Ovulation Induction for Development and Growth of the Oocyte (Egg)
During the first stage of the IVF process, Dr. Douglas will cause the ovary to produce many quality eggs (see understanding ovulation). Generating multiple eggs gives the lab more material to work with and creates a greater chance for a successful cycle. If the couple has multiple eggs during a cycle, this can also allow for the freezing, or cryopreservation, of embryos for use in later frozen embryo cycles.
At IVF Plano, we use different fertility medication combinations to achieve oocyte growth. Dr. Douglas determines these medication combinations, or protocols, based on your individual medical history and your response to the various fertility medications used in a typical cycle. Because the chances of a successful embryo implantation in the uterus are greater when several eggs are collected, fertility medications promote the simultaneous maturation of multiple eggs for collection. Patients usually take fertility medications for seven to twelve days, with state-of-the-art ultrasounds and hormone testing used to monitor the woman’s progress.
IVF Treatment Information
During the first step, Dr Douglas will prescribe a pack of birth control pills (OCP), which may seem strange to couples who want to get pregnant. The birth control pills contain estrogen and progesterone, which shut off the ovary. This will help to synchronize the eggs so that more will mature at the same rate. When patients finish the BCP pack, they usually have a period. This period signals to Dr. Douglas that your body is ready for stimulation of the ovaries.
To stimulate the ovaries to produce many eggs, Dr Douglas will need to “turn off” the body’s normal hormone production. At this point, most patients will receive an injectable medication, Lupron (leuprolide acetate). Lupron functions by preventing the pituitary gland from releasing Luteinizing Hormone (LH). A release or surge of the LH hormone would cause ovulation to occur prior to the egg collection and result in cancellation of the cycle. Once the body is synchronized, Dr Douglas can begin the stimulation process.
We utilize several different medication protocols, including the use of injectable gonadotropins, to stimulate the ovaries and produce multiple oocytes.
Understanding Injectable Gonadotropins
Medications such as Gonal-F, Follistim, Bravelle, and Menopur contain follicle stimulating hormone (FSH). FSH, which naturally occurs in a woman’s body, causes the follicles in the ovary to begin to make oocytes every month. Follicles are fluid-filled sacs located on the ovaries; the immature egg (oocyte) is attached to the inner wall of the follicle. As the egg becomes more mature, the follicle becomes larger. In a normal month, when the woman’s body regulates the cycle, secreted hormones will cause several follicles to grow, but only one follicle will mature to ovulation. In IVF cycles, Dr Douglas controls the growth of the follicles, causing multiple follicles to grow and produce many mature eggs.
Injectable gonadotropins require daily subcutaneous injections to maintain adequate blood levels so that the follicles continue to grow. Dr. Douglas will monitor your blood work (estrogen, LH, and progesterone) as well as perform transvaginal ultrasound examinations every two to three days to monitor the size of the growing follicles. The ultrasound will give Dr. Douglas a clear picture of how the follicles are growing and when the retrieval step can occur. The gonadotropin stimulation usually takes8 to 12 days, but each case may differ slightly.
Once the follicles reach maturity, as determined by their size as well as their estradiol production, you will receive a dose of HCG, human chorionic gonadotropin, also called a “trigger shot”. We plan this injection 36 hours before the scheduled retrieval to allow for maturation, which prepares the eggs for fertilization and readies the ovary to release the eggs.