The Ins and Outs of In Vitro Fertilization (IVF)

Getting Started

Every IVF cycle involves multiple steps, each of which occurs at a specific time during a four- to six-week period. To help synchronize the timing of everything, you may have to start oral contraceptives a month before starting your IVF cycle. This helps to ensure that GnRH analog therapy (to help control the ovaries) will start at the proper time for those who have irregular menstrual cycles. Some research also indicates that oral contraceptives can help prevent ovarian cysts, which may occur during GnRH analog therapy.
There are basically two methods to ensure ovulation does not occur before egg retrieval. One way is pretreatment with a GnRH agonist, and the other involves treatment after six or so days of stimulation with a GnRH antagonist.
The GnRH agonist used most commonly in IVF is short-acting leuprolide (Lupron®), which is injected once a day. This medication is used to prevent a premature LH surge, which could result in the eggs being released from the follicles before they are retrieved. GnRH agonists can also be used to help initiate the growth of follicles or help with the final stages of egg maturation. Although the dosage of this medicine may be adjusted after ovarian stimulation has begun, it is usually stopped the day the hCG (human chorionic gonadotropin) is given.
GnRH antagonists (such as Antagon® or Cetrotide®) are used to prevent premature ovulation. They are usually administered several days after stimulation and are given as injections just beneath the skin (subcutaneously).
About the time of your expected period, you will have what's called a baseline pelvic ultrasound. This is done to examine the ovaries. If there is a cyst, your healthcare provider may recommend waiting until the cyst resolves spontaneously (which is usually about a week), or he or she may drain the cyst by inserting a needle in it connected to a syringe. The baseline ultrasound is often accompanied by a blood test called a serum estradiol measurement to make sure the ovaries are properly suppressed.
Last reviewed by: Arthur Schoenstadt, MD
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