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Patient Education

Medically reviewed by Dr. David H. Barad - Written by CHR Staff - Updated on Oct 04, 2018

Pre-Cycle Training

In Vitro Fertilization (IVF) Fresh Cycle, Using Standard Lupron Protocol

Every cycle stimulation may have to be individualized and, therefore, may end up deviating from the here described routine. Please always follow the instructions, given by the CHR staff. When in doubt, call CHR at 212-994-4400, rather than taking the wrong step. Our staff is available for inquiries 24 hours a day, 7 days a week.

Once you have read through all the relevant material according to the type of IUI you will be going through, print this page for future reference, then please complete the Completion/Question Form.

Please read each item carefully, and make a list of questions you might want to ask. This way, you will be more prepared when you meet with your nurse coordinator for your training session. When you are unsure about something along the way, you can always come back to this page to refresh your memory.

1. What is IVF?

IVF is a procedure that can offer a chance of parenthood to women who have blocked or absent fallopian tubes, or men with low sperm counts. In an IVF cycle, you will take hormone injections/medications to encourage your ovaries to produce more than one mature egg. You will be closely monitored using ultrasound and blood tests while you take your medications to determine when your eggs are mature. Once your doctors have determined that your eggs are almost ready, you will use an additional medication to allow their full development and your retrieval will be scheduled. Retrieval is a short in-office procedure for which you will be given light sedation. After your eggs are retrieved, they will be mixed with sperm (inseminated). The following day, our embryologists will check to see if the eggs accepted the sperm and are fertilized. Three to five days later, some of the resulting embryos will be placed in your uterus (embryo transfer), bypassing the fallopian tubes. Two weeks after the embryo transfer, you will find out if you have achieved pregnancy by having a blood test for pregnancy.

OPTIONAL: If you need more general information on IVF, you can continue on to read about IVF.

2. Pre-Cycle Checklist

A series of tests are required before an IVF cycle can take place, on both female and male partners. You should discuss your specific checklist requirements with your clinical-coordinator who will be responsible for guiding through this process.

Download the Pre-Cycle Checklist.

3. Informed Consents

Typically, your initial consultation with a physician determines the type of treatment you will be undergoing. (Some patients may not have a formal treatment plan until they have their follow-up consultation to review some information that was unavailable at the time of the initial consulstation.). Once you and your physician determine the type of treatment for you, you will receive a packet of informed consent forms from your clinical coordinator. CHR's comprehensive informed consent for IVF is also posted below.

All signed informed consent documents are required prior to any procedures performed at CHR. Please read through the informed consent forms you receive so that you are well informed by the time you meet with your nurse coordinator for further explanation and signing of the form(s). You should NOT sign the consent form(s) until you meet with your nurse coordinator to go over the consent forms.

If applicable, your partner will also have to sign the consent forms. If you are siging the forms outside of CHR without a CHR employee to witness your signature, consent forms need to be notarized.

Download the Comprehensive Informed Consent for IVF, ICSI, AZH and Embryo Cryopreservation.

4. Billing Clearance

A full payment for your treatment cycle is also due at this time. Our front desk staff can help you with cost questions and payment. With pre-cycle checklist completed (or waivers signed), informed consent forms executed and billing clearance in place, you are ready to start your cycle.

5. Timeline of IVF Using Standard Lupron Protocol

After the initial consultation with a physician (which determines the type of treatment you will be undergoing), you will need to complete all the required pre-cycle tests (please refer to the Pre-Cycle Checklist). After this step is complete, you will be ready to start your cycle. After your checklist is complete and before starting a cycle of treatment, you should carefully review the material on this web page and schedule an appointment with one of our clinical nurse coordinators to review instructions for preparing and injecting your medications, in a step we call a "Teach."

This appointment will be an opportunity for you to address any questions that you may have after studying the information provided on this page. For this appointment, please bring a copy of the completed questionnaire provided at the end of this material. This visit will also provide an opportunity for you to receive necessary prescriptions and to initiate any required pre-authorization from your insurance carrier, if applicable.

At CHR, if you are using a "Standard Lupron Protocol," you will return for a blood test and sonogram about 10 days before your next anticipated menstrual period (about day 18 to 19 of a normal 28 day cycle). If your tests confirm that you have ovulated, you will begin using Lupron (see the medication list for more detail).

Standard Lupron Cycles

standard lupron

STEPS
0Before your treatment cycle
  • Complete the pre-cycle checklist.
  • Review the informed consent forms, ask your coordinator any questions and sign the informed consent forms. (The forms need to be notarized unless you sign the forms in front of a CHR employee.)
  • Get billing clearance.
110 days before the start of your next period
  • Visit CHR for a blood test and ultrasound to confirm that you have ovulated. If you don't have regular menstrual cycles, we will give you specific instructions.
  • Start Lupron injections (see the medication list for more detail).
2Day 1 of your next period
  • If your menstrual period does not start within two weeks of the start of your Lupron injections, please call us ASAP.
  • Call 212-994-4400 to make an appointment for baseline tests (ultrasound and blood work) the next day.
3Day 2 or 3 of your next period in the morning:
  • Visit CHR for baseline ultrasound and blood work.
  • You will meet with your nurse coordinator to go over the medications. We call this a "Teach."
4Later the same day:
  • When the results of your morning tests are available, your physician will determine the dosage of medications you will use.
5Day 7 of your cycle (After 5 days of hMG and FSH injections)
  • Visit CHR for ultrasound and blood work.
  • After this day, your physician will adjust the dosage depending on your response to the medications.
66-10 days after the start of FSH and hMG
  • You will visit CHR one or more times (as instructed), for monitoring (blood work and ultrasound).
78-14 days after the start of FSH and hMG
  • You will be instructed to trigger ovulation with an hCG injection (see the medication list for more detail). It is crucial that you administer this injection at the precise time that your nurse coordinator instructed you.
8Approximately 34 hours after hCG injection
  • Visit CHR one hour before the scheduled time for egg retrieval.
  • Your husband (who will accompany you) will produce semen sample.
  • Your eggs will be retrieved through ultrasound-guided needles.
  • Retrieved eggs will be fertilized with the semen sample.
  • Appointment for embryo transfer is given at this time.
  • You will need to rest for 1-2 hours at CHR, then 2 days at home.
  • Start Prometrium capsules twice daily (in your vagina).
93 days after egg retrieval
  • Visit CHR for embryo transfer at the scheduled time, usually between 10 am and 2 pm.
  • You will need to be accompanied by your partner or friend.
  • Embryos will be transferred to your uterus through a catheter.
  • You will need to rest for 1 hour at CHR, then 2 days at home.
  • Appointment for pregnancy test, two weeks later, is given at this time.
  • Start Progesterone injections today.
  • Continue Prometrium and start Estrace pills (both vaginally) today.
1014 days after the embryo transfer
  • Visit CHR for pregnancy test.

Pre-cycle checklist and medication list

6. Medications

For IVF cycles using the Standard Lupron Protocol, there are five main medications. The five main medications are followed by six support medications that you may be instructed to take. Brand names of the medications you use will vary, so we've listed the generic name on the left-hand column, with general information on each medication at the top of the right-hand columns. For usage instructions of the specific brand-name medication you will be using, click on the icons below (standard lupron cycle & standard lupron cycle).

Estrogen PillsEstrogen pills (Estrace) are used in IVF cycles to thicken your uterine lining (endometrium), so that your uterus is ready to welcome the transferred embryo(s).
  • Insert one 2mg pill daily vaginally.
Leuprolide AcetateIn IVF cycles, Leuprolide Acetate (often called Lupron, even though it's a brand name--a bit like Band Aid and Hoover) is used to prevent premature ovulation. Because Leuprolide Acetate does this by suppressing the estrogen production in your body, you will need Follicle Stimulating Hormone (FHS) and/or Human Menopausal Gonadotropin (hMG) to encourage follicular development.
  • Leuprolide Acetate is taken as subcutaneous injections.
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
LupronPDFN/APDF
Follicle Stimulating Hormone (FSH)Follicle Stimulating Hormone (FSH) is used in IVF cycles to stimulate your ovaries to produce multiple mature eggs.
  • FSH is taken as subcutaneous injections daily
  • Take FSH as directed.
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
Bravelle®N/AVideoPDF
Follistim®PDFN/APDF
Gonal-f®PDFVideoPDF
Human Menopausal Gonadotropin (hMG)hMG contains natural follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In IVF cycles, hMG is used to regulate ovulation and encourage growth of multiple eggs when clomiphene citrate did not work well.
  • hMG is taken as subcutaneous injections daily.
  • Take hMG as instructed.
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
Menopur®N/AVideoPDF
Human Chorionic Gonadotropin (hCG)hCG is similar to LH. In an IVF cycle, one-time injection of hCG is used to trigger ovulation to get your mature eggs ready for insemination. You should wait until you are instructed specifically to administer this injection.
  • Take one injection when instructed.
  • Timing for this injection is critical!
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
Novarel™N/AVideoPDF
PregnylN/AN/APDF
ProfasiN/AN/AN/A
OvidrelPDFVideoPDF
ProgesteroneProgesterone is used to thicken your endometrium (lining of the uterus) so that the implantation of fertilized egg(s) will be easier. Medications used in ovarian stimulation can suppress progesterone levels in your body, so it is important to supplement it with exogenous progesterone. You will be taking both Progesterone injections and Prometrium vaginally.
  • Inject 50 µg Progesterone once a day.
  • Insert 2 capsules (200mg) Prometrium in your vagina 3 times a day.
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
Prometrium®PDFN/APDF
ProgesteronePDFN/AN/A
Micronized EstradiolMicronized estradiol helps maintain and build your uterine lining so that the transferred embryos will find a comfortable environment there.
  • Insert a 2mg tablet in your vagina 3 times a day.
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
EstraceN/AN/APDF
Micronized DHEADHEA improvers the quality of eggs and embryos.
  • Take one 25mg pill orally, 3 times a day with meals.
  • Continue until the positive pregnancy test.
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
FERTINATAL®PDFN/AN/A
Coenzyme Q10Coenzyme Q10 (CoQ10) improvers the quality of eggs and embryos.
  • Take one 333mg softgel orally, 3 times a day with meals.
  • Continue until the positive pregnancy test.
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
OVOENERGENTMPDFN/AN/A
Baby AspirinAspirin helps increases blood supply to your uterus and ovary. It also prevents clotting.
  • Take one 81mg pill daily.
Prenatal VitaminsPrenatal vitamins, such as Folate, will help prevent neural tube defects. Iron will build up your blood count. Calcium helps build your babies' bones and will help you maintain yours.
  • Take one pill a day.
PrednisonePrednisone suppresses male hormones and immune function.
  • Take one 10mg pill daily until further instructions.
Brand NamePrintable InstructionVideo InstructionsPrescribing Information
PrednisoneN/AN/APDF
Doxycycline Doxycycline is an antibiotic used to prevent infection after the egg retrieval.
  • Take one 100mg pill twice daily, for 5 days.
  • Wait for specific instructions.

7. FAQs

Why am I using Microdose Lupron?

If you are a woman who is over age 40, or has premature ovarian aging (POA), then you are especially sensitive to ovarian suppression. When Lupron is used as supplied from the manufacturer, it will profoundly suppress your own hormonal function. We use Microdose Lupron (highly diluted leuprolide acetate) to avoid suppressing your system too much.

How long will my Microdose Lupron cycle take from the start to finish?

You will begin preparation for your cycle with estrogen pills about 10 days before your menstrual period (See the timeline section above). Once you begin using Microdose Lupron, your retrieval will be 8-18 days later. Your embryo transfer will follow three to five days later. In other words, from preparation to embryo transfer, it will take approximately four weeks.

How many visits should I expect to make?

Approximately 5-8 visits.

What if my husband/partner will be out of town during the treatment?

We can freeze his sperm for back-up, in case he is not in town on the day of your IVF procedure. If he turns out to be in town on the day of the procedure, he can always provide fresh sample.

What are the most common side effects of the hormone medications?

Symptoms similar to PMS (Premenstrual Syndrome) are the most common. You may experience bloating, mood swings, cramping and headache. It is okay to take Tylenol as needed. Symptoms from these medications may continue for up to two weeks after your last dose. In fact, some women continue to experience symptoms for the first few weeks of pregnancy.

8. Completion/Question Form

For future reference, we recommend printing this page (a printer-friendly version is here). Then, click here for the Completion/Question Form where you will be asked to answer a few questions on this IVF training material, as well as have an opportunity to ask additional questions, if you have any. After you have submitted the Completion/Question Form, you will be asked to print out a certificate, so that you can bring it in with you the next time you have an appointment with CHR.

Dr. David H. Barad

Dr. David H. Barad

David H. Barad, MD, MS, is an expert reproductive endocrinologist with decades of experience in treating women with aging ovaries and patients with multiple failed IVF cycles. Dr. Barad is Director of Assisted Reproductive Technology and Senior Scientist at CHR.