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April 26, 2012

Your IVF Protocol

If you and your physician have decided that you need IVF, you will be given a protocol of your upcoming IVF cycle. A protocol is a schedule or blueprint of how your cycle will be done. It includes the medications you will be taking, the instructions on how to take these medications, and the procedures you will need to follow though the cycle. The first thing you should do upon receiving your IVF protocol is to read it and read it again and again until you are familiar of what you will need to do. Ask questions as to the particulars so you know exactly what is to be done and take the time to learn from your physician, your nurse and read and review the materials they give you. Many fertility centers, including ours, will sit down with you and explain all you will need to know. In addition, all of this information is conveniently on our website to facilitate teaching not only what you need to do but also how to do it.

There are a finite number of protocols for doing IVF. Some include pretreatment with birth control pills and many forms of medications requiring injections. One protocol does not fit all and your doctor will select the one thought to be the best for your particular situation based on your age, weight, previous cycle experience, and the results of your screening tests. If you are under age 35 and your baseline hormone levels are normal, you may be started on one of two basic protocols each requiring sub-cutaneous (under the skin) injections. The first is a down regulating cycle using a GnRH Agonist called Lupron and is referred to as either a Long Cycle Lupron or Luteal Lupron protocol because it starts in the luteal phase of the cycle before the ovaries are stimulated to make eggs.  The second most common protocol uses a GnRH Antagonist called Ganorelix or Cetrotide. This is given after the ovaries have begun to be stimulated.  Both of these protocols are designed to suppress your own LH surge so you will not ovulate before your eggs are retrieved.

In addition to being given one of the above medications to prevent egg release, your protocol will also include gonadotropins in the form of follicle stimulating hormone (FSH). These medications require sub-cutaneous infections either once or twice a day to stimulate your ovaries to make eggs.  These medications come in several varieties under the brand names Gonal F, Follistim, and Bravelle. In addition, many physicians add additional gonadotropins to their protocols that have the hormone LH as well as FSH in them. The most common of these medications is called Menopur and contains equivalent amounts of both FSH and LH. This medication is also a sub-cutaneous injection.   Medications to stimulate the ovaries to make eggs are usually begun on Day 2 after your period starts while medications containing LH are generally but not always begun on the fourth day after starting FSH.  Many physicians call when LH is added to FSH, a “sweetened protocol.”

You will be asked to have blood tests and ultrasounds performed at various times during your ovulation induction cycle to monitor the progress of egg development. Just before the most advanced follicles are thought to be mature according to the estrogen levels and ultrasound appearance of your ovarian follicles, the final steps of egg maturation are set in motion with an injection of human chorionic gonadotropin (hCG).  You will then be scheduled for your egg retrieval.  Being anxious about how to mix and administer the medications required in an IVF cycle is normal. One way to manage such stress is to take the time before you start to learn how to do it. Many centers offer IVF classes either in person, online, or both. You medications will arrive before your cycle is to begin. When they do open the package and make sure you have all that your protocol requires. If in doubt call for an appointment with your team nurse and go over again and again your protocol until you are comfortable in doing what you will need to do.  At the Fertility Centers of New England, we understand the fear and anxiousness going through IVF can cause. That is why we will be by your side every step of the way before, during and even after treatment.

 

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Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility