Our patients will meet with their physician to discuss their diagnosis and develop a treatment plan. During this conversation, their doctor will also review the various tests and fertility medications that they will need prior to the IVF process. After this point, the patient will be assigned to one of our nurse coordinators, who will review their IVF plan, explain their medication schedule and answer any and all questions.
Medications our patients are likely to receive may include birth control pills started in the month before the IVF treatment cycle, and the injectable medication leuprolide (Lupron), started just before finishing the oral contraceptives. Together, these medications prepare a woman for ovulation induction or the releasing of eggs from the ovaries. Alternatively, a physician my recommend a protocol that uses a medication called Cetrotide, taken 10 days after ovulation in the cycle preceding the IVF stimulation cycle or oral estrogen in the last 7 days prior to the IVF cycle. One of our most common protocols does not require any medications prior to the IVF cycle.
Birth control pills
Although it seems counterintuitive, the birth control pill is helpful in a number of ways: it prevents formation of ovarian cysts, which can interfere with normal ovarian function; enables the ovaries to rest before treatment; and helps to regulate a woman's cycle, which in turn enables their doctor to time ovulation induction and egg retrieval to their best advantage. The use of birth control pills as a pre-treatment is most common in women that do not have regular menstrual cycles.
These are synthetic hormones that turn off a woman's normal menstrual cycle and prevent them from ovulating before the appointed time. Lupron is taken by injection starting about one week prior to the start of the stimulation medications and continuing for the 10-12 days of stimulation.
A medication that immediately lowers a woman's FSH and LH levels. This is useful in patients that may have a tendency to stimulate very quickly and/or make only one or a few follicles. It helps to keep one of two dominant follicles from developing too quickly when taking the IVF stimulation medications. Oral estrogen works in the same way.
Pre-IVF tests that patients may need:
Cycle day 3 blood tests for FSH and Estradiol, as well as AMH
Taken on day three of the menstrual cycle, these tests assess the health of the pituitary gland and ovaries. We will also be testing thyroid and Prolactin hormones, genetic tests, a complete blood count, vitamin D levels, blood type and infectious disease status.
Near the time of ovulation, the doctor will perform an ultrasound to measure the endometrium or lining of the uterus, where the embryo develops; as well as the health of the uterus, cervical canal and ovaries.
This is an X-ray that allows the doctor to look at the uterus and fallopian tubes, which carry the egg from the ovary to the uterus. During the X-ray, a small amount of fluid is injected into the uterus and fallopian tubes. As dye moves through the uterus and fallopian tubes, the doctor can check for any blockages that could prevent eggs from traveling to the uterus, and look at the structure of the uterus itself to see that it is ready to accept a fertilized egg. If the ultrasound is normal and IVF is the only treatment option (such as in cases of severe male factor), an HSG may not be necessary as IVF will bypass the fallopian tubes anyway.
Hysterosonogram (Saline Sonogram)
This test also evaluates the uterine cavity for polyps or fibroids. Here, the doctor injects a small amount of sterile saline fluid through the cervix and into the uterine cavity while at the same time conducting a vaginal ultrasound. The vaginal ultrasound is a painless procedure, wherein the doctor inserts a probe into the vagina. The probe sends out sound waves, which reflect off of body structures. A computer receives the sound waves and uses them to create a picture of the patient's reproductive organs.
Using a long, thin telescope with a light and lens called a hysteroscope, the doctor can examine the inside of the uterus and identify such problems as polyps or fibroids (non-cancerous tumors made of muscle cells and other tissues that grow in and around the uterine wall) which could prevent an embryo from attaching. The doctor can also remove polyps and fibroids with the use of the hysteroscope. Hysteroscopy is ONLY needed when prior ultrasounds or a hysterosonogram has shown a uterine abnormality.
Evaluation of the male partner:
By taking a sperm sample, doctors can determine sperm volume, motility (normal, forward movement) and morphology or shape – all of which are key elements in male fertility.
Infectious Disease Testing
California state law requires testing of all male partners in IVF treatment for agents of viral hepatitis (B and C), HTLV-I, syphilis, and HIV I and II. State law also requires us to screen female partners for the same diseases should they decide to freeze and store their embryos.