Once you have made the decision to start treatment, the first step is to call the Patient Liaison Administration team prior to the first day of your period, to organise payment and collection of your medication, so you are ready to begin treatment without delay.
 

Day 1:

Call the nurses

On the first day of your period (full flow of bleed), telephone the nurses who will review the doctor’s treatment recommendations – this is called Day 1.  If you have not previously organised payment, you will need to speak with the Patient Liaison Administrators first in order to do so.  The nurses will provide you with instructions on starting the oral contraceptive pill (OCP) on day 5 of your period.
 

Day 2:

Down regulation begins

Start taking medication (Synarel nasal spray or Lucrin injection – the nasal spray is more common) on day 2 of your cycle.  The primary role is to suppress the release of Follicle Stimulating Hormone and lutenising hormone preventing ovulation before egg collection.
 

Day 3:

Stimulation Begins

You will usually commence the Follicle Stimulating Hormone (FSH) injections (Gonal –F or Puregon), on day 3 of your cycle.  This is known as the “stimulation phase” and you will continue the FSH injections for approximately 5-7 days.  Remember to continue taking your Synarel nasal spray or Lucrin injection throughout this time.

What is an FSH injection?
FSH is given as a subcutaneous injection (just under the skin into the fatty tissue) for 5 – 7 days prior to the stimulation scan.  The FSH injection is administered daily at the same time each day (normally in the evening).

How does FSH work?
The FSH injection is a synthetic hormone, which stimulates development of ovarian follicles (think of a small sac that holds the eggs).  Naturally there will be a number of follicles that a receptive to grow every month but only one reaches maturity.  By giving a higher dose of FSH than is naturally produced each month, we are able to recruit some of those follicles that wouldn't normally grow to maturity.
 

Day 8 to 10:

Stimulation Scan
 

After 5 - 7 days of FSH injections, a stimulation scan is orgnanised. At this scan your doctor will measure the endometrial thickness, size and number of follicles on both ovaries, and based on this will determine whether you are ready for egg collection, or whether you will need to attend the clinic again in a few days for another scan and/or increase the dose of FSH.
 

Day 12 (approx):

Trigger Injection
 

Once you have the optimum number and size of developed follicles you are ready for the trigger injection.

What is a trigger injection?
The role of the trigger injection is to trigger the final maturation of the eggs ready for your egg collection.  It is a once off injection given in the same manner and site as the FSH injections.  The nurses will advise you two days before your egg collection of the exact time that you are required to administer the trigger injection.  This is usually 37 hours before egg collection.
 

Day 14 (approx):

Egg Collection

Egg collection procedure:
The egg collection procedure is undertaken in the morning in a day surgery under a sedation anaesthetic and takes around 30 minutes.  You will be at the hospital for around 4 hours and will need someone to drive or escort you home afterwards (don’t plan to work that day).  The procedure is performed using an ultrasound probe.  Attached to the ultrasound probe is a needle guide through which the fine needle passes through the vaginal wall into the ovary and draws the fluid (and egg) from the ovary.  The vessel containing the follicular fluid is then immediately passed to the Melbourne IVF laboratory and checked to ascertain whether it contains an egg.  

Sperm Sample:
On the morning of your egg collection your partner will need to provide a fresh semen (sperm) sample (unless using frozen sperm) so we can fertilise your eggs after collection.

Following the egg collection procedure:
After egg collection you may feel a bit sore; abdominal cramping is normal – and you may take Panadol or Panadeine and use a hot pack to ease the discomfort.  If you find this is not sufficient then please contact the clinic for advice.  It is not recommended you take Aspirin, Nurofen or Naprogesic unless specified by your doctor as these may interfere with implantation and/or luteal function.  You can expect some light red or dark brown bleeding for a few days, which comes from the puncture sites in the vaginal wall.  If you experience heavy bleeding contact the clinic.
 

Day 14:

Fertilisation

Following egg collection, if you are having IVF the egg and sperm will be placed in a dish allowing fertilisation to occur naturally.

If you are having ICSI, an embryologist will insert one single sperm directly into the egg, allowing fertilisation to occur.
 

Day 15:

Embryo Development

The day after egg collection a representative from the embryology laboratory will contact you to let you know the time for embryo transfer.

The embryos will grow under the care of the embryologists for normally two days.  Any extra suitable embryos will be frozen for future use.
 

Day 16:

Embryo Transfer

Embryo Transfer Procedure:
 
The embryos are returned to the woman’s uterus in a simple procedure called an Embryo Transfer, a simple procedure similar to a pap smear, performed by a fertility specialist.  

No anaesthetic is needed for the procedure, which involves a speculum being inserted into the vagina, and a narrow (about 2-3mm diameter) soft tube called a catheter, gently passed through the opening of the cervix.  The embryo is then introduced into the uterus.  The procedure takes only a few minutes and is usually painless. 

No special precautions need to be taken after the embryo transfer procedure.  You may get dressed and leave for home or work straight away and your husband/partner may stay with you during the procedure. 

You will see the nurses after the transfer to arrange luteal phase support.

It is common for there to be a small amount of vaginal discharge after the procedure and a panty liner should be worn.

The evening of embryo transfer you will start progesterone medication and continue for two weeks.
 

Day 30:

Pregnancy Test

Pregnancy test

A pregnancy blood test will be organised for two weeks (14 days) following egg collection.  If you have any worries or concerns throughout this time please contact the nurses.

Should the pregnancy be positive, the nurses will organise an appointment with your Fertility Specialist for an ultrasound scan normally at around 6 weeks.  Sometimes additional blood tests may be required to monitor the progress of your pregnancy hormone levels prior to a scan.  The scan will confirm the number of sacs (that is the number of babies) and heartbeat. Your GP or fertility specialist can refer you to a local obstetrician, if you do not already have one.

Should your pregnancy test be negative, you may commence another cycle and the nurses will liaise with your Fertility Specialist as to the next steps involved in your treatment.  Alternatively, you may attend a follow up appointment with your Fertility Specialist to review your treatment plan and discuss future options.

Support throughout your cycle
The counsellors are available anytime throughout your treatment to provide additional emotional support and advice.  All counselling at Melbourne IVF is included as part of your treatment fees.