Evaluation and Testing
In Vitro Fertilization (IVF) Test and Process
Evaluation and Testing
Prior to any type of in vitro fertilization (IVF) treatment, one of our physicians will meet with you (usually as a couple) at our Raleigh or Durham, NC center and review your history and desires. You may need some further medical tests prior to starting treatment.
A “trial transfer” is done at some point to simulate the transfer process of the embryos and intrauterine catheter. This gives us information about the depth and curvature of the catheter for when we perform the actual embryo transfer. This catheter is very thin, but you may experience mild cramping and spotting that day.
When your evaluation is complete, your physician will provide you with a folder of information that discusses the IVF process. If you decide to proceed with the treatment, you will need to complete our online course. This course discusses the IVF process and risks.
Following completion of the online course, you will be scheduled for a clinic visit at our Raleigh or Durham, NC center to learn how to self-administer the medications you will be taking as part of the IVF process.
The class teaches you about the process of preparing and injecting the medications. The class will also give you another overview of what will be happening during your treatment cycle.
Ultrasound and Medications
After the evaluation, we will need to coordinate a date for a baseline ultrasound and pregnancy test. This is usually done on day 24 of your cycle, or as close as possible.
The baseline ultrasound is performed just like the monitoring ultrasounds. A vaginal ultrasound probe that is smaller and usually more comfortable than a speculum (used for gynecologic exams) is used for the monitoring.
The lining of the uterus is measured, as are any cysts that may appear on your ovaries. These are usually cysts from follicles that formed in previous cycles and are rarely anything to worry about.
On the same day as your baseline ultrasound, you will have a pregnancy test. We occasionally do have a positive pregnancy test, which is always welcome news.
If the pregnancy test is negative, you will begin Lupron 10 units or 0.1 ml. Lupron is a gonadotropin-releasing hormone (GnRH) agonist that manipulates ovulation for clinical purposes.
Continue taking Lupron every morning until you are directed otherwise by someone from our clinic. You may be on Lupron for one week or several weeks depending on when your cycle is actually scheduled.
When your next menses occurs (full flow, not spotting), you should call the clinic. If you have not had a menses after 14 days on the Lupron, you should inform the clinic.
We will give you a date to begin taking your gonadotropins, which are drugs that stimulate the ovaries. On the same day you begin gonadotropins, you will also decrease your Lupron dose to 5 units or 0.05 ml.
Monitoring
At the same time you are instructed to take gonadotropins and decrease the dose of Lupron, you will be given a date for your first monitoring visit. The monitoring visit consists of a monitoring ultrasound, a serum estradiol (sometimes called an IVF blood test) and a brief discussion of your progress.
Since this clinic visit is designed for monitoring progress, the discussions will focus on the findings and informing you what to do next. If you have questions about the overall management of your care, you may wish to schedule an appointment with the physician in our clinic that enrolled you in IVF. The monitoring phase of the IVF cycle usually requires three to five visits.
During these visits, we monitor the rise of the estradiol in your blood while you are taking gonadotropins. Estradiol is released by the follicles.
There is not a magic number your estradiol “should be.” We like to see a rise in the values early in the cycle but do not want the value too high toward the end of the medications.
A high estradiol level (greater than 4,500) can be a concerning indicator for the risk of ovarian hyperstimulation in some patients. The IVF cycle may be delayed or canceled if this becomes too great of a risk.
An ultrasound will look at the endometrial lining as well as growth of the follicles. Preferably, the endometrium will be greater than 5 mm. The target size for the follicles is 18 to 20 mm for the lead or largest follicle and greater than 14 or 15 for the other follicles.
Once the follicles are thought to be mature, we will instruct you to stop taking your Lupron and gonadotropins. You will be given written instructions on what to do for the retrieval.
Human Chorionic Gonadotropin (HCG) Injections
Human chorionic gonadotropin (HCG) will be administered between 9 and 10 p.m. for weekday retrievals and between 5:30 and 6:30 p.m. for weekend retrievals.
This injection is timed in conjunction with your retrieval so the oocytes will be “released” from the wall of the follicle but not “released” from the ovary into the abdomen.
After you have been given instructions to take HCG, you will not take any more medications, including Lupron and gonadotropins. (You will still take Lupron on the morning of your HCG injection.)
You will likely be advised to have intercourse on the night of HCG administration and abstain from intercourse until after the retrieval has been completed. There will be no further injections until after the retrieval.
Learn more about HCG injection.
Learn more about egg retrieval.
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