In order to get sufficient follicles and eggs for the in vitro fertilization process, the woman is stimulated with injected medications to develop multiple follicles (egg-containing structures). The injections are usually given by the woman, or by her male partner. The technique is easy to learn.
Usually, two different injectable medications are used in IVF drug stimulation protocols. One drug is given to suppress ovulation from occurring before we take the eggs out and the other drug is used to stimulate multiple egg development.
The most commonly used IVF protocol is called “down-regulation” or “long Lupron”.
With this Lupron drug regimen, the Lupron is started on about day 21 of the woman’s cycle. The purpose of this medicine is to “down-regulate” the pituitary gland with regard to production of FSH and LH hormones.
This gives us more complete control of the subsequent stimulation of follicle and egg development in the ovaries. The Lupron is given as a subcutaneous (under the skin) injection with a small needle into the thigh or abdomen area.
The woman gets her period at the normal time (for example – day 28 of her cycle). The next medication begins a few days after her period starts. This is the FSH (follicle stimulating hormone) that will stimulate the ovaries to make multiple follicles and eggs.
There are several name brands of injectable FSH product available including Gonal-F, Follistim, Bravelle, Menopur and Repronex. These drugs can be given as subcutaneous injections or as intramuscular injections. We use them sub-Q because the women prefer it.
Once the FSH stimulating injections have begun, blood and ultrasound testing is done about every 2-3 days to monitor development of the follicles in the ovaries and the hormone levels.
Follicles contain eggs for IVF
Ultrasound of multiple follicles in a stimulated ovary
When the woman’s follicles are mature and sufficient, an egg aspiration procedure is performed to remove the eggs from her ovaries for subsequent fertilization in the lab with her partner’s sperm and then embryo transfer back to her uterus.