I have found that there isn’t really such a thing as a ‘typical round’. Every round has been different for me, but I thought I would summaries here what usually happens from day 1 of my period until egg collection to give people an idea of what to expect in terms of doctors visit, scans and blood tests as I had no idea what to expect on round one.
Baseline Testing – Day 1
On the second or third day or your period you will go and visit the doctor in the morning. He will perform a trans-vaginal scan. From the scan he will be able to check the thickness of the endometrium and the left and right ovary to make sure everything is ok to start the process (e.g.: there are no cysts, there are follicles showing etc). The more follicles showing in each ovary the better. This is called your baseline scan.
The doctor may then order a baseline blood tests of your FSH, LH, Progesterone and Estradiol. The tests will usually be done in 3-4 hours, so you can go back and see the doctor in the afternoon to get the blood test results and for him to prescribe his recommended medication to help stimulate the ovaries.
Starting Ovarian Stimulation
Ovarian stimulation will involve daily injectable fertility medication and sometimes oral medication. It is usually started on day 1 (day two or three of your period) and lasts 8-10 days. Most patients are asked to take the injectable medication in the evening time in case the dose of medication needs to be changed during the day.
Cycle Monitoring Starts Day 5
Starting day 5 of stimulation you will have regular visits (approximately every 2 days) to see the doctor to get a trans-vaginal scan and blood test. You blood test will check your estradiol and sometimes your FSH, LH and Progesterone (depending on the scan). You will ideally have your scan and blood test in the morning and then go back after 3-4 hours to get the results of your blood test and receive further information for continued medication. You should start to see your estradiol go up and you want your LH to stay down.
Ovulation Suppression
On day 6 I usually start taking an additional injectable medication in the mornings called Cetrotide. This is taken to stop premature ovulation which is common in older patients. So from Day 6-10 you are usually taking one injection in the morning to stop you from ovulating early and then another one again in the evening time to keep stimulating the ovaries and help the follicles grow.
Fly to UK
If all looks good on day 7 or 8 of stimulation and the follicles look like they are growing then I would book a flight to the UK for that evening. I usually tried to get a late evening flight which arrived in the UK very early in the morning this would avoid having to travel with too many medications (some of which need to be kept refrigerated – not easy when flying!).
NOTE: make sure if you do have to fly with medication you get a letter from your doctor saying what you are traveling with and why, or you won’t be allowed to take your medication in your hand luggage. I take mine in a little cooler bag to keep them a ‘fridge’ temperature.
The day I arrive in the UK I go and see my doctor there for a scan and blood test plus get the necessary medication I would need for the next few days.
Ovulation Induction: Between Day 8 and 12
Between day 8 and 12 (since stimulation was started), once the doctor believes the follicles look mature (usually about 18mm in size), you will be instructed to take an injection of human chorionic gonadotropin (HCG) to trigger ovulation. The timing of the HCG dose is very important, because egg collection (follicle aspiration) is performed exactly 36 hours after the HCG injection.
Egg Retrieval: 36 Hours After HCG
On the day of egg collection, I arrive at the clinic approximately 1 hour prior to my procedure. I am lucky that I have a wonderful sister and mum who take me. I fill out various bits of paperwork and get ready for the procedure (cannula put in your arm, nice gown on etc!)
Anesthesia for egg retrieval
Anesthesia medications is given through an IV so that I am “out” during the egg retrieval procedure under sadation. The procedure only takes about 15 minutes and being ‘out’ means no pain, so I am all for that!
Egg retrieval procedure
For the eggs to be retrieved a needle is passed through the top of the vagina under ultrasound guidance to get to the ovary and follicles. The fluid in the follicles is aspirated through the needle and the eggs detach from the follicle wall and are sucked out of the ovary. The eggs are then given to the embryologist to check and watch under a microscope for 3-4 hours to ensure they are ok to freeze.
I usually come round 30 minutes after the procedure and am monitored, given a drip for an hour before I am released. You won’t be allowed to drive so having someone take you home and keeping an eye on you for a few hours is a good idea. I haven’t felt any pain after the procedure only tiredness and a bloating feeling. Usually I get a phone call from the embryologist after 4 hours to confirm how many eggs are mature and are therefore able to be frozen.
Flying Home
I usually fly back to the UAE the next day ready to get back to work and try and loose some of those additional pounds this lovely procedure has given me!