Frequently Asked Questions
What do I do when I do not have any medication on the weekend?
You should make every attempt to ensure that you have enough medication to last through weekend. In the event that you should find yourself without enough medication, you will need to get a refill from your pharmacy. If you’re unable to get a refill from your pharmacy, you’ll need to find a local pharmacy that has the medication and contact the on-call person. With proper planning this can usually be avoided.
How big do my follicles have to be?
We like to see at least one follicle greater than 18 mm and the remainder of the follicles at least 15 mm. These sizes correlate to oocytes that are mature. The follicles may become larger than 18 mm, which will not present a problem.
Will I be put to sleep for the retrieval?
During the retrieval you will be given a sedative and a pain medication. However, you will not be completely unconscious. It is possible that you may not be aware of what is occurring or may not remember the retrieval, but the goal is to prevent excessive sedation.
Will the retrieval hurt?
With adequate anesthesia you may feel very brief discomfort as the procedure begins. This is very mild and is over very quickly. It is normal to be anxious about the retrieval, and the sedative will help alleviate your anxiety prior to the procedure.
What do I do with the HCG injections?
The human chorionic gonadotropin (HCG) can be used to trigger ovulation at the appropriate time. When the monitoring team feels your follicles are at the appropriate size to trigger ovulation you will be instructed when to take HCG. This is often referred to as “released.”
The type of cycle and day of the procedure (oocyte retrieval or insemination) will determine what time the HCG injection will be given. The additional HCG will be used as supplemental HCG for luteal support. You will receive mixing instructions either on the day of release or on the day of retrieval. You will take an injection on the day after retrieval and three days following that injection.
When will my follicles be ready?
The amount of time it takes from the start of gonadotropins to the day of release by HCG injection varies among individuals. On average, 10 to 14 days of gonadotropins will be necessary. The retrieval will be scheduled when the follicles reach adequate size. The larger the follicles get, the easier it is to predict the date of retrieval.
What’s the difference between a day three and a day six transfer?
Day six embryo transfers are also known as blastocyst transfers. The theoretical advantage of doing a blastocyst transfer is that it allows the transfer of an embryo that has grown to a more advanced stage.
By putting back fewer embryos at this more advanced stage, the risk of multiple gestations can be reduced. With only a few embryos (about two to four) or in women who are 40 and older, all of the embryos can usually be transferred on day two without a high risk of multiple gestations.
The techniques for “growing” embryos to the blastocyst stage are still very difficult. Currently at Duke, we are only performing day two to three embryo transfers until the techniques for blastocyst are further refined.
When will I know about fertilization results?
You will be called the day after your retrieval with your fertilization results. The results will likely be called between 9 a.m. and 11:30 a.m. Expect to hear something no later than 1 p.m. Please call the clinic after 1 p.m. if you have not heard anything.
Why didn’t we get all of the follicles we expected?
The ultrasound is useful as an estimate of the number of follicles we may get at retrieval. Numbers that are lower than expected may be a result of oocytes that are not detached from the wall of the follicle or oocytes that were not aspirated.
Remember that the oocytes are microscopic, so we can only see the follicle on ultrasound. There are times when we get more than expected, but this tends to be less of a concern.
Do I take Lupron on the day I take HCG?
Yes. Take your Lupron in the morning prior to coming to monitoring clinic. If you will not be coming in to clinic but have instructions to take your HCG in the evening, plan to take the morning dose of Lupron.
Will someone call to let me know how the embryos are doing while we wait for the transfer day?
No. There are no interval updates on the number or quality of embryos. The embryos are sensitive to their environmental conditions and manipulation is kept to a minimum. The doctors in the clinic will not even know the status of the embryos until the day of the transfer.
If you do not have any surviving embryos on the day of transfer you may not be notified until you arrive at our clinic. In some instances an attempt will be made to contact you prior to leaving home on the day of transfer. However, timing may prohibit early notification.
Should I limit my activities?
You will not cause any harm or decrease the success of your cycle by continuing with normal activities and exercise. As your ovaries increase in size, you may experience some discomfort and should limit your activities based on your comfort level.