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Thread: First IVF cycle....

  1. #1

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    Default First IVF cycle....

    I'm just wondering what happens? We have our next appointment on Wednesday to discuss what's going to happen, but in the meantime I'm curious as to how it all works.



    Will I go straight onto the IVF stim cycle when this cycle ends? Or is there some other cycle I have to do beforehand?

  2. #2

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    Are you doing a down reg cycle with the BCP?
    If so, then i guess when your next AF arrives, you'll start the BCP a couple of days later, then the Synarel/Lucrin about 3 weeks later, then a week later, stop the pill (keep taking the Synarel/Lucrin), AF arrives, then you have a scan to check that your ovaries are all rested up, and your lining is thin.
    Then the good bit starts - jab away!!! (still taking the Synarel, though), then another ultrasound to check how your nice follies are growing, then tweak your drugs if necessary, otherwise they'll give you a date for the trigger shot, and a date/time for your EPU.

    (well that's what happened to me anyway, but everyone is slightly different, but basically the same IYKWIM)

    Wow, when you write it out like that it looks like no effort at all!!

    Good luck Sarah - keep us posted.

  3. #3

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    *shrugs*

    If we were going to start with the injections etc next cycle I should be on a down reg now? So we're probably looking at finishing out this cycle (CD8 today) then doing a down reg cycle in July then the stim cycle in August? Gosh this is confusing LOL!

    It does sound easy when you read it in the info pack but from reading actual experiences it's so not!

  4. #4

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    Sarah, your first IVF cycle actually starts about a week before CD1, if that makes any sense at all.

    You need to begin a process of down regulation, which basically turns off your ovaries. This is done with either lucrin (injections) or synarel (nasal spray). Sometimes you'll start the pill just to give the doctors complete control, in that case you'd start the synarel/lucrin a couple of days before you stop taking the active tablets.

    Generally, you can expect to be on lucrin or synarel for around a week, then AF will arrive. After another week or so (I'm hazy on all of this now, and I can't find my info from the clinic which outlines the protocols) they do a blood test to ensure that your levels are low enough (looking for a low estrogen level), and if everything is ok you start the stimulation drugs... If things aren't ok things get rather interesting - but you don't need to worry about that unless you get there. Trust me to be one of the ones that does!

    The stimulation drugs (puregon or gonal F - I don't know what the difference between them is) go for anywhere between 10-14 days, you'll have a series of blood tests and scans to check that everything is going along as it should, and possibly have your dosage of puregon/gonal F adjusted.

    When you have a nice number of big fat follies you'll have a trigger shot of HCG, which happens 38 hours before your egg collection. This matures the eggs so that they are ready to go, but the doctors remove them before your body ovulates. You'll need luteal phase support after this - in the form of crinone pessaries or HCG booster shots. I won't go into details of exactly how the eggs are collected - it was something I wish I didn't know beforehand, but was rather glad I was under a full anaesthetic at the time!

    The eggs that are collected will then be handed over to the scientists (along with DH's sample) and they do their thing. If it's ICSI, they need to catch each sperm and inject it into the egg. The embryos are watched for a few days and then transfer takes place. This could be anywhere from day 2 to day 5, depending on how long your clinic wants to grow them for.

    I think that's the rough idea of what goes on... different clinics will do things slightly differently. I've also only ever done it once, and didn't get to transfer, so that part of things is a bit of a mystery to me!

    BW

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    I just dug this out of archives, from when someone else asked a similar question. I hope it makes sense, Sarah, hun.

    There are a few protocols with IVF, and it will largely depend on the protocol you are on as to how long it will be from the first day of meds to the transfer of your embryos.

    A down reg protocol will span about 2 months from AF, and a flare with take only a month. That's because with a down reg, you are put on suppresant drugs prior to the pick up cycle, and with a flare, you don't have this 'preparatory' cycle, you launch straight into Follicle Stimulating Hormones the day after AF arrives.

    In the cycle where you have your pick-up (or Egg Collection), you start your meds to start stimulating the follicles in your ovaries. This will generally follow the natural rythym of your body, which means your follicles will take between 12-16 days to mature. Depending on how your body responds, they will be aiming for about 10 eggs to pick-up.

    You will normally have regular blood tests and untrasounds to monitor follicular growth and when your most mature follicles are around 18-20mm big, they will book you in for your Egg Pick Up. This involves a GA or sedation, and they will do a mini op to retrieve your eggs using a fine needle through your vaginal wall. Once the eggs are retrieved, they are put with your DH's sperm for fertilisation. At this point, around 60% of eggs fertilise, but this number is variable.

    Depending again on your clinic, 1-2 of these fertilised embryos will be transferred to you after 2-5 days from pick up. Then, you wait until when you AF would normally be due to see if it worked!

    That's the really summarised version, and skimmed a lot of things that are done differently between clinics. But it should give you some idea.
    ETA I did two flare cycles and 3 down reg. I think most Drs tend to lean towards down reg because they have more control over the cycle.
    Last edited by sushee; June 1st, 2007 at 09:45 PM.

  6. #6

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    Thank you BW Just what I need to hear! I knew from the stimulation drugs part, but not before that.

    ETA: Posting at the same time Sush. So do you know how they decide if it's a down reg or a flare cycle?

  7. #7

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    Sarah, it seems that down reg is the starting point for first cycles - they may start to do things differently on subsequent cycles if they want to get a different response.

    If you're on CD8 now, I don't see any reason why you couldn't start synarel/lucrin towards the end of this cycle and then stim drugs after AF. But that will depend on whether your clinic wants you to take the pill before hand or not. If you can skip that part then you should be fine... otherwise it could be a long, drawn out wait for AF, start the pill, then start suppression drugs, have AF, start stimming... It's all going to depend on what your FS wants to do. Perhaps someone who uses the same clinic/doctor as you may have a better idea of exactly what will happen.

    BW

  8. #8

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    I know that with younger couples, they more often tend to do down regs. It gives them more control over the cycle and produces more evenly matured eggs.

    Flare cycles seem to be used more with older women, where egg quality may be an issue. I did 2 flares then 3 down regs.

    ETA if you're CD8 now then whether you do a flare or down reg is not going to matter, coz either way you can't transfer until next cycle, unfortunately, my sweet.

  9. #9

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    We have to see if there are any LP issues with our results next week, but ovulation isn't a concern at all. The only thing there's a concern with me is progesterone levels after ovulation.

    Hmmm, just have to wait & see I guess.

  10. #10

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    If you have progesterone issues, Sarah, make a note to discuss a CD21 BT with your FS when you see him. Make sure you get one! Not all clinics do them as a matter of course.

  11. #11

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    It's been done Sush, just have to get the results next week

  12. #12

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    Hi Sarah!

    Of my 4 cycles, the first 1 was a flare cycle, 2nd a down reg, and 3rd & 4th flare cycles too... they will always do a down reg if there is any concern with ovulating... but you said you don't have a prob in this area, so it could be either.
    I only did the down reg cycle once - mainly because my body just does not like the pill... my ear drums rupture within 10 days of being on it!!! Happens every time, I had a lot of trouble when I was younger trying to fix my endo at 9yrs old (way back in the middle ages it seems now as far as tretment for endo goes!)
    I was lucky I am like you and have no prob with ovulation - my body is like clockwork as far as my cycles go.

    The only other thing I can suggest if you have progesterone issues (because I seem to only when I'm on cycle) - is to look at having acupuncture weekly leading up to your cycle and throughout it.
    If you have a look in my sig, my first 2 cycles were a bust really - its because my lining wasn't good enough, and my luteal phase was extremely short.... the acupuncture improved my lining by almost doubling the thickness of it by the time of EPU & transfer.
    My FS at first was a little sceptical about the acupuncture until I said was doing it regardless, and then was utterly amazed when doing my scan before EPU!!!
    He ended up asking for my acupuncturists card to have her number to refer for other ladies with the same problem!!!!
    I also had 3 HCG shots after transfer to help with progesterone levels as well.

    Hope all of my rambling is of some use to you!!!!

    Love Holly
    xxx

  13. #13

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    Hi Sarah

    I am on my first down reg cycle. I was lucky and didn't have to wait very long to start. I am on the pill at the moment and started the Synarel nasal spray last Tuesday. I finish the pill on Tuesday of this coming week and then cross my fingers for an AF. I then have my first scan on the Monday following to check the thickness of the lining of my uterus.

    I didn't seem to have problems with ovulating or progesterone levels but have started on a down reg cycle anyway, and I don't think I fall into the young category anymore!

    I found the best source of information for me was the magazine size book and DVD that our FS gave us at our first visit. It all looked quite overwhelming in the book - so many medical terms, procedures and drugs - but once you realise that these are pretty much all different options, not all going on at the same time, then things started to make sense. The DVD was very informative - I watched it 3 times and I am sure i will watch it again before EPU. The ladies here are also wonderful and have helped answer my questions whenever I needed.

    Take care and good luck on your IVF journey and may it be short for all us!

    Cheryl x

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