Baseline Estradiol Level: This blood test is obtained 1 to 2 days before stimulation medications start. This test is confirm that the patients estradiol hormone is <50. The estradiol hormone must be <50 to start stimulation. This applies to all conventional patients and egg donors. If the patient starts her period approximately 4 days prior to this scheduled baseline estradiol blood test, she does NOT need to have the estradiol level checked. By starting her period in this time frame indicates a low estradiol hormone. Thus, she can start her stimulation protocol as per her calendar.
This ultrasound is performed 1 to 2 days prior to the start of injections. This ultrasound may apply to all recipients, surrogates or any patient undergoing a frozen embryo transfer cycle in addition to patients undergoing a conventional IVF cycle. In some cases a baseline estradiol blood test is performed instead of the baseline ultrasound depending upon the location of the patient and the availability of the physician. This baseline ultrasound assesses the ovaries for cysts. The ovaries must be free of ovarian cysts to start the injections. FDA Testing: As of May 2005, the FDA requires that all cycles using an egg donor (anonymous or known) must repeat infectious screening within 30 days of the Embryo Transfer. All sperm sources when using a surrogate must also repeat this testing. The testing is performed at the baseline estradiol or baseline ultrasound time during the cycle. The testing that must to be repeated for all egg donors are: HIV 1&2, HTLV 1&2, Hepatitis Bsag, Hepatitis B core AB, Hepatitis CAB, RPR/VDRL, Cervical Gonorrhea/Chlamydia. The testing that must be repeated for all sperm sources when using a surrogate are: HIV 1&2, HTLV 1&2, Hepatitis Bsag, Hepatitis Bcore AB, Hepatitis CAB, RPR/VDRL, urine GC/Chlamydia. IMPORTANT: All results of repeat infectious testing must be back and negative before the Embryo Transfer. If results are not back or abnormal the embryos will NOT be transferred.
Following the initial visit, the patient will be given a new calendar with specific instructions on how to proceed. She will be told what medications to continue taking and when to come back for another ultrasound. Usually another visit will be made 2-4 days after this date.
Usually one week after the start of the fertility drugs (such as Gonal-f® and or Menopur®), the patient will come in for her first appointment at PFC-Los Angeles. For out of town patients, this ultrasound can be done by a local doctor or center). During this short appointment, the following will be performed: A vaginal ultrasound examination: The purpose of this examination is to visualize the ovaries and count the number of follicles present. A follicle is the fluid-filled sac that contains the egg. Each follicle usually contains one egg. By counting the number of follicles we can determine how well the patient has responded to the fertility drugs. We will also measure the follicles. The size of the follicle gives a good idea about the maturity of the egg. As the patient continues to take the fertility drugs, these follicles will grow (about 3 mm in 2 days); and at a certain point in time they will be ready to be harvested. We usually like to retrieve the eggs when the majority of the follicles are between 18 and 20 mm in size. After evaluating the number and size of the follicles, the thickness and pattern of the uterine lining will also be evaluated. This is a crucial part of the examination because a poor lining will not be able to sustain a pregnancy. Occasionally a blood test for the hormone Estradiol (E2): As the follicles (containing the eggs) mature, the eggs secrete the Estradiol hormone. Therefore measuring the level of this hormone in the blood often gives us a good idea as to how the ovaries are responding to the drugs. The level increases over the next several days as the eggs are maturing and the follicles growing. The more eggs or follicles a patient has the higher the Estradiol level.
Following the initial visit, the patient will be given a new calendar with specific instructions on how to proceed. She will be told what medications to continue taking and when to come back for another ultrasound. Usually another visit will be made 2-4 days after this date. During this follow-up visit, an ultrasound examination (and possibly a blood test) to evaluate the growth of the follicles will be performed. The patient will again be given further instructions on what to do on a daily basis. Sometimes, yet another visit for another ultrasound examination and blood estradiol level will be required. Usually, however, two visits are all that is required prior to egg retrieval. HCG injection: When the physician decides that the follicles are ready to be aspirated (to remove the eggs), the patient will be given instructions to take an HCG injection 36 hours prior to the Egg Retrieval. This medication is crucial. It will “push” the eggs through their final stages of maturation and will release them from their attachments to the walls of the follicles to float inside the follicular fluid. If HCG is not taken correctly and at the exact time specified, the eggs will not be mature and will not be able to be aspirated. The patient will be given written instructions on how and when to administer this medication. She will also be given a new calendar, the HCG Calendar, which will contain additional instructions on what other medications (such as Progesterone) the patient should start taking. The HCG injection is usually given at night (usually between 7 PM and 11 PM), the Egg Retrieval is scheduled 36-38 hours after the injection, which falls two days later in the morning between 7 AM and 11 AM.