Previously a women’s natural cycle used to be suppressed by giving pituitary down regulating drugs (decapeptyl injection). Once the natural cycle was stopped, ovarian stimulation was started. With the advent of new drugs (antagonists), pituitary down regulation is not necessary. Ovarian stimulation can be started on the 2nd or 3rd day of menstrual cycle without down regulation and making the IVF procedure less painful.
A baseline sonography of uterus and ovaries is done to rule out presence of any functional cyst in ovaries. A cyst measuring 10cm or more requires aspiration. Husband’s semen is also cryopreserved. This provides a backup sample, in case husband is unable to produce semen on the day of ovum pickup.
Female is born with 2 million eggs into her ovaries. After 1st menstruation (Menarche) every month about 500 eggs comes out of ovaries for maturation. Pituitary gland produces that much hormone where only one egg matures and ovulates and remaining eggs gets destroyed (atretia). By giving some extra hormones from outside it is possible to mature more number of eggs. IVF, with one egg, will have a very low success rate. Hence ovaries are stimulated to produce multiple eggs for better results. Ovarian stimulation is done by drugs like recombinant FSH, Highly Purifies HMG or U-HMG. The injections can be started on 2nd or 3rd day of menstrual cycle. If necessary, stimulation can be started at a later date while continuing the down regulation with decapeptyl injection.
This is done by periodic examination of blood for E2 and Progesterone levels and routine ultrasound examination of the ovaries. This is called USG Follicular study which monitors the growth of the follicles in the ovaries and helps determine the time of Ovulation. Eggs are retrieved on they of ovulation by a procedure call Ovum Pick up.
Patient has to report to the clinic every day from 2nd day of menstrual cycle till the eggs are aspirated. The number of injections to be given each day will depend on the number and size of follicles in ovaries seen by Ultrasonography and Hormone Assay. Maturation of eggs may require 7 to 15 days of ovarian stimulation.