1. What’s meant by Day 1?
Day 1 of your menstrual cycle is the first day of full flow period. If this happens after 5pm, then the Day 1 is conventionally the next day.
2. Can we have sexual intercourse during treatment?
Yes, but protected intercourse from Day 1 of that cycle. This is because during your treatment, you will be taking medications which may increase the risk of miscarriage if taken in early pregnancy.
3. Can I exercise?
Yes, gentle exercise is actually recommended as it favours the release of endorphins which reduce stress levels. It is also indicated if you need to keep your Body Mass Index below 30. Regular exercise also helps maintain regular bowel movements.
4. My GP has recommended the flu vaccination. Is this safe?
Yes, we recommend that you have the vaccination if it was offered to you. The current flu vaccine does not pose any higher risk in pregnancy and will protect you against Swine Flu. It may be taken at any point in your treatment. Swine flu has been shown to have high mortality rates in pregnancy.
5. How long will the down-regulation last?
Down-regulation lasts for an average of two and a half to four and a half weeks (before the next phase of your treatment). Sometimes patients need to stay longer on down-regulation due to lack of response. The duration of down-regulation does not affect the treatment outcome. It is important to remember that the ‘down-regulation’ medication must be continued throughout the stimulation phase until the ‘trigger’ injection (Ovitrelle or Pregnyl).
6. Is it normal to bleed during down-regulation?
You are likely to bleed whilst on the medication. This bleeding is similar to a period if you started on D21. If you started the down regulation on D2 of your cycle, you may not have a further bleed or it may just be light spotting.
7. What is the best time to take my medication?
We currently advise you to take your medications between 6pm and 8pm, with the exception of Cetrotide, which you should take as instructed. The ‘down-regulation’ should be given as instructed.
8. I forgot to take my medication – what should I do?
Please take it as soon as you remember. It is unlikely that a delay up to 10 hours will cause any problem. If the delay is longer, please take the medication and let the Nurse know at the time of your Scan.
If you have forgotten to take the hCG (Ovitrelle or Pregnyl) injection or you have had a problem with the injection and have not been able to administer it, please ring the out of hours number (if it is before 10pm). If this occurs after 10pm, please continue with your ‘down-regulation’ medication and ring the clinic the following morning.
This may well affect the timing of your egg collection.
If you have forgotten to take a dose of the Crinone gel, please take it as soon as you remember. Have the next dose as normal.
9. I don’t remember the dose of Gonal F that has been recommended to me. Can you advise me?
If you have not started treatment yet, it is better not to start at all but to ring the clinic the next day – once we have reviewed your notes, we will be able to advise you on the correct dose of this medication. A day’s delay in starting treatment does not cause any problem, whereas taking an inappropriately high dose could lead to the recruitment of an excessive number of follicles, putting you at risk of ovarian hyperstimulation.
If you are already on Gonal F, and you are unsure if the dose of the medication was changed after your scan, please ring the Clinic for advice. If it is out of hours (after 10pm) we suggest you continue on the same dose you had the day before, and ring the clinic the following morning for further advice.
10. Is it safe for me to take other medications whilst in treatment?
Yes, you have to take any medication that has been prescribed to you by your doctor. However we recommend that you inform your doctor that you are under treatment here and therefore that you might be pregnant, or may be in the near future. In this way, your doctor will be able to prescribe you medicines that are safe in pregnancy.
11. I feel bloated whilst taking Gonal F? Is this normal or am I at risk of OHSS?
Almost every patient complains of bloating during treatment. This is caused by the increasing levels of estrogen (female hormone) in your circulation, which may make your bowels sluggish.
OHSS is triggered by hCG and will not occur before the egg collection.
If you are at risk of developing OHSS after egg collection, the nursing or medical staff at the Clinic will discuss this with you in more detail.
12. I am constipated. What can I do?
Constipation is a very common complaint during IVF treatment and in early pregnancy. We recommend simple measures such as an increase in exercise, in fluid intake and fibre (fruit and vegetables). If this does not have any effect, you may try some Senna tablets before egg collection, and Lactulose solution after the procedure. This should be beneficial.
If, despite all the above, constipation is still a problem, please inform the nursing staff at the Clinic.
13. Can I fly after embryo transfer?
Yes, there is no documented evidence of any risk for the potential mother or fetus.
For long haul flights we recommend the normal precautions to prevent risks of Deep Vein Thrombosis (DVT), such as keeping well hydrated and exercising your legs from time to time.
If your risk of DVT is higher than normal (for example, if you have had DVT in the past), please see your GP before you travel. Your GP may recommend the use of knee high TED stockings to try and prevent a recurrence.
14.There is no needle with my pre-filled pen?
The Gonal F needle can be used on the Ovitrelle pen.
15. I have lost some of the medication trying to prime the pen or the syringe?
For Gonal F – the new pens do not require priming.
For Ovitrelle – it will happen only if you try to remove the air bubble, which you are not supposed to do. Losing a few drops is unlikely to affect your treatment; however losing more will affect the maturity of some of your eggs and therefore we would recommend that you do not take the injection at all, but ring the Clinic the next morning for advice.
16. I sneezed after taking the nasal spray.
If you sneezed within 5 minutes, please take another full dose (one or two sniffs, depending on the stage of treatment you are in). If more than 5 minutes have elapsed before the sneeze, the medication will be already in your circulation.
17. Can my partner be with me for my egg collection?
Your partner is not permitted to go into theatre/procedure room with you for the egg collection, but we do encourage them to accompany you when you have your embryo transfer.
18. I have had my egg collection. I am in a lot of pain.
It is common to experience some abdominal pain up to 3 days after egg collection. We recommend using a mild pain-relief medication like paracetamol (at the normal dose), and placing a warm water bottle on your tummy to alleviate the symptoms. If, however, the pain persists in spite of these simple measures, please contact the Clinic for advice.
If the pain worsens and you need further advice out of hours (after 10pm) you may wish to attend your local A+E Department.
19. I am bleeding after egg collection.
Some light period-like bleeding immediately after egg-collection is normal and usually, this settles down promptly. However, if the bleeding is brisk and heavy, please return to the Clinic or, out of hours (after 10pm) please attend your local hospital/ A + E department without any delay.
20. I am using Crinone gel. I have a bloodstained discharge and I am passing clumps of white/brown material.
This is normal. There is no need for concern. Please continue with the Crinone as this is important to support the lining of your womb.
21. I have started to bleed – either before my pregnancy test, or after my pregnancy test but before my Day 35 viability scan. What does this mean?
If the bleeding is lighter than a menstrual period, this may be of no concern, and you should continue with the luteal support medication (either Crinone gel or Cyclogest pessaries) as before. If the bleeding is as heavy as a menstrual period, this may be a sign that the treatment has failed and that either your pregnancy test or your viability scan will be negative. However, even with heavy bleeding, it is still possible that a pregnancy could sometimes continue normally. You should, therefore, try to stay positive, continue with the luteal support medication, and await the outcome of your pregnancy test or viability scan. It is advisable that with heavy bleeding you should rest as much as possible, but please remember that nothing you do may alter the natural course of events. Please call the Clinic the following morning to inform one of our nurse co-ordinators.
Here’s some more information on specific aspects of fertility and fertility treatment.
- Female Fertility, Age and the Menopause
- The Menstrual Cycle, Hormones and Fertility Treatment
- Top Ten Tips for Improving Fertility
- How Do Fertility Drugs Work?
We believe that the following organisations may be useful for you, although we’re not responsible for the quality of information or service(s) provided.
The Human Fertilisation and Embryology Authority (HFEA) is the UK’s independent regulator, overseeing safe and appropriate practice in fertility treatment and embryo research. This body licenses and monitors all IVF centres in the UK, and provides a range of detailed information for patients, professionals and the government.
The National Institute for Health & Clinical Excellence (NICE) provides guidance on the health technologies, medicines, treatments and procedures available from the NHS.
This charity raises funds to invest in medical research, and in the professional development of doctors and nurses specialising in reproductive and gynaecological health.
Aspire offers practical support to the 40,000 people in the UK living with a spinal cord injury, allowing them to lead fulfilled and independent lives.
This organisation provides information and support to women who have gone through an early menopause (before the age of 45).
This charity – called Unique – offers information and support to families affected by any rare chromosome disorder.
This is a charity for women whose lives are affected by polycystic ovary syndrome.
This charity supports people who use assisted conception as a means to establish a family.
This organisation provides information and practical support to anyone affected by infertility.
This is an online community with free message boards and chat rooms for people experiencing infertility, and for those needing support in parenting after infertility and adoption.
This organisation offers a support service to those who remain involuntarily childless.
This association offers support and information to people suffering the effects of pregnancy loss.
This event focuses on same-sex parenting, co-parenting and surrogacy.
Based in Cambridge, this informal and friendly group provides an opportunity to meet other lesbian/bisexual parents/partners and those considering parenthood.
This organisation offers support and guidance in relation to all lesbian and gay parenting issues.
The Multiple Births Foundation works to improve the care and support of multiple birth families.
The Twins and Multiple Births Association (Tamba) provides information and support to families of twins, triplets and more.
This organisation supports and informs anyone with an interest in surrogacy within the UK.
Childlessness Overcome Through Surrogacy (COTS) provides support and advice to surrogates and intended parents.
This American company has outreach offices in the UK and elsewhere. Its services help people through the process of surrogacy, egg donation, sperm donation or co-parenting arrangements.
Gamete and Embryo Donation
The National Gamete Donation Trust (NGDT) is a charity that aims to raise awareness of the shortage of gamete (sperm, egg and embryo) donors, and to find ways to alleviate the shortage.
This is a self-help network of families created with the help of donated sperm, eggs or embryos. It also supports adults conceived using a donor, and those contemplating or undergoing treatment.
This is a voluntary information exchange and contact register.
Macmillan Cancer Support works on behalf of people affected by cancer, raising awareness as well as funds for research, and lobbying for change wherever it’s needed.
Part of Cancer Research UK, CancerHelp UK provides patients and their families with a free, comprehensive information service about cancer and cancer care.
National Health Service Groups/Units
This charity provides self-help information, advice, support and training on all aspects of adoption.
The British Association for Adoption & Fostering (BAAF) co-ordinates adoption agencies, publishes information guides and runs the ‘Be My Parent’ service. The aim is to bring children and permanent families together.
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