Ovarian Follicle Development
Women are born with more than 1,000,000 immature eggs. When puberty is reached and menstruation begins, only about 400,000 follicles remain. Every month women lose around 1,000 eggs during their menstrual cycle. By the age of 35, there are approximately 25 000 remaining eggs in the ovaries and this number continues to decline rapidly. The egg production stops at the time of menopause.
At the beginning of every menstrual cycle, multiple eggs start to mature due to the elevated FSH (follicle-stimulating hormone) levels. The most dominant egg is then picked up and released from the ovaries. Usually, an egg reaches 18-22mm in diameter before being released. The maturation of more than one egg per month happens very rarely.
With IVF in Cyprus, your ovaries will be stimulated to produce multiple eggs. The mature eggs will be then retrieved using ultrasound-guided aspiration. Egg retrieval is a painless and relatively short procedure that is performed at our North Cyprus IVF clinic.
Ovarian stimulation is the second step of the IVF process following fertility testing. During this time, fertility drugs in the form of shots are taken to stimulate the ovaries to produce multiple eggs. The goal is to collect as many mature, good-quality eggs as possible for fertilization. Having more eggs increases the chances of fertilization, implantation and pregnancy success.
Prior to ovarian stimulation, you will undergo extensive fertility testing. Testing includes blood tests to measure the levels of hormones in your body as well as ultrasound to scan the ovaries for any abnormality. This step allows our euroCARE IVF doctor to recommend a treatment plan that’s suited only to you.
IVF Medication Protocol
Before we determine what medication protocol is right for you, we will require you to undergo extensive fertility testing. Only after all required testing is done, we will determine your treatment protocol. Every patient is different and some women may be recommended one type of fertility drugs while others may need other medications. The dosage of medication is different for each woman and depends on the patient’s age and test results.
What Are IVF Injections?
An IVF ‘cycle’ refers to a round of IVF treatment that starts on the second or third day of your menstrual period. You will start taking injections as prescribed in your medication protocol. The dosage of injections varies from patient to patient. Our euroCARE IVF doctor decides on the medication protocol depending on the maternal age, ovarian reserve (egg supply) and fertility test results.
Types of IVF injections
- Birth control pills
These medications help to regulate the menstrual cycle in women and prepare the reproductive system for ovarian stimulation. Birth control pills contain hormones and are used to suppress the natural cycle in some patients undergoing IVF treatment in Cyprus.
These fertility drugs contain a hormone called follicle stimulating hormone (FSH) that is normally produced by the pituitary gland which is located at the base of the brain. FSH stimulates the ovaries to produce eggs. FSH works best when given by injection. These injections are given subcutaneously (underneath the skin) using a very thin/short needle. The ovarian stimulation normally takes 9 to 10 days to complete although this may be subject to change as the egg development is not the same for every patient. The dosage of the IVF injections and the length of the ovarian stimulation phase will depend on your personalized medication protocol.
Some injectable fertility drugs contain a combination of FSH and LH (luteinizing hormone). LH is another pituitary hormone that helps the maturation of the eggs in the ovaries and regulates the egg release at ovulation.
hCG (Human chorionic gonadotropin) is a hormone produced during pregnancy. This hormone is measured by a test called a beta hCG test to determine if a woman is pregnant. In IVF, hCG is used to trigger ovulation. A final injection of hCG is used during the stimulation phase to trigger ovulation and egg release.
Post Transfer Supplementation
Progesterone is naturally produced by the ovaries in the second half of the menstrual cycle when the egg is released from the ovaries. Progesterone prepares the uterine lining for implantation of transferred embryos. In IVF, post transfer supplementation is used to maintain progesterone hormone levels. If an embryo attaches to the wall of the uterus, the ovaries will produce progesterone until eight weeks into the pregnancy. After that time, progesterone will be produced by the placenta until the end of the pregnancy. Some patients will be recommended to take post transfer supplements in the first few weeks after the embryo transfer to help with the implantation.
When Do You Start IVF Injections?
In IVF treatments, the chances of success are higher if you produce more good-quality eggs. Normally, patients start to take hormone injections on the second day of the IVF cycle as indicated in their stimulation protocol. This is when the ovarian stimulation phase begins. Ovarian stimulation involves taking IVF injections for 10-12 days, to stimulate the ovaries to produce multiple good-quality eggs. The stimulation process depends on the growth of the follicles/eggs.
On day five of the cycle, you will be monitored via blood tests and ultrasound to see how your ovaries are responding to the IVF injections. Starting with day five of the stimulation phase, every two days until egg retrieval you will have an ultrasound scan.
Depending on the results of the ultrasound, it will be decided whether you will continue the stimulation of your ovaries or you are ready for the final hCG injection. If the follicles are large enough, you will have an hCG injection (also known as trigger shot), which will trigger the final maturation of eggs.
What Do IVF Injections Do?
The IVF injections contain Follicle-stimulating hormone (FSH) and Luteinizing hormones (LH) have the following effects:
- FSH is one of the hormones involved in egg production during a menstrual cycle. By maintaining higher levels of FSH in the body, your ovaries are able to produce more eggs.
- LH is another hormone that facilitates egg production and regulates ovulation. When combined with hCG (Human chorionic gonadotropin), LH initiates ovulation. After the administration of hCG injection (trigger shot), you can move to the next step – egg retrieval.
What To Expect With IVF Injections?
IVF injections are prescribed by our euroCARE IVF doctor. During the ovarian stimulation phase, you’ll likely be self-administering a combination of multiple injections. Once you start taking hormone injections to stimulate your ovaries, you’ll need regular blood tests or ultrasound scan to measure the levels of hormones in the body. At this point, an adjustment to the medication protocol may be done as every woman responds to IVF injections differently. Depending on the test/scan results, the medication dosages may be altered to ensure enough eggs are developed, and to prevent ovarian hyperstimulation syndrome (OHSS) from happening. In addition to hormone tests, you will have an ultrasound to monitor the growth of the follicles.
You will be in constant communication with our medical team.
How To Give IVF Injections?
IVF involves injections, which you self-administer on a daily base at home. They are given just under the skin (subcutaneously), into the fatty tissue that lies between your skin and the muscle underneath, typically in the thigh or abdomen.
At first, it may seem difficult to self-administer injections at home, but our nursing team will show you exactly how to do it. We can also instruct your partner or a relative if they want to be involved in the process. You’ll receive full instructions about the dosage and time to inject the medications.
If you need help during the stimulation phase, you can contact our medical team anytime on +90 533 885 42 22 or +44 203 389 7633 (UK Patients). We are here to give you support every step of the way.
How To Make IVF Injections Less Painful?
- Choose an area that has a little extra fat. If your stomach is very lean, try injecting into your thighs. If your thighs are small, try giving the injection into your stomach.
- Try deep breathing and relaxation exercises right before the injection.
- Try rotating your injection site if you experience pain or bruising.
- Pinch up the area where you’ll insert the needle to separate it from the muscle below.
- Carefully squeeze your flesh between your fingers to distract from the pinch of the needle.
- Lightly poke the needle around the area to find a spot that’s less sensitive.
- Use a cold pack on the skin to numb the area prior to the injection.
- Consider heat. Some prefer applying a heating pad to the injection site for about 10 minutes before giving yourself an injection.
- Try different needles. Finer gauge needles within the range 25 to 27 are generally more comfortable.
- Wait for the alcohol to dry completely before inserting the needle.
- Try distraction! Use the tv, music, or a magazine to draw focus away from the injection.
- Practice makes perfect. Our clinic will walk you through this in detail and will provide you with tutorial videos. Over time you will become a pro in giving yourself IVF shots.
What To Eat During IVF Injections?
If you are trying to conceive through IVF, it is important that you follow a healthy, well-balanced diet to ensure that no further obstacles come in your way.
- Consume fresh fruits and vegetables.
- Incorporate more foods rich in zinc in your diet. These include dairy products, grains, potatoes, and nuts, along with certain meat items rich in zinc.
- Choose lean proteins. It is recommendable to consume at least 60g of it on a daily basis. Poultry, fish, and eggs are great sources of proteins, so are legumes and nuts of different varieties.
- Consume healthy carbohydrates for various activities throughout the day. Eat whole grains, like quinoa, farro, and whole-grain pasta.
- Eat foods rich in folic acid. These include peas, spinach, broccoli, kiwi, poultry products, tofu.
- Include more legumes, such as beans, chickpeas, and lentils.
- Eat healthy fats, such as avocado, extra-virgin olive oil, flaxseed oil, nuts, and seeds.
- Avoid red meat, refined sugar, foods containing artificial sweeteners, refined grains, and processed foods.
- Cut out salt. Use herbs and spices instead.
- Avoid alcohol.
- Cut out caffeine. Drink coffee and tea in limited amounts. Reduce or avoid consuming other beverages that contain caffeine.
- Drink plenty of water.
Incorporating diverse foods in your diet will ensure you get all the necessary nutrients and there are no obstacles on your way to reaching success through IVF. Having a healthy diet will ensure your results of the procedure are the best that you can get.
Can I Drink Alcohol During IVF Stimulation?
Egg and sperm maturation takes up to 3 months, so it is best to reduce or eliminate alcohol for at least three months before trying to conceive. You should avoid drinking alcohol while undergoing IVF. Alcohol has been proven to dramatically reduce the chances of pregnancy success. It can also be detrimental to the baby’s health during pregnancy because it may cause numerous birth defects to the child.
Can You Exercise While Taking IVF Injections?
Many people immediately assume that exercise is good. But, that my not be the case when it comes to IVF. Patients undergoing IVF should be careful what type of exercise they perform during their cycle. Some mild to moderate exercises may be beneficial, so it is highly recommendable to modify or reduce the amount of exercise you do during IVF. Generally, you should follow these guidelines:
- Work within your own comfort zone
- Avoid strenuous activities such as aerobics, running, weight lifting and other cardiovascular activities
- Avoid exercising during certain stages of IVF (before egg retrieval and after embryo transfer)
- Exercise for a shorter time (for example, 30 minutes) no more than four times per week
- Focus on moderate exercises such as walking, light stretching, Tai Chi, water exercises, etc.
Along with light exercising, you can try some relaxation techniques such as massage, meditation, yoga, or even acupuncture to help you maintain an optimal state of your body, both physically and mentally.
Traveling With IVF Injections
Traveling while taking IVF injections shouldn’t be as challenging as you may think. Here are a few tips you can follow to make your IVF cycle as much stress-free as possible:
- Create a medication plan
- Take all prescribed medications with you
- Obtain a note from our euroCARE IVF specialist
- Take an ice pack with you if it soothes your pain
- Learn about the rules of the airline company for traveling with medications
- Keep all your meds in a separate bag, preferably in a carry-on bag or small cabin luggage
- Keep in touch with our support team in case you need advice or help regarding your medications
Your Fertility Treatment At euroCARE IVF
Not every woman finds the IVF injections painful. Pain is a subjective experience and the level of discomfort varies from one person to another.
We understand that managing IVF injections may seem difficult at first but over time you will become a pro. Whether you decide to take the shots by yourself or to delegate the task to your partner or someone close to you, contact our medical team at euroCARE IVF to get useful tips on how to manage the shots and get the best possible result. Getting informed about the IVF process and the stimulation phase, in particular, can prepare you mentally for what’s to come and will make the whole experience easier.