How to Begin an IVF Cycle?

assisted reproductive technology procedures

An IVF patient should call fertility clinic on day 1 or 2 of her period. A nurse or a doctor will relay instructions as to when to come to the clinic for the first shots of ivf  for an Antagonist cycle or visit on day 21 of the menstrual cycle in case of a down-regulated cycle.

IVF Medications

Each patient’s medication plan is individualized, but most IVF regimens include one or more of the following:

GnRH Agonist

GnRH Agonist is used to helping create equally mature eggs. Some statistics indicate that GnRH Agonist may be associated with higher success rates and lower IVF cycle cancellation rates.

HMG (Human Menopausal Gonadotropin), is administered by intramuscular injection

Recombinant FSH

This ultra-pure FSH product, currently available in India, is made by genetic engineering. From a treatment point of view, it will be similar to pure FSH in all respects. A KIC staff member will teach the patient and her partner to reconstitute the different medications and administer the injections at their places from a doctor if the patient is from out- of- station. Most of the patients and their partners have little trouble getting used to the shots. Placing an ice-pack on the injection site, before and after the injection is given will help reduce any related discomfort. Patients must have their visit between 10:00 AM to 6 PM on weekdays and from 11:00 AM to 12:30 AM on Sundays to ensure consultation with the infertility specialist.

Patient Monitoring

Patients are usually asked to come into KIC for blood tests and sonograms to determine the maturity of their developing eggs beginning on cycle Day 3, 5, 7 or 9. Further monitoring will be carried out as needed until the eggs are determined to be mature. Occasionally, some patients will need to be monitored on a daily basis near the end of the ovarian stimulation phase of the cycle.

Blood Tests

Patients usually receive 2 or 3 blood tests during the course of the monitoring process: Estradiol (Estrogen) and Progesterone. Estradiol allows us to approximate the relative maturity of the eggs. Generally, the tests will show between 100 and 200 units of estrogen for every matured egg. Progesterone tells us if the eggs are becoming overripe, the patient’s progesterone level, which depends on the number of egg follicles created, should be below 2 units.


The maturity of the follicles developing in the ovaries is monitored via vaginal ultrasound. During this painless procedure, a radiologist inserts a small probe into the vagina. This enables him/her to visualize the ovaries and the uterus, to evaluate the maturity of the Endometrium (the inner lining of the uterus), and to count and measure the follicles developing in each ovary. A mature follicle measures from 16 to 22 millimeters. An Advance technology of Color Doppler study is used at KIC to monitor the blood in the follicle and Endometrium.

The Final Step to Egg Maturation

When blood tests and sonograms indicate that the eggs are mature(18mm or more), the patient will be instructed to be administered a final injection called HCG (Human Chorionic Gonadotropin) to complete the maturation of the egg. The HCG shot must be taken at KIC, (Hyderabad) between 9:30 PM and 11:00 PM on the date specified, and the retrieval will be scheduled for some 36 hours after the HCG injection. For example, if a patient’s Monday monitoring showed her follicles to be of the appropriate size and her estrogen levels were found to correlate with maturity, she would be instructed to take her HCG between 9:00 PM and 11:00 PM Monday evening. Her egg retrieval will then be performed on Wednesday morning.

The timing of the retrieval after the HCG injection is critical, since HCG may cause the egg follicles to release prematurely, making IVF retrieval impossible. Fortunately, this rarely happens.

Before the Procedure

The patient will be instructed not to eat solid foods after midnight, prior to the procedure. It is advisable to abstain from sexual activity for two days prior to the procedure to ensure the highest possible sperm count from the male.

What are the chances of success with IVF?

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The specific chance of success varies with a number of factors including the indication for the procedure, the patient’s age, the number of embryos transferred and a variety of other factors. Your chances of success with IVF will be discussed on an individual basis with your fertility specialist. The success rate with IVF must be viewed considering the natural fertility rate of infertile couples that are approximately only 10% per month. We advise you to be mentally prepared to undergo at least 3 cycles so that finally we can ensure you at least 85-90% success rate. Appropriate concessions are given in the financial aspect of treatment if you undertake 3 full cycles