Superovulation with Gonadotropins
A commonly used treatment for infertility involves the use of fertility medications to stimulate the ovaries to develop multiple eggs. There are two distinct therapies – ovulation induction and superovulation.
- Ovulation induction: This is used for women who do not ovulate on their own. The goal is to induce the development of 1-2 follicles (the cysts that contain an egg)
- Superovulation: This is designed for women who already ovulate on their own. The goal is to stimulate the development of 2-3 follicles.
The protocol is similar for each technique.
Superovulation protocol
On the first day of your menstrual cycle (the first day of full flow bleeding, call the office. Don’t worry if it is a Saturday, Sunday or holiday. If we are not in the office, the answering service will answer and page one of us.
You will be scheduled to come in on the 2nd or 3rd day of bleeding for a baseline blood test and transvaginal ultrasound.
If everything looks o.k. on the blood and ultrasound, you will be instructed to begin your medication. The first medication you will take will be either Gonal F or Follistim (depending on your insurance). You will take the medication each evening for four or five nights. You will then return to the office to have another blood test and ultrasound.
Depending on your response to the medication, there are a few different possibilities for what might happen at this point in the superovulation protocol:
You may be instructed to continue on the same dose of medication and return to the office in another 2-3 days
We may increase or decrease the dose of your medication
We may have you start a second medication called Cetrotide or Ganirelix and continue the initial medication.
It is possible that you will return top the office for this type of monitoring a few more times. Although, it is not typical to bring you back on a daily basis, this is a possibility for some patients.
Once we have determined that the follicles (and therefore the eggs inside) have matured appropriately, you will stop all the medications you have taken to that point. On that night, for one night only you will take a different medication called the “hCG Trigger Injection“
Intercourse and Insemination
You will be instructed to have intercourse on the night you take the hCG trigger injection (there may be some exceptions to this). The next night, we will ask you to abstain from intercourse.
Two days after the hCG trigger has been administered, you will be asked to have intercourse again or if you are doing an intrauterine insemination (IUI), it will be scheduled for that day. The interval between the hCG trigger and the intrauterine insemination (IUI) will be 36 to 44 hours.
Progesterone supplementation
After the IUI, you will start taking progesterone supplementation vaginally. Depending on your insurance, this will either be a vaginal progesterone cream called Crinone or vaginal disintegrating tablets called Endometrin. Crinone is taken once or twice each day (morning and evening). Endometrin can be taken one to three times each day.
About one week later, you will be scheduled to return to the office for a blood test to check your progesterone levels. (See Progesterone Testing in Infertility) If your progesterone levels are low, you will be instructed to take progesterone injections intramuscularly, in addition to the vaginal progesterone.
Testing for pregnancy
One week later, you will be scheduled for a blood test to determine if you are pregnant. This must be a blood test performed in our office.
Don’t assume that if you have started spotting or bleeding that it means you are not pregnant. Vaginal bleeding is commonly associated with the use of fertility medications. You must come for the pregnancy test in the office.
Please don’t attempt to use a home pregnancy test to determine if you are pregnant. Home tests may give you a false positive due to the hCG in your system from the hCG trigger injection. You may also get a false negative if you are pregnant since the home tests are not as sensitive as the blood test we do in the office.
If you are pregnant, you will be instructed to stay on the progesterone and come to the office for further monitoring.
