Here's how I anticipate this might play out.
- April 4th Third IUI (my opinion- why even bother)
- May 2nd, first drug free cycle expected Ovulation (need 2 cycles with no medication prior to staring IVF).
- May 30th Ovulation, 2nd drug free cycle
- June 13th Menses- IVF Process begins
- Start Nasal Spray aprox cycle day 21 (July 4th)
- Baseline ultrasound 14-16 days after starting nasal spray (July 18-20th)
- 1-2 days after ultrasound start FSH hormone injections (July 20th)
- Hypothetically July 20th FSH injections begin for 10-12 days (July 30th)
- Blood test on the 4th day of injections (July 24th)
- Blood test & ultrasound on 7th day
- 9-14 days after FSH, take HCG trigger shot once eggs are 1.8-2cm in size to prepare for retrieval (July 30th hypothetically)
- HCG + 35 hours, Egg Retrieval
- 3-5 days (August 2nd-4th)
- Transfer
A typical timeline for a regular IVF cycle is outlined here.
Female partner calls day 1 of each month of cycle
Treatment will not be offered until all testing completed
Conventional IVF Cycle Time-Line – Step 2: Stimulation
Following normal baseline ultrasound, patient will be told when to start daily FSH injections & decrease Suprefact® to three times per day
IVF Registration
Conventional IVF Cycle Time-Line - Step 1: DownregulationFemale partner calls day 1 of each month of cycle
Treatment will not be offered until all testing completed
| Menstrual Cycle Day | ||
| 1 | Patient calls clinic (403) 284-5444 | |
| 7-10 | Treatment offered by clinic | |
| 11-20 | RFP Pharmacy contacts patient regarding filling their prescriptions and sending their timetable & consents | |
| 21 approx. | Downregulation - Suprefact® nasal spray five times per day | |
| Baseline ultrasound - 14-16 days after commencement of Suprefact® - may be done out of town - If normal, patient will be instructed when to start FSH injection (stimulation) | ||
| Within 1 - 2 days of ultrasound, start daily FSH injections as directed by clinic (see next table)From set up of IVF cycle to baseline ultrasound is approximately 4 - 4½ weeks |
Conventional IVF Cycle Time-Line – Step 2: Stimulation
Following normal baseline ultrasound, patient will be told when to start daily FSH injections & decrease Suprefact® to three times per day
| Stimulation Day | Monitoring | Medication / Treatment |
| 1 | Daily FSH injections start | Suprefact® nasal solution three times per day and daily FSH injection Average length of FSH injections is 10 - 12 days. All blood tests and ultrasounds are done on a first come first served basis. |
| 2 | ||
| 3 | ||
| 4 | E2 Blood test in Calgary at 8:00 a.m. or out of town to determine FSH dose | |
| 5 | ||
| 6 | ||
| 7 | Patient in Calgary ; Blood test ( 8:00 am ) Ultrasound (following blood test) | |
| 8 | ||
| 9 - 14 | You will be advised when you are required to return to the clinic for a blood test and/or ultrasound until follicles are mature | |
| hCG given when lead follicles are mature (approx 1.8 - 2.0 cm) | ||
| 35 hours | ||
| Egg Retrieval | ||
| 3 to 5 Days | ||
| Embryo/Blastocyst Transfer | ||
| From Day 1 of the cycle when IVF is offered to embryo transfer is approximately 7 - 7½ weeks. Patient will perform pregnancy test approximately 16 days after embryo transfer. | ||
Information:
Step one: suppressing the natural monthly cycle
You are given a drug that will suppress your natural menstrual cycle. This is given either as a daily injection (which you'll be taught to give yourself) or as a nasal spray. You continue this for about two weeks.
Step two: boosting the egg supply
Once your natural cycle is suppressed, you take a fertility hormone called FSH (follicle stimulating hormone). These fertility hormones are known as gonadotrophins. This is another daily injection you give yourself, usually for about 10-12 days, but it can vary depending on your response.
FSH increases the number of eggs your ovaries produce. This means more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.
Step three: checking on progress
The clinic will keep an eye on you throughout the drug treatment. You will have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests. About 34-38 hours before your eggs are due to be collected, you'll have a final hormone injection that helps your eggs to mature.
Step four: collecting the eggs
For the egg collection, you'll be sedated and your eggs will be collected under ultrasound guidance. This involves a needle being inserted through the vagina and into each ovary. The eggs are then collected through the needle.
Some women experience cramps or a small amount of vaginal bleeding after the procedure.
Step five: fertilising the eggs
The collected eggs are mixed with your partner's or the donor's sperm in the laboratory. After 16-20 hours they're checked to see if any have been fertilised.
If the sperm are few or weak, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI (see below).
The fertilised eggs (embryos), continue to grow in the laboratory for one to five days before being transferred into the womb. The best one or two embryos will be chosen for transfer.
After egg collection, you will be given medicines, either progesterone or hCG (chorionic gonadotrophin), to help prepare the lining of the womb to receive the embryo. This is given either as a pessary (which is placed inside the vagina), an injection or a gel.
Step six: embryo transfer
The number of embryos to be replaced should have been discussed before treatment starts.
Women under 37 in their first IVF cycle should only have a single embryo transfer. In their second IVF cycle they should have a single embryo transfer if one or more top-quality embryos are available. Doctors should only consider using two embryos if no top-quality embryos are available. In the third IVF cycle, no more than two embryos should be transferred.
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