Medications Before IVF Treatment Abroad

Between your two visits you’ll take a series of medications that are designed stimulate your ovaries in order to assist the IVF process.  We are often asked about these, so here’s a guide to the medications that you’ll probably be given. Plus the role that we’ll play in the process during your IVF treatment abroad.

 Here’s what the medications aim to do:

• To maximize your chances of success with IVF, we want a number of high quality eggs. So we aim for 8-15 eggs to be retrieved during egg collection.
• Research shows that good a number of eggs retrieved often means high success rates. More the merrier as they say! However fewer eggs DOESN’T necessary spell disaster.
• You’re given several ovarian stimulating drugs that are used to enlarge the ovaries to help make sufficient follicles and eggs. Without theses stimulating medications, you’d only release 1 mature egg per month, which isn’t enough for an ivf cycle.
• You may have heard of FSH? It’s the most commonly used with injections of follicle stimulating hormone, to persuade your ovaries to produce multiple follicles.

So, how many follicles do I need?

Occasionally the ovaries will respond poorly to the medication, meaning that only a few follicles will develop. The ultra sound test (Antral follicle count) can usually show your doctor, how likely ovaries will produce enough eggs for IVF.  The precise number of follicles needed to proceed with IVF comes down to a number of things:

• The woman’s age
• Size of the follicles available
• Previous medical history
• If the consultant is willing to  retrieve and continue IVF low numbers of eggs.

Opinions differ. Some consultants believe that a patient must have a  minimum number of 5 follicles, that each measure 14mm or more. Whilst another may be prepared to transfer a single follicle.  However for the majority, the threshold is usually a minimum of 3-4 mature or nearly mature follicles.

Women that have a low antral count or higher FSH levels and are older than 37 and women with elevated FSH levels, are more likely to respond poorly to ovarian stimulation medications.

*Our IVF Treatment abroad prices are subject to change without notice.

Ultra-Sound Scans

When have your IVF treatment abroad, you will normally have your ultra-sound scans at a local fertility clinic in the UK. This minimises the time you’ll need to spend away from home. The image below shows a 3D ultra-sound of developing follicles. This 3D method gives a more accurate measure of each follicle’s actual size.

 Types of Medications

Your IVF stimulation will usually consist of 3 different kinds of medications.  You’ll be given theses and instructed on how to use them at your first consultation. These are usually:

1. A drug to suppress the ‘LH surge’ which otherwise would bring about ovulation before the optimum number of eggs are ready for retrieval. There are two medications generally used for this: GnRH-agonist (gonadotropin releasing hormone agonist) such as Lupron & GnRH-antagonist such as Centroid.

2. Follicle stimulating hormone (FSH) is then also taken to produce multiple eggs rather then a single egg. Your ovaries will be stimulated with the FSH medications for about 7-12 days, until numerous mature follicles have developed successfully: Gonal-F, Menopur. We’ll help to co-ordinate the three to four ultra-sounds scan that you’ll need as we monitor the progress of the developing follicles.

3. Finally human chorionic gonadotropin (HCG) is used to stimulate the latter stages of the eggs’ growth and to prepare your body for egg collection which takes place at the clinic.

Key stages during your stimulation

The aim of this stimulation phase is to ideally harvest 8 to 15 high quality eggs. However, it’s important to remember that your doctor must strike a balance. We do not want to have over stimulation of your ovaries, which can cause some discomfort or even OHSS (Ovarian Hyperstimulation Syndrome) in some rare cases.  At the same time your doctor doesn’t want the ovarian stimulation to give us too few eggs. Especially if it might have been possible to gain more at a higher dose of  FSH medications.

IVF treatment abroad may still be successful with low numbers of eggs. But research proves that your chances of success are significantly better when more than three or four eggs are successfully retrieved.

WHAT WILL YOUR DOCTOR DO DURING THE STIMULATION?

Your consultant will always have three main aims for your treatment during stimulation:

• Choose the optimum medication protocol (type & mix of drugs) and dose for you.
• To monitor your progress throughout stimulation with blood tests & ultra-sound scans. With our IVF treatment abroad we’ll help co-ordinate this with your local fertility clinic. So if necessary, the amount of medication that you’re taking can be adjusted as you proceed with the treatment.
• To trigger ovulation at the best time for the eggs’ development with HCG. Timing here is very important because, triggering ovulation either prematurely or too late reduces success. If triggered too late it may lead to ovarian hyperstimulation (OHSS). Your consultant will give you an exact date & time when you need to do this.

IF YOU’RE HAVING IVF TREATMENT ABROAD, HOW WILL YOU BE MONITORED WHEN YOU ARE AT HOME?

InterTrust Fertility will help co-ordinate your IVF treatment abroad with your scans back in the UK. Ensuring you receive the best care. Throughout this whole process (8-12 days) your consultant monitors all your scans and blood results and adjust your medications if necessary. We’ll help to ensure fast, accurate communication between the local clinic & your IVF treatment clinic abroad. During this process here’s what your consultant will be looking for:

• The main aim is to harvest a minimum of four follicles, each with a diameter of 14-20mm.
• Ideally, we’ll be able to retrieve a good number of quality eggs: around 8-15.
• Hopefully, there will be no less than eight follicles between 13-20 mm.
• The hormone levels in your blood and developing follicle sizes are monitored throughout the process by your consultant.
• Estradiol. Estrogen hormone levels are significant. They are normally under 60 pg/ml (during cycle baseline – that’s a normal menstrual cycle in plain English!), but increase significantly as your ovaries are stimulated and multiple follicles develop.
• During your treatment estradiol levels peak once the HCG medications take effect. Usually between 1000 and 4000 pg/ml.
• Your consultant will time your HCG injection to coincide with when both your follicle measurements and estrogen levels appear at their best for successful outcome. The HCG shot is needed to induce final egg maturation. Your consultant will tell you exactly what time to take you HCG, as egg retrieval will take place at your clinic in Spain or Prague 34-35 hours afterwards.

During IVF treatment abroad, once your consultant tells you to take the HCG medication, it’s time to finalise your travel plans. InterTrust Fertility will help co-ordinate this for you, easing the stress, wherever possible. See our patient journey.