In most cases, the ovarian stimulation treatment cycle starts with the patient taking birth control pills. By putting the patient on BCPs, Dr. Vicken Sahakian, Dr. Michele Evans, and Dr. Yvonne Yanqing Han in Los Angeles, CA, are able to make her menstrual cycle predictable. In this manner, we are able to better plan ahead and provide the patient with specific treatment dates that can be set well in advance. The patient will usually take these pills for a period of at least 17 days to up to 6 weeks.
BCPs will in no way harm the patient’s chances of conceiving. In fact, it might help produce a synchronously growing batch of follicles or eggs.
Roughly 5 days before the last BCP, the patient starts taking daily Lupron® injections. The dose will be indicated on the Calendar. Lupron® will suppress the pituitary-ovarian axis (i.e. it will put the ovaries to “sleep”) so that we can control the ovaries with fertility medications. If Lupron® is not taken, then there is significant risk that the eggs might be released before we are ready to “harvest” them.
Lupron® is administered as a subcutaneous injection (under the skin) with a small needle. The patient will take daily Lupron injections until otherwise indicated. In some patients, based on many different factors, we might use Ganirelix or Cetrotide® to prevent ovulation rather then using Lupron®. These subcutaneous injections are usually taken once a day starting few days before the egg retrieval.
The fertility hormones are usually started 10-12 days after the Lupron injections and after a baseline Estradiol blood measurement or ultrasound examination to check for the presence of cysts. These include one or a combination of the following:
- Gonal-f®, Follistim® or Bravelle® (given subcutaneously (SQ) )
- Repronex® (Intramuscular (IM or SQ)) or Menopur® (SQ)
These medications will stimulate the ovaries to produce multiple eggs. The response to these fertility drugs varies according to the patient’s age, her ovarian reserve and the amount of drugs given. The dose should be clearly indicated on the Calendar. These drugs are given once (usually in the evening) or twice daily (morning and evening). Mixing and injection instructions will be given to the patient prior to treatment initiation. The patient will be told when to stop taking these drugs. If the patient stops taking these medications prematurely, it might lead to the cancellation of the cycle.
These drugs are usually taken for 10 to 14 days prior to egg retrieval. Some patients might need a longer period of time to have a successful stimulation. This is common in older patients or women with elevated FSH levels. A vaginal ultrasound examination will be performed one week after the start of these medications in most patients.
Tip From Our Doctors
Folic acid is a vitamin that every patient
attempting to conceive should take prior to
conception along with prenatal vitamins. Pacific Fertility Center Los Angeles
All patients will be given a hormone called Progesterone, at or around the time of embryo transfer. This hormone helps to support the developing zygote. Occasionally, patients are placed on other medications concomitantly including blood thinners such as Heparin, Lovenox, Baby Aspirin and/or Medrol (steroid) for immunologic problems. These drugs are also started the same day the fertility drugs are started. Further instructions will be given to the patient as to when to discontinue these medications.
Folic acid has been shown to reduce the incidence of serious birth defects (neural tube defects such as spina bifida) when taken during the first 50-70 days after conception.
Folic acid is a vitamin that every patient attempting to conceive should take prior to conception along with prenatal vitamins. The patient will be placed on Folic acid 1 mg/day or a prenatal vitamin starting the day of stimulation with fertility drugs. Occasionally, other medications might need to be administered such as Medrol or IVIG. Further instructions will be given to the patient in these cases.
Learn More About How Ovarian Stimulation Can Benefit You
At Pacific Fertility Center, our doctors are committed to helping patients achieve successful results. During a consultation, we will guide you through the process and answer any questions you may have. To set up an appointment at one of our locations, please send us a message or call one of our office locations.