Step 1: Medicines to produce eggs
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.
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.
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 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
- mood swings
- poor concentration
If you have any of these symptoms, they will improve when you start your daily hormone injections. 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 of the vagina in the assisted conception unit (ACU). This scan 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.
After this scan, we set your egg collection date for 2 to 3 weeks after you start the hormone injections.
Your body naturally produces follicle stimulation hormone (FSH). Injections of FSH help or 'stimulate' your ovaries to produce eggs.
A scan confirms if it is OK to start FSH injections. This is usually 2 to 3 weeks after the start of down-regulation.
You have daily injections for 10 to 14 days. They are given just under the skin on the thigh or tummy. We teach you or your partner 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 you need another scan, which is usually 48 hours 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
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 this medicine as part of your IVF cycle instead.
We usually 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 during this step of IVF treatment. 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.
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 phone the nurses on 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/VER3
Last reviewed: June 2019
Next review date: June 2022