IMPORTANT PLEASE READ:  IVF Connections maintains this web site as a resource for IVF patients. Although some information on this site is about medical issues it is not intended to provide medical advice or to replace the care of your existing health care professional. Do not rely on any of the information contained in the IVF Connections web site for diagnosis or treatment. If medical advice is needed, the service of a licensed physician or healthcare professional should be sought. IVF Connections and its affiliates assume no liability whatsoever of any kind for the information and data contained on this web site or for any diagnosis or treatment made in reliance thereon. Please read our full disclaimer before continuing.

During the stimulation stage of your IVF cycle, you take hMG (Pergonal, Humegon, Repronex etc.) or FSH (Gonal F, Puregon etc.) to stimulate follicle growth.

Can I ovulate while on the suppression drugs?
It is very unlikely that you will ovulate while on suppression drugs. The suppression drugs suppress the ovulation function. When you are on stimulation drugs you may feel some soreness as your ovaries get larger. This soreness may be there one day and then gone the next. This does NOT mean that you have ovulated. A variety of things can cause your symptoms to change, including your activity levels. Contact your clinic if you are concerned.

Why do I have to continue to take the suppression drugs, when I start my stimulation drugs?
With most IVF drug protocols, you will continue to take suppression drugs while you are taking the stimulation drugs. If you do not take the suppression drugs you may ovulate on your own before the clinic has a chance to retrieve your eggs. The clinic wants to keep you on suppression drugs, so that they can time the retrieval of the eggs when the follicles are at their optimum size for their number.

What side effects can I expect from the stimulation drugs?
You may experience some of the following side effects below. Some women are very sensitive to the effects of the medication while others experience hardly any changes. Always contact your doctor if you have any concerns or questions about your side effects or the medications you are taking.

• Abdominal bloating
• Nausea
• Diarrhea
• Weight gain
• Fatigue

How does the clinic know when my eggs are ready to retrieve?
The clinic will monitor you closely, once you begin the stimulation stage of your IVF cycle. The clinic can monitor you in 2 ways: through ultrasounds and through blood work. Some clinics only use the ultrasound method. The number of days that you will be on stimulation drugs varies greatly depending on your drug protocol and how well you stimulate. In the US most clinics are looking for 150-300 units of Estradiol for every mature follicle. In Canada, clinics like to see between 750 and 1,000 units of Estradiol for every mature follicle. A mature follicle is usually between 18 and 23 mm. The clinic tries to do the retrieval when the most number of mature follicles fall within range. This may mean that some eggs may be too mature and some too immature to fertilize.

My stimulation numbers explained

My first IVF cycle was an "average" IVF cycle at my clinic with good response and an above average number of eggs retrieved. I have observed that Canadian clinics tend to stimulate their patients more slowly than American clinics. 13-14 day cycles are considered the norm at my clinic using the newer fertility drugs (Follistim, Gonal-F, Puregon). Day 6 is the first day of bloodwork at my clinic and they like to see a number of at least 500 (Canadian) 136 (American). I was at 557 (Can.) 152 (Am.), so my numbers were rising nicely. I stimulated well and at a steady rate; therefore I was only required to be at the clinic every other day for an ultrasound. My dosage of Puregon stayed the same throughout the whole cycle. On day 12 my follicles were getting close to being ready, so the clinic asked me to come in again on day 13. The dip in the number of follicles on day 13 can be explained by the fact that ultrasound images are only 2-dimensional and they don't always give an exact picture. Slight variations in sizes from day to day are normal. On day 13, based on my E2 level and the size of follicles, the clinic felt that one more day of Puregon was all that I needed. I took my last injection of Puregon on day 14 followed by the hCG injection later that evening. 17 eggs were retrieved and 12 of them fertilized.

For my 2nd IVF cycle, I had a slow start and my dosage of Gonal-F was boosted at my first E2 check on day 6. It is common for IVF cycles not to be exactly the same. After my day 11 bloodwork I was still moving slowly. I decided to start giving myself injections in the abdomen instead of thigh. I had heard that this increases the absorption of the stimulation drugs by the body. The result was my E2 nearly tripled in 2 days where it had not even doubled at the previous E2 check. My numbers began to rise more quickly after day 13, so the clinic had me come in for bloodwork and ultrasound everyday. On day 16 the clinic decided I was almost ready. On day 17 I did one more injection of Gonal-F and then took my hCG injection later that evening. 16 eggs were retrieved, but two mature follicles were not drained because they were located too close to an artery. 10 eggs fertilized.

How do I convert my Canadian Estradiol (E2) numbers to American measurements?
In Canada E2 levels are measured in picomols and in the United States E2 levels are measured in picograms. If you want to compare numbers, here is how to convert them:

Do I have to take the hCG injection exactly when the clinic has told me to?
You must take the hCG at the precise time that your clinic has told you. They are timing the retrieval so that it will fall between 34-36 hours after the hCG injection. If for some reason you didn't take your injection at the right time, please inform the clinic immediately.