Fertility treatment FAQs

Here are some answers to the most common fertility treatment concerns, to put your mind at rest.

During treatment

Day one of your menstrual cycle is the first day of full flow period. If this happens after 5pm, then day one will be the next day.

Yes, but you should have protected intercourse from day one of that cycle. This is because you will be taking medication that may increase the risk of miscarriage if taken in early pregnancy.

Yes, gentle exercise is recommended as it helps to release endorphins, which reduce stress levels.

It’s also good for you if you’re overweight, especially if you have a Body Mass Index (BMI) above 30. What’s more, regular exercise helps maintain regular bowel movements.

Yes, there is no documented evidence of any risk for the potential mother or foetus. For long-haul flights, take the normal precautions to prevent the risk 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), speak to your GP before you travel.

Down-regulation

Around 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, but the duration of down-regulation does not affect the treatment outcome.

It’s important to remember that the down-regulation medication must be continued throughout the stimulation phase until the trigger injection (Ovitrelle or Pregnyl).

Yes, you are likely to bleed while taking the medication. This bleeding is similar to a period if you started on day 21.

 

If you started the down regulation on day two of your cycle, you might not have a further bleed, or it may just be light spotting.

Medication queries

Yes, we recommend that you have the vaccination if it has been offered to you, and it may be taken at any point in your treatment.

 

The current flu vaccine does not pose any higher risk in pregnancy and will protect you against swine flu, which has been shown to have high mortality rates in pregnancy.

Take it between 6pm-8pm, with the exception of Cetrotide, which you should take as instructed.

 

The ‘down-regulation’ should be given as instructed.

You need to take it as soon as you remember. It is unlikely that a delay of up to 10 hours will cause any problems, but if the delay is longer, 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 if you have not been able to administer it, please ring the out of hours number (before 10pm). If it occurs after 10pm, continue with your down-regulation medication and ring the clinic the following morning. This may 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, then have the next dose as normal.

If you haven’t started treatment yet, it’s best not to take the medication and to ring the clinic the next day. Once we have reviewed your notes, we’ll be able to advise you on the correct dose. A day’s delay in starting treatment does not cause any problems, whereas taking an inappropriately high dose could lead to an excessive number of follicles being produced, putting you at risk of ovarian hyperstimulation.
If you are already on Gonal F and you’re unsure whether your dose was changed after your scan, ring the clinic for advice. If it is out of hours (after 10pm or on a Sunday) continue on the same dose you had the day before, and ring the clinic the following morning.

Yes, you should take any medication that has been prescribed by your doctor. However, we recommend that you inform your GP that you are having treatment here and, therefore, that you might be pregnant – or may be in the near future – so he will be able to prescribe you medicines that are safe in pregnancy.

 

The Gonal F needle can be used on the Ovitrelle pen.

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.

If you sneezed within five minutes, take another full dose (one or two sniffs, depending on the stage of treatment you are in). If more than five minutes have elapsed before the sneeze, don’t worry – the medication will be already in your circulation.

Side effects

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 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.

This is very common during IVF treatment and in early pregnancy. We recommend simple measures such as increasing your exercise levels, fluid intake and fibre intake (such as fruit and vegetables).

 

If this doesn’t help, you could try taking some senna tablets before egg collection, and lactulose solution after the procedure. If it’s still a problem, tell the nursing staff at the clinic.

Egg collection

Your partner is not permitted to go into the theatre/procedure room with you for the egg collection, but we do encourage them to accompany you when you have your embryo transfer.

It is common to experience some abdominal pain up to three 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, contact the clinic for advice. If the pain worsens and you need further advice out of hours (after 10pm or on a Sunday), go to your local A&E department.

Some light period-like bleeding immediately after egg-collection is normal and usually settles down promptly.

 

However, if the bleeding is brisk and heavy, return to the clinic or, if it’s out of hours (after 10pm or on a Sunday) go straight to your local A&E department.

Bleeding/discharge

If you are using the vaginal gel preparation of natural progesterone (Crinone), then it’s most likely to be some of the Crinone gel residue. This is normal, as the gel has been designed to turn solid after 20-30 minutes.
The residue of inactive gel may look almost like wet tissue paper, but it can be any colour including white, brown, black or slightly blood stained. The vast majority of women will only pass tiny bits of the gel residue from time to time, but very occasionally it may build up inside the vagina.
At some point it may come out all at once, looking like a large piece of tissue. Don’t worry – the amount of residue can be kept to a minimum by going for a short walk each time you apply the gel.

This is completely normal. Continue with the Crinone, as this is important to support the lining of your uterus.

If the bleeding is lighter than a menstrual period, it may be of no concern – just continue with the luteal support medication (either Crinone gel or Cyclogest pessaries). If the bleeding is as heavy as a menstrual period, it may be a sign 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 continue normally. 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 will alter the natural course of events. Call the clinic to inform one of our nurse co-ordinators.