Duration of ovarian stimulation depends on the kind of IVF protocol: long, short or protocol with using antagonists. IVF long protocol is one of the most effective.
With a view to optimize ovarian stimulation, hormonal medicines like Buserelin, Leuprorelin, Triptorelin, Cetrorelix and Ganirelix etc are prescribed nearly in 1 week before the periods. As alternative patients can start to take them on the second day of the cycle. These IVF medicines suppress two hormones which are produced by hypophysis and make ovaries ovulate. Suppressing these two hormones, FSH and LH, eggs block the process of ovulation and production of estradiol. Patient have to take these IVF medicines for nearly 10-15 days. In the end of such a hormonal treatment US of uterus and Blood Count for estradiol level are conducted.
If the results are unsatisfactory, a patient have to take the same IVF medicines for one week more and make US and Blood Count again. Sometimes as a response for such a blockade of ovaries, cysts might appear. In more cases they disappear on their own but if it doesn’t happen a fertility specialist just punctures them.
Controlled suppression of ovaries with IVF long protocol (till the stage when ovaries don’t include follicles more than 15mm in size and level of estradiol in blood is not more than 50 pg/ml) allows a fertility specialist totally control ovarian stimulation and prevent premature luteinization.
Next step of the IVF long protocol is ovarian stimulation with GnRH-agonists. Since their prescription cycle starts. Patient takes the prescribed dozes of agonists during two days till the Blood Count for estradiol. Depending on the results of the tests dozes can change. Then intake of IVF medicines is continued till the 5th day of cycle when blood test for hormones is performed again.
On the 7th day of IVF long protocol US is made. Generally, woman have to pass US and check level of hormones in blood each 1-3 days to control the development of follicles. Majority of women need 8-12 days of ovarian stimulation and 4-6 ultrasonograms and blood counts.
To start intake of HCG (Human Chorionic Gonadotropin) as minimum two follicles with diameter not less than 18mm and corresponding level of estradiol (150-200 pg/ml) are required. A patient is introduced HCG nearly 36 hours before eggs puncture. e.g. If medicine is introduced at 7:00pm on Monday, eggs will be punctured at 7:00am on Wednesday. By taking HCG intake of other gonadotropins is stopped. HCG provokes final stages of ovarian stimulation with IVF long protocol and outlet of the eggs.