About IVF

The following refers to the standard antagonist protocol in our service. Information regarding alternative protocols can be obtained from the QFG Nurses.

What is the role of the baseline scan?

  • The baseline scan is an quick scan assessment to make sure that the ovaries and endometrium (lining of the uterus) are ready for IVF.
  • The ovaries are checked to see how many antral follicles are present (small “bubbles” in the ovaries measuring less than 1cm).
  • Each of these follicles contains an immature egg
  • The number of small follicles indicates the maximum number of eggs that can be retrieved in the cycle.
  • The endometrium is measured and should be thin (less than 4mm) at the start of a cycle.
  • Many women have their period at the time of the scan and this is normal.

  • After the scan, you will meet with one of the nurses for education regarding starting your needles. You will be given the medications to take home.

    Most women feel well/normal during the first 5 days of injections.

    Many women are very nervous about starting injections. Small bruises are common so don’t panic if this happens. It is hard to avoid the fine blood vessels under your skin when injecting!

    Many women are worried about how the medications will impact on their mood. The majority of women I speak with report that their mood is normal during the first 12 days of the cycle. Approximately one third of women feel very anxious or very sad during the cycle. If you are experiencing these feelings, please contact the nurses or let me know when you see me for appointments.

    If you are experiencing side effects or having difficulties with the injections, contact the nurses by phone or email.

    Why is a scan done at this stage?

  • It checks how many follicles (bubbles) are growing in the ovaries
  • Follicles that are responding to the injections will be 11-15mm
  • It helps decide when to start the second injection (the antagonist)

  • A second injection (the antagonist) is started after this scan and is usually given at night. It will stop high levels of hormones (in particular, LH) being produced in your brain so that the eggs are not released into your body before the egg retrieval procedure.

    You may start to notice pressure/heaviness/bloating in your pelvis between day 7 and day 11 of injections.

    You may notice egg white mucous during this time. This is common and is due to the increased levels of oestrogen in your blood. The antagonist injection in the IVF cycle prevents ovulation; so don’t worry if you notice this.

    Contact the nurses if:

  • You have pain or bleeding
  • You are experiencing other side effects
  • You are having difficulties with the injections

  • What is this scan for?

  • This scan (usually on day 11) assesses if it is ok to proceed to the egg retrieval procedure and can provide an idea of how many eggs may be retrieved
  • Follicles measuring between 15 and 24mm are likely to contain a mature egg
  • A blood test is performed before the scan and measures three hormones: Oestrogen, LH and Progesterone
  • Progesterone and LH should not be elevated. If they are elevated, eggs can be released prior to the egg retrieval procedure.
  • The Oestrogen level: This helps understand how many eggs may be retrieved and provides information on the risk of developing ovarian hyperstimulation syndrome (OHSS)

  • You will be given instructions on how to give your final injection (the trigger injection). This injection leads to the maturation of the eggs that will be retrieved. Mature eggs have the right amount of chromosomes so that they can be fertilised by sperm. The timing of this injection is very important. It is usually given in the late evening. You will have no injections the following day (which is of course great news!).

    The nurses will also advise you of the time and location of your egg retrieval procedure. They will let you know when to fast. They will also advise the time for sperm collection (if this is relevant).

    The egg retrieval procedure takes 10-20 minutes and is performed at the Cairns Day Surgery. You will have an anaesthetic and will be asleep during the procedure. You will be able to go home to rest by lunchtime on this day. I will speak with you after you wake up and let you know how many eggs were retrieved.

    Most women will need simple pain relief for the first 2-3 days after the procedure. Some will need stronger pain relief and a script will be provided. Some women choose to go back to work the next day; others will take a few days off. If you have questions about time off during your cycle, during your cycle, let me know.

    On the day after the egg retrieval procedure, you will be phoned by one of the nurses to let you know how many eggs have fertilised. If you are having a fresh embryo transfer, you will be taking progesterone pessaries twice daily.

    In our service, embryos are routinely cultured for 5-6 days (blastocyst culture). This can be a pretty stressful time in the cycle as you wait to hear if there are good embryos or not. If you have questions or concerns, contact the nurses.

    Embryo transfer is performed in our procedure room. You will meet with our scientist (Sally) prior to the procedure to discuss the quality of your embryo. She can answer any questions that you have. You do not need to rest in bed after the procedure. Some women will go back to work and this is ok. You are welcome to take it easy for the afternoon if you want to!

    Most women want to know what they can or can’t do after embryo transfer. My advice is that you should try to live life as normally as possible. Many people find that the two-week wait is the hardest part of IVF. Our service offers after-hours education on managing feelings during treatment. Our counsellor, Maggie, provides the education. Ask the nurses for more information if you are keen to attend.

    Can I exercise?

    Absolutely. You can maintain mild to moderate exercise during this time. Exercise is good for reproductive health. Exercise is an excellent way of managing anxiety.

    What should I eat?

    Maintain good general nutrition. Mediterranean style eating is likely to be beneficial for reproductive health. Avoid excess caffeine. Avoid alcohol.

    Will stress stop the embryo implanting?

    There is no consistent evidence that stress will stop the embryo from implanting. Keep in mind that embryo implantation is a very complex process that occurs at a microscopic level. Embryo factors are responsible for the majority of unsuccessful cycles and these are out of your control.

    Things to keep in mind:

    The two-week wait is a tough time. Time feels like it has slowed down, emotions can be all over the place. It is a good idea to try to be mindful of the things that you choose to do in this time. Consider what makes you feel more positive and what makes the time more difficult. Try to do something positive each day i.e. exercise, relaxation, getting outdoors. Be careful about how much time you spend researching on the Internet. It can become very emotionally exhausting (this advice comes from personal experience!). Try to avoid frequent and/or early pregnancy testing if you can. Keep in mind that IVF medications can create side effects that are similar to pregnancy symptoms.

    Please stay in touch with the team if you are experiencing difficulties or have questions.