Cycle Preparation - What to expect before your IVF Cycle?

The cycle preparation phase starts 2 to 4 weeks before you start your IVF cycle. In this phase, your body is prepared for your treatment. Your doctor may recommend some medications. This phase may also involve a few tests and appointments.

First, let's talk about the tests.

Tests for the female partner

SIS: Prior to the IVF process, Saline Infusion Sonohysterography (SIS) allows your doctor to determine the shape and depth of your uterine cavity and identify any abnormalities of the uterus that might affect chances of conception or pregnancy.

Ovarian reserve testing: Ovarian reserve tests are performed to gain a better understanding of your remaining egg supply and how your ovaries will respond to stimulation medications. There are many ovarian reserve tests available, and since none of the tests are perfect, many clinicians run more than one test and cross-reference the results. Some doctors use a transvaginal ultrasound to measure and count the antral follicles, which are small follicles (about 2-9 mm in diameter). Measuring hormones is another approach that clinicians often use. Some perform blood tests that measure anti-Müllerian hormone (AMH), while others measure follicle-stimulating hormone (FSH). FSH is also known as day-three FSH because it’s typically tested on the third day of the menstrual cycle.

Baseline ultrasound: Around day three of your IVF cycle, you may receive a transvaginal ultrasound scan to examine your ovaries. This test is used to ensure that your ovaries are not currently producing eggs and that there are no cysts or other issues that may interfere with your cycle. If a cyst is detected, your treatment may not continue until any cysts resolve on their own (usually in about a week). If your baseline ultrasound is normal, you will begin the next phase of your cycle: stimulation.

Tests for the male partner

Sometimes, the male partner is asked to go for a semen analysis right before the IVF starts, even if an earlier test has been done. This is just to ensure that sperm quality and counts have not changed.

Tests for both

In many cases, you and your partner may receive tests for HIV, hepatitis B and C, chlamydia, or any other infectious disease.

What about the medications?

Depending on your IVF protocol and your fertility history, your doctor may want you to take one or more of the following medications.

Birth control pills

Even though it may seem counter-intuitive, many patients receive oral contraceptives or birth control pills (BCPs) prior to the start of their IVF cycle. While BCPs prevent pregnancies, they also provide some benefits when taken before a fertility treatment. BCPs decrease the chance of developing ovarian cysts, which can disrupt or delay the treatment cycle. They are also very helpful in regulating irregular menstrual cycles, which helps the timing of the rest of the IVF cycle. The other benefit of BCPs is that they help optimize the chances of uniform follicle growth.

Estrogen & progesterone

Depending on your IVF protocol, you may be asked to take estrogen supplements, which can be in the form of oral tablets, vaginal suppositories or even patches that are applied directly to the abdomen where the estrogen is absorbed through the skin. Some patients may also be required to start taking progesterone or other hormones during this phase.

Suppression medications

Suppression medications may also be prescribed during this phase to ensure that you do not ovulate too early. There are multiple types of such medications. The first type is called GnRH agonist, and most of them are known by the name Lupron. These daily injections typically begin about seven days before a woman’s expected period. This medication has the effect of stopping natural ovulation, but not menstruation, to put the doctors in control of the course of egg development and prevent unexpected ovulation. The second type of suppression medication is the GnRH antagonist which is prescribed in the next phase of IVF after stimulation has started.

Moving forward

The goal of all the tests and treatments described here are to prepare you for your IVF cycle. A comprehensive cycle preparation will give you the best chances at a successful IVF experience.

Acknowledgement: a big thanks to Stefan Halisky for proofreading.