These are some of the questions that the nurses at NFC hear often, grouped by cycle phase. Please don’t hesitate to call your nurse with any questions!
We hope this helps you!
Cycle Start
Call your IVF nurse with the first day of your next period, or the Monday following and she will work out your plan for you.
Our calendars we send out with your IVF chart review packet are templates, not exact plans. Most of our specific IVF plans actually don’t follow the templates exactly, rather they vary a few days at just about every step.
Yes, these are generic forms of Desogen that are ok to take.
Yes, spotting on the pill won’t interfere with your cycle at all. Approximately 30% of our patients report this side effect. Please confirm you are taking only active pills and continue taking them as prescribed in your IVF plan.
The short answer to this question is yes, probably. The biggest factor is where in your plan the conflict occurs. Your IVF nurse can more easily work around your schedule before your plan is dated. Once your dates are determined, there is not a lot we can do to change your path. Please let us know as soon as you know of potential conflicts to minimize disruptions to your cycle.
There are MANY factors that go into the doctor’s decision of which plan to use. Even for those the same age, and with the same primary diagnosis there may be other significant factors that direct your physician to develop a plan tailored to you. Keep in mind too that as advances in IVF are made, protocols change and may improve your chance for success.
Yes!
No, but it should not get hot, so if you are traveling do use an ice pack.
Typically not because once the vial is pierced, it may not retain its potency. It’s VERY important to distinguish between microdose and regular lupron. If you did a lupron cycle, then are planning a microdose lupron cycle, PLEASE make sure you use the correct lupron. Using regular lupron in a microdose cycle or vice versa could result in cycle cancellation!
Your period will likely come on the 3rd or 4th day after you take your last active pill (even if you have previously had spotting), but may come before your last pill, or really any time after stopping.
Please confirm that you have taken only active pills and that you stopped taking them when your plan said you should, even if you have active pills leftover. If you stopped pills appropriately, keep your appointment for your suppression check, you may be suppressed and not ‘need’ to have a period in order to start your cycle. Approximately 10% of our patients experience this with no problem.
Ovarian Hyperstimulation Phase
No, you should take your FSH as close to the same time every day as is possible, but if you will be an hour or two later in taking it, it’s not a problem, just get back on your normal schedule the next day.
Call NFC and your IVF nurse right away, you may be able to ‘catch up’ or you may just need to miss the dose entirely, it will depend on the timing of when you realized you missed the dose. Please try not to let this happen!
This can vary from patient to patient, but an average stimulation phase lasts 10 days, with monitoring on stimulation days 5, 7, 9 and 10. If you need more medicine and time, you will need more monitoring.
You will have your blood drawn first, then have your ultrasound. The typical experience of our patients is 30 minutes to 1 hour from the time they check in to when they check out. If you ask to speak to your IVF nurse or there is an emergency, you may be at NFC longer.
This is a very stressful situation that you should avoid because IVF meds are not available locally, and pharmacies cannot deliver on Sunday. You will need to call the on-call physician on Saturday and let them know, but this situation could be disastrous for your cycle so please make sure you have meds before a weekend!
Refills on all your meds are available by calling your mail-order pharmacy. Typically if you call by 5 you can have medicine delivered by noon the next day (the exception being Saturday – see above). If you have questions about how much medicine to order, please talk to your IVF nurse.
Egg Retrieval
Your doctor may do your procedure if it occurs on a day that they are doing procedures, but if your doctor is seeing patients in the clinic on the day of your retrieval, you would see one of the 4 other doctors.
Unfortunately, medications are not returnable. Your IVF nurse strives to order the exact amount of medicine you will use, but if you stimulate for a shorter time than expected, or your dose is decreased you may have leftover medicines. If this happens you may donate them to a friend or talk to your IVF nurse about other options.
The egg retrieval procedure is minimally invasive, and most of our patients report only mild cramping for a day or so after the procedure. Rarely someone will experience more cramping or pelvic pain, but we will help you manage this, and it tends to last for only a few days.
The anesthesia used for your egg retrieval is MAC – “Monitored Anesthesia Care”, which is the gentlest kind of sedation. It is sometimes called ‘twilight sleep’ and is mild. You will not remember your egg retrieval, and you should wake easily with minimal nausea or side effects, however you should not drive on the day of your retrieval. For more information about the anesthesia you will receive, click here Anesthesia Patient Information Guide (NFC).
Probably not. Most of our patients who report issues with anesthesia in the past do very well with MAC anesthesia. Please discuss your concerns with the anesthetist before your procedure, and if you know the kind of medicine that made you sick, that may be helpful as well.
The day of the retrieval, you should not drive or work. The day after the retrieval most of our patients do feel well enough to work, but if you have the freedom to take the day off, you may feel like resting instead.
Embryo Transfer
This can be very confusing. In general, patients who meet criteria for a day 5 transfer are those with many good quality embryos. If you have few embryos, or only one or two that are of dramatically better quality than the others, you may benefit from a day 3 transfer. If further observation of your embryos is unlikely to change our decision of which embryo(s) to transfer, then we would recommend a day 3 transfer. Please talk to your doctor if you have further questions about this!
***Importantly, if your transfer is moved to a day 3, your pregnancy test and progesterone blood tests should remain as initially scheduled. Do not move up your pregnancy test or progesterone test!***
Yes – you may fly with your liquid medicines and syringes to administer them, you just need to prepare in advance. You will need a letter from your doctor (your IVF nurse can get this for you) and all your meds must be labeled with your name. Check with your airline before you fly to see if there are additional requirements.
IVF Pregnancy Testing and Early Pregnancy Concerns
Gestational age is normally calculated by a woman’s Last Menstrual Period (LMP). That means that she is considered 2 weeks pregnant at ovulation (which is the same time as your egg retrieval). So to calculate your gestational age, know that you are 2 weeks pregnant at your egg retrieval. For example, if your retrieval happens on a Wednesday, you are 2 weeks pregnant that day, and the Wednesday 2 weeks later you are 4 weeks pregnant and would have your pregnancy test around then. If your pregnancy test is positive after that, we would look for fetal heart motion after 6 weeks gestation, or one month after your egg retrieval. Think of it as 2 bonus weeks of pregnancy! Interestingly, if your retrieval falls on a Wednesday, so would your due date be on a Wednesday!
The infamous 2 week-wait (2WW) feels like an eternity our patients tell us. We wish there was a reliable test that could tell us if your treatment was successful long before your blood test, but that technology has not been developed yet. It is tempting to use a urine pregnancy test, but these are very unreliable. It is somewhat common that a patient will call with a negative result with a urine pregnancy test, and she will then have a positive blood result. It is rare to get a false positive 16 days after egg retrieval (Ovidrel or hCG from your trigger shot can linger in the body for as long as 12 days). Your most reliable result will come from your Quantitative Beta test on the day your IVF nurse recommends. Testing before that day can result in a worrisome low level. We wish we could speed this part up, but we just have to wait!
If an embryo doesn’t implant, it cannot support itself and will stop dividing. It then is shed from the body with your period. Because the pregnancy test was negative, this is not considered a miscarriage.
This varies on an individual basis, please ask your doctor or IVF nurse when you may cycle again.
The good and bad news is that there is nothing you can do (beyond normal pregnancy precautions) to ensure the health of your embryo. Continue taking your IVF meds and prenatal vitamins as you have been, but there is nothing additionally that you can do to help your embryo develop. By the same token, normal behavior and accidents (like worrying and falls) will not harm your embryo. Your embryo is very well protected in your uterus and bed rest is not routinely recommended unless there is a medical indication.
Spotting in early pregnancy is probably THE most common reason our patients call us. This is always scary, but there is nothing you can do other than talk to your nurse and see if another blood draw or ultrasound would be appropriate. Sometimes we recommend waiting a few more days before doing anything. Miscarriage rates are the highest before 10-12 weeks gestation, and are based on the age of the female or the egg donor. 10-12% of all pregnancies in woman under 35 will miscarry. That number may be as high as 40% in women over age 40 (unless she uses an egg donor), so it is a very real risk. Once fetal heart motion is seen at 6 weeks, the chance of miscarriage drops a little, and as each week passes the chance drops a little more, until by 12 weeks the chance of loss is ~3%. Your particular circumstances may vary, please consult with your doctor or nurse for information specific to your situation.
We advise that you start normal prenatal care with your OB when you are 10 weeks pregnant. Normally we do an ultrasound at 8 weeks, and we will forward that report and the other ultrasound and blood work reports to your OB with a letter about your pregnancy to date. Please make sure we know who your OB is so that they may receive this information in a timely manner. Most of our patients schedule their first OB appointment a month ahead, so call your doctors office after fetal heart motion is seen at your first or second ultrasound at NFC.
