Maturing the eggs

You may undergo additional ultrasound examinations or blood tests over the next few days to determine when the eggs are ready to be fertilised. When the largest follicles reach a diameter of 18 mm or more, the lining in your uterus is thickening well and your oestradiol levels are still rising, the time to collect your eggs is getting close.

Before eggs and sperm can finally meet, the eggs have to be matured and for this you have an injection of human chorionic gonadotrophin (hCG), which acts like luteinising hormone to prompt maturation of the eggs. The injection is scheduled between 34 and 37 hours before the planned egg collection. The timing of the injection usually works out to be late in the evening two days before your eggs are due to be collected.

The nurse tells you the exact time for your injection and is sure to carry on a bit about the importance of sticking to this schedule — for a good reason:

1 Receive your dose of hCG too late and your eggs won't get enough exposure to it, so they may not be perfectly mature when they're collected.

1 Receive your dose of hCG too early and, even worse, the eggs may not be available when the doctor tries to collect them, because hCG also triggers ovulation after the eggs are mature.

Understanding what can go wrong with stimulation

No-one can predict exactly how you (or any woman) may respond to the fertility drugs you're given on your first IVF cycle. For most women the response is sufficient to proceed to the next hurdle — egg collection. But in 10 to 15 per cent of cases, treatment in the first cycle may end with stimulation because either not enough or too many follicles are seen on ultrasound, or the oestradiol level isn't quite right (see the section 'Stimulating your ovaries' earlier in the chapter).

i If very few follicles are evident, the chance of getting eggs is low, so your doctor may suggest cancelling the cycle and trying again with a higher dose of drugs.

1 If more than 20 follicles are seen, you may be at risk of ovarian hyperstimulation syndrome (OHSS). (I explain the nasty nature of this extreme response to the drugs in Chapter 10.) If your doctor thinks that continuing the cycle is too risky, he or she may advise you not to go ahead with egg collection and start a new cycle with a lower dose of drugs.

In addition, sometimes problems are unearthed when you have the ultrasound examination. For example:

1 The signs may indicate that the best time for egg collection has passed.

1 You may have a cyst on your ovary, which can mess up your hormone levels. Your doctor will talk to you about what that means in terms of future treatment, but these cysts are generally harmless and disappear with time. You may be asked to have an ultrasound and/or hormone tests before trying again.

Collecting the Eggs

If you respond well to the stimulating part of the IVF cycle, you're over the first hurdle! The next step is egg collection, which is a relatively simple and quick procedure.

The nurse tells you what time you need to arrive for admission, when your surgery is scheduled and when you can expect to be discharged. You must fast before surgery — that is, have nothing to eat or drink — starting the night before admission. And you must show up without make-up and nail polish — very unglamorous.

Even though egg collection doesn't take long, don't plan to do anything else on the day you have the surgery because you may not be up for it.

You can't drive in the 24 hours after the egg collection because the anaesthetic can affect your coordination, so arrange for someone to take you home.

Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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