The IVF Cycle Schedule
There are eight phases involved within the IVF cycle schedule. The following is a detailed description of each of these phases. Please direct any questions you may have to our office staff.
- Individual IVF consult with physician
- Group IVF- both IVF physician and IVF nurse orientation
- Consent signed and deposit.
IVF screening performed. This includes blood work, trial transfer, and contract ultrasound. This phase also includes injection teaching, and CCCT (if needed).
While pre-screening will be individualized to each couple, it is essential that all screening be completed before proceeding into the IVF cycle. The IVF Coordinator and IVF Secretary will assist you in scheduling all necessary tests and procedures. The medications administered at the end of your cycle require Intra-Muscular injection. Please identify someone who will learn intra-muscular injection technique and schedule that individual to come with you to the injection teaching class. Drugs used at the first part of stimulation are given subcutaneously. Most patients choose to administer these injections themselves. Appointments for injection teaching are available only in the afternoon. Please remember to schedule this appointment prior to starting stimulation drugs.
It is recommended that the IVF screening appointment be scheduled on the same day for both partners. This will allow the husband and wife to read all consents and ask the physician and nurse any questions they may have. All consents must be signed and notarized. If the couple feels comfortable with all the information in the consents, they may sign all consents with the IVF Secretary (who is a notary) on this appointment. Also on this appointment, it is recommended that the financial payments be made to Advanced Reproductive Concepts.
Patient begins taking birth control pills and Lupron.
If you have not already been placed on BCP's, please call the office at (407) 896-7575 and inform the secretary that you are an IVF patient and have started your period. Please call at the beginning of your period. If your period starts on the weekend, you should call on Monday to get instructions.
Steps involved in this phase:
- You will be told to begin BCP's on the evening of the third (3rd)
day of your period. Please take the pill at night with food. It
may be necessary for you to start a second pill pack without a
break. If this is the case, you are to take active pills only and
may discard the placebos. It is very likely that you will have
break-through bleeding while taking the pill. While this may be
annoying, it is not a problem. Please continue taking a pill each
day until you are told to stop. If you miss a pill, please take it
as soon as you realize that you have missed it and then continue
on with your daily schedule. It is OK if this means taking two (2)
pills close together or at the same time.
- When your screening has been completed and results reviewed by our
IVF Physician and Nurse, we will contact you to schedule your
tentative stimulation start and retrieval dates.
- Lupron Start: Individuals on BCP's will be overlapping the BCP and
their Lupron start. Lupron is a subcutaneous injection and will be
started based on your projected Retrieval date. You will continue
the BCP for one (1) week after starting Lupron. It is normal to
have bleeding after stopping the BCP. This bleeding may be
equal to or lighter than your normal menstrual flow. Some
people only have spotting. Needles and a biohazard box will be provided at
- At the time you start Lupron, you will be scheduled to come into the office in approximately 10 days to have your blood drawn and an ultrasound. If your ovaries do not have cysts and your estradiol levels are appropriate, you will proceed to stimulation drugs. At the time you begin FSH for stimulation, the Lupron dose will be decreased to 1/2 dose for the remainder of the cycle. You will be told when to stop.
* Your financial deposit must be made before you start Lupron if it was not made at the time of your screening visit.
You will be given a written protocol which will be reviewed with you in detail as to the timing of your FSH injections. An appointment for blood estradiol and ultrasound will be made for the morning of the sixth(6th) day of FSH. Your dosage of FSH may be adjusted at this visit according to your follicular development and estradiol levels. Your next appointment will be scheduled according to your response. The average patient requires approximately ten (10) days of stimulation. Your stimulation may require more or less time depending on your response.
If too few follicles develop, your physician may decide to "cancel" your cycle. You would stop all drugs and would not proceed to Retrieval. The physician will speak with you about changes that can be made in your cycle to make it possible to try again at a later date.
Administration of HCG
When follicles have developed appropriately (15-20mm) with appropriate estradiol levels, you will be instructed in the next very important step- administration of HCG. HCG is essential for further maturation of the oocytes (eggs) and must be given at the time you are told. This time will be calculated for you to correspond with 37 hours from administration to Retrieval.
All supplies (with the exception of the drugs) and full instruction for administration of HCG, along with instruction for the remainder of your IVF plan, will be given to you in writing and reviewed in detail with you prior to your leaving the office on this visit.
You will be instructed to stop your FSH and Lupron as well as being given the schedule for the remainder of the drugs to complete your IVF cycle. These drugs will include: HCG, Progesterone (injections), Medrol, and Tetracycline.
Oocyte (egg) Retrieval
On the day of oocyte retrieval, you will be asked to arrive one hour prior to the procedure. You should have nothing to eat or drink after midnight the night prior to the procedure. Your husband will be asked to collect a specimen on this morning after your arrival to the center. Freezing a specimen for back-up is encouraged and can be arranged with the front office. You will meet the anesthesiologist on the morning of the retrieval. He/she will place an IV in your arm or hand as a way to provide pain medication and light anesthesia. You will not be aware of the events of the procedure and should have minimal discomfort when you wake. You will be given something by mouth at that time as necessary. It will take 15-30 minutes for the retrieval. Someone must be with you to drive you home. You will be discharged approximately two (2) hours after the procedure after you have had something to drink and voided (urinated).
Please review your micromanipulation instruction sheet which was given to you on the day of HCG. It is very important that these instructions be followed.
You will be told the number of oocytes retrieved as soon as possible after the procedure. This information is usually available before you leave the center.
Embryo Transfer takes place three or five days after egg retrieval. You may eat a light breakfast and should arrive with a full bladder. Please do not urinate upon arrival to the office. If you feel that you cannot wait, please consult with the front office and the nurse will be notified. Please arrive 30 minutes prior to your scheduled transfer time. The embryo transfer does NOT require an IV and is rarely uncomfortable. Your husband is encouraged to be with you during the transfer. The transfer will take place in a darkened room. Abdominal ultrasound will be used for visualizing placement of the embryos.
You will lie quietly for 30 minutes after the procedure and then discharged to home. Light activity is recommended for five days following the transfer.
Please review your instructions. We emphasize that your progesterone continues until you are told to stop.
Your blood pregnancy test will be scheduled 12 days after the embryo transfer (excluding weekends). You will have another test if the first test is positive. The relationship between these two numbers is important. An ultrasound will be scheduled the day your second pregnancy test is drawn.
Again, we emphasize that your progesterone continues until you are told to stop.
If you are not pregnant, your progesterone will be discontinued and your period will start within a few days. Please call our office with your period so that we can discuss a plan. If you have frozen embryos, you may be starting the birth control pill again to prepare for your Frozen Embryo Transfer. If you do not have frozen embryos, you will be scheduled for a post IVF consult with your physician to discuss questions and future options.
We are available around the clock for any emergencies. Any questions during office hours will be directed to the IVF nurse or physician and one of them will return your call as soon as possible.
For more information on our IVF program, please contact our office. We would be happy to answer any questions that you may have.