There are risks associated with the use of ovulation induction medications including an increase in the chance for high order multiple births and the development of ovarian cysts. A rare side effect that may occur is ovarian hyperstimulation syndrome (OHSS); symptoms include severe pain in the pelvis, abdomen and chest, nausea, vomiting, bloating, weight gain, and difficulty breathing. The medications most commonly used in fertility treatment are clomiphene citrate, gonadotropins, Metformin and Parlodel.
The purpose of “super-ovulating drugs” is to stimulate the ovaries to produce more than one egg. Bravelle, Repronex, Pergonal (hMG), Follistim and Gonal-F (FSH) are given as an injection once or twice a day to recruit multiple eggs.
After receiving injections for approximately five days, a transvaginal ultrasound will be performed at RFC. You will be asked to empty your bladder and proceed to the examining room, where you will undress from the waist down. A vaginal transducer will be inserted into your vagina. You may experience some vaginal discharge after the procedure as transmission gel is used on the vaginal probe, but the procedure itself should not cause any discomfort.
Ultrasound is a process whereby high-frequency sound waves are transmitted through tissue. As the ultrasound waves strike the tissues, they project a white image on the ultrasound screen. Follicles are round sacs of fluid within the ovaries. Therefore, the follicles appear as dark circles on the ultrasound screen. Hopefully, each follicle contains an egg; however, the eggs cannot be seen during the ultrasound. In some cases, the follicle has no eggs and in others the follicle contains more than one egg. The number of follicles, therefore, does not correspond to the number of eggs. We monitor follicular growth and also the number of follicles being produced.
Beginning treatment on approximately day 6, you will undergo daily blood sampling to determine your estradiol level. This level is used to individualize your medication treatment for that afternoon and the following morning. Estradiol is produced by the lining of the follicle (fluid filled structure where the egg develops). In addition, a progesterone and LH determination may be made if your estradiol level is rising rapidly.
After physician review of your estradiol numbers, you will be notified of any change in your medication dosages. We are not looking for specific numbers when we perform ultrasounds and run blood work. We are looking for the relationships between the blood work and the ultrasound findings.
When your fertility doctor determines that you are ready for retrieval, you will be given instructions on how to administer an injection of hCG (Ovidrel, Novarel). This injection is given late in the evening approximately 37 hours prior to retrieval. This medication ripens the developing eggs and initiates ovulation. Ovulation occurs about 42 to 48 hours from the time of injection if you do not have an egg-retrieval procedure. Many patients experience abdominal discomfort after the hCG due to ovarian enlargement and are convinced that they are ovulating. Rest assured that we are monitoring you very closely, and the chance of ovulating prior to retrieval is extremely slim, and almost zero if you are receiving Lupron, Antagon or Cetrotide.
Sexual abstinence too long before retrieval (more than five days) or relations too close to retrieval (24 hours) could possibly decrease the quality of the semen sample. If you did not have sexual relations the day before hCG, we recommend that you do the day of hCG. If your husband has a low sperm count you may need a four to five day period of abstinence. Your fertility specialist will discuss this with you early in your cycle, should you have any questions regarding this matter.