There are many controlled ovarian hyper-stimulation protocols for conventional IVF (C-IVF). At LIFE, we specialize in Natural IVF and Mild IVF. However, we do perform modified Conventional IVF when necessary. The C-IVF protocol we use at LIFE is an antagonist protocol. The patient may be asked to take 2-3 weeks of OCP prior to starting her cycle. She will call our office when she starts her period. She needs to make CD 2 baseline appointment to do blood work (E2 and FSH) and ultrasound. The patient will then be instructed to use daily injections.
Our patient must learn how to do daily shots of gonadotropins ( Follistim, Gonal F, or Menopur) starting on CD3. The dosage varies based on her age and ovarian reserve. In general, 150 iu to 450 iu daily. Our patients will be instructed for a follow up visit around CD 8 to check her E2, FSH, LH levels and ultrasound to exam her follicular response to the medication. Our nurse will send patient email or give direct instruction regarding any medication change. Most patients will continue her medications for a few more days. Dr. Yelian may choose to start Ganirelix (GnRH antagonist) to prevent LH surge or premature ovulation. The dosage we use is 125 mcg to 250 mcg daily. The patient will be instructed for a second follow up visit around CD 10-12 depending on CD8 findings. E2, P4, LH levels, follicular size and numbers will be checked at that visit.
If Dr. Yelian concludes that the follicle size and hormone level is optimal, the trigger shot will be given. Nurse will send an email to give detailed instruction regarding the trigger shot medication, time, and dosage. Most often, the trigger shot is Lupron (20 or 30 iu). Sometime we give hCG for patients who do not respond well to Lupron. The common dosage for hCG used at LIFE is 5000 unit. On the day of trigger shot, you may be asked to stop all other medications, and some patients may continue medication for one more day. Please read instruction carefully.
Egg retrieval is usually scheduled 35-36 hours after trigger shot. Because most patients who use C-IVF will produce more than 10 eggs, we suggest patients to consider IV sedation during egg retrieval. But you can still choose to have no IV sedation if you prefer. Patients need to follow the specific instruction regarding IV sedation (No food or drink 6 hours prior to the procedure). Otherwise, the procedure will be cancelled.
One of the most serious complications of C-IVF is Ovarian Hyper-stimulation Syndrome (OHSS). The patient will be instructed to notify our medical team regarding her signs and symptoms of OHSS: abdominal distention, bloating, weight gain, shortness of breath, or leg/calf pain (risk of DVT).