Follow up and instructions during the stimulation phase

Ovarian stimulation must be closely monitored in order to customise hormone dosage to your needs. If you follow the long protocol, you should come back to BioDimiourgia for ultrasound scan and estradiol measurement 10 – 15 days after starting taking the analogue (usually at the end of the period).

You will receive doctor instructions about the starting day and the time at which you will take gonadotropins after 19.00 on that day. At the time when injections start, the husband will be informed about the start of his prophylactic antibiotic treatment with Vibramycin. You will also be informed about your next visit to our Centre.

If you follow the short protocol, you will be given instructions on the same day (second day of your cycle) regarding the suppression treatment start day and gonadotropin dosage. Three to five days after the start of the stimulation treatment, you should come to the Centre for estradiol measurement and ultrasound scan; however, don't be surprised if you are asked to come sooner or later than that.

If you follow the antagonist protocol, upon start of your cycle you will be given instructions on the gonadotropin dosage, as in the short protocol. However, suppression treatment with antagonist will only start on the sixth day of stimulation.

Lab test results are available on the same evening. Based on the estradiol value and ovarian images from the morning ultrasound scan, you are given instructions on your treatment and an appointment for your next visit to our Centre (usually two to three days later). This procedure is repeated two to three times more. You will notice that follicles grow at a steady rate (their diameter gradually increases) and at the same time the estradiol value rises.

You should be aware that things do not always go according to plan and there may be some setback. However there is no need for concern. We can always increase or decrease the dosage and most of the times bring things back to normal. Moreover, you should always call if you feel strong discomfort (e.g. abdominal bloating, pain, shortness of breath, etc.). Such adverse events are rare, but we need to be informed about their occurrence, so as to adjust the dosage of hormones or, in extreme cases, discontinue the treatment.

Special reference is made to natural cycle IVF (i.e. IVF without the use of medications). In this case, the ovarian follicle growth is monitored with ultrasound scans usually from the 8th day of the cycle onward. At some point of the process you may be asked to have your E2 estradiol and LH levels tested. You will not need to take any medication as long as your body functions normally. In the event of premature ovulation, gonadotropins and antagonists may be administered for a couple of days. This is the modified natural cycle IVF.