Step 1: Medicines to produce eggs

IVF treatment

There are different steps to IVF treatment. The first step is to use medicines to help your ovaries produce eggs. This is so that we can collect as many eggs as possible.

There are 2 ways of doing this:

These protocols have the same chance of resulting in a pregnancy. Your doctor should let you know which one is better for you at your first appointment. 

You then have an appointment with a nurse. They explain how to use the medicines and give you a written personalised plan to follow.

Long protocol

The long protocol stops your body from producing eggs for a short time.

When your ovaries are encouraged to produce eggs again with hormone injections, the follicles (sacs containing your eggs) grow at the same time and speed as each other. This gives us a better chance of collecting more eggs at the same time, which are ready for fertilisation. 

Stopping the release of eggs (down-regulation)

We ask you to take a medicine for 2 to 3 weeks. The medicine stops your ovaries from releasing any eggs for a short time. This is called down-regulation. 

You take the medicine as a nose (nasal) spray or inject it under the skin of your stomach or thigh. The medicine:

  • makes your ovaries 'inactive' for a short time
  • helps your ovaries respond better to hormone injections
  • stop your ovaries from releasing your eggs before we can collect them

You start the first medicine on day 21 of your menstrual cycle (counted from the first day of your period).

You continue this treatment until 2 nights before your egg collection.

The side effects of the medicine for down-regulation can sometimes feel like menopause symptoms (when you stop having periods). Most are caused by low levels of oestrogen (a hormone produced in the ovaries). They include:

  • hot flushes
  • night sweats
  • headaches
  • mood swings
  • poor concentration

If you have any of these symptoms, they will improve when you start your daily hormone injections that stimulate the ovaries. You inject the hormone that your body naturally produces to encourage the ovaries to produce more eggs. This causes your oestrogen levels to rise again. 

Scan to check your ovaries

After 2 to 3 weeks of down-regulation, you have an internal scan. This is done using a probe that is gently inserted inside your vagina. For some patients who cannot tolerate an internal scan, we can use an ultrasound scan probe on your tummy instead.

The scan takes place in the assisted conception unit (ACU) and checks that:

  • your ovaries are inactive
  • your ovaries do not contain any large follicles (sacs containing eggs) or cysts (fluid-filled sacs)
  • the lining of your womb is thin

If this is not the case, we will ask you to continue the down-regulation medicine for another week.

Sometimes, if you have an ovarian cyst after down-regulation, we might drain this using a procedure similar to egg collection.

Hormone injections to produce eggs

Your body naturally produces follicle stimulation hormone (FSH). In your natural cycle, this hormone makes only 1 follicle to grow and release an egg. Injections of FSH help or 'stimulate' your ovaries to produce more than 1 egg.

A scan confirms if it is OK to start FSH injections after 2 to 3 weeks of down-regulation.

You have daily injections of FSH for 10 to 14 days. They are given just under the skin on the thigh or tummy. We teach you or your partner how to do this.

We monitor the number and size of the follicles in your ovaries using internal scans. We usually do the first scan 9 to 11 days after you start the injections. In some cases when follicles have not reached the right size, you may need another scan, which is usually 2 days later.

We aim to get at least 2 to 3 follicles that measure about 18 to 20 millimetres in diameter. We can then book your egg collection.

Side effects from FSH can include:

  • tender breasts
  • bloating (when your tummy feels full and uncomfortable)
  • feeling sick (nausea)
  • increased emotions

Short protocol

In the short protocol, you do not need to take the medicine that stops your ovaries from releasing eggs (down-regulation) 2 to 3 weeks in advance. You have a slightly different medicine that does the same job, but could be started after 6 days of stimulation.

We sometimes ask you to start contraceptive pills to time the start of your IVF. You need to email our fertility services on the first day of your period.

When you are ready to start the hormone injections, we plan for you to stop the contraceptive pills and come for a scan. We usually do this scan during your period. After the scan, you start taking hormone injections to stimulate your ovaries to produce eggs.

In this short protocol, we add the 'down-regulation' medicine that stops eggs being released to your hormone injections from day 6.

Having a period

It's normal to have a period after down-regulation medicine in a long protocol. This does not mean that the medicine has stopped working.

Do not stop taking your medicine until we ask you to. If you stop the medicine too soon, your eggs could be released before we have had a chance to collect them.

Having sex

You can have sex throughout your treatment. It's possible to get pregnant naturally during the down-regulation stage. If this happens, it is important that you tell the nurses so they can give you the correct advice.

Getting your medicine

We send your prescription to an independent medicine delivery service. They contact you directly about delivering the medicine to your home or place of work.

If you pay for your own IVF treatment, you need to pay the medicine delivery company directly for the prescription. We cannot order your medicine until you have paid in full for the treatment cycle.

We usually prescribe hormone injections (FSH) for 12 days.

If you need more FSH injections or any other medicines, please email the nurses on [email protected] or phone 020 7188 2300.

We can then send another prescription to the medicine delivery company. Please let us know before the weekend because this phone line is only open from Monday to Friday.

Resource number: 2687/VER4
Last reviewed: July 2023
Next review: July 2026

Trusted Information Creator. Patient Information Forum

Contact us

If you have any questions about IVF, please contact our assisted conception unit (ACU).

Phone: 020 7188 2300

Email: [email protected]

Do you have any comments or concerns about your care?

Contact our Patient Advice and Liaison Service (PALS)

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