swollen follicles. In the course of an egg retrieval procedure, the doctor aspirates the fluid from the follicles with a needle. He uses ultrasound to guide his needle to the proper spot and can see the follicle collapse as the fluid is drawn.
The fluid will be examined under a microscope to discover whether an egg has been retrieved. Eggs are found in this follicle fluid only around 70% of the time. This means that if a woman produces ten follicles, she can expect to have an average of seven eggs retrieved.
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