The reassuring part is that most IVF medication schedules follow the same basic shape. Once you understand what each medicine is for, the calendar starts to make sense, and the small decisions along the way feel far less daunting.

Key points

• • Most IVF cycles move through four medication stages: stimulate, protect, trigger and support.
  • Stimulation injections usually run for about 8 to 12 days, with blood tests and scans every few days.
  • The trigger injection is timed to the hour, usually around 34 to 36 hours before egg collection.
  • Many IVF medicines are subsidised through a dedicated PBS program, prescribed by your fertility specialist.

What are the stages of an IVF medication schedule?

Your clinic will write your exact protocol, and no two are identical. Doses depend on your age, your hormone levels and how your body has responded before. But nearly every stimulated IVF cycle moves through the same four stages.

First, medicines that encourage your ovaries to grow several eggs at once. Second, a medicine that stops you ovulating before the eggs can be collected. Third, a single trigger injection that finishes maturing the eggs. Fourth, hormone support that prepares the lining of your uterus for an embryo. Knowing which stage you are in makes every instruction from your clinic easier to follow.

What happens in the first week of injections?

In many protocols, injections start on day 2 or 3 of your period. The main medicine is follicle stimulating hormone, or FSH. Your body already makes this hormone every month to grow a follicle, the small fluid filled sac that holds an egg. In IVF, a higher dose encourages several follicles to grow at the same time. Some protocols add a second hormone called LH to support that growth.

These are small injections under the skin, usually given in the evening. Every few days you will have a blood test and an ultrasound so your clinic can see how the follicles are developing. Your dose may go up or down based on those results, sometimes with only a day's notice. Keep your phone nearby on monitoring days, and write every dose change on your calendar as soon as the clinic calls.

Why am I adding a second injection partway through?

Around day 5 or 6 of stimulation, many people start a second daily injection. This is usually a GnRH antagonist. It blocks your body's natural surge of LH, the signal that normally tells your ovaries to release an egg. Without it, your eggs could be released on their own before the clinic has a chance to collect them.

Some clinics use a different approach, often called a long protocol, where a similar blocking medicine is started before stimulation begins. Either way, a few days with two injections each evening is completely normal. It is a sign the cycle is on track, not that something has changed.

How precise does the trigger injection need to be?

Very precise. When your follicles reach the right size, your clinic will tell you to give a trigger injection at an exact time, down to the minute. This medicine completes the final maturing of the eggs, and egg collection is booked around it, usually about 34 to 36 hours later.

Set two alarms, and have your trigger dose checked and ready well before the time. If you give it late, give the wrong dose, or are unsure whether it went in properly, call your clinic straight away rather than guessing. Most clinics have an after hours number for exactly this reason.

After collection, call your clinic urgently if you notice severe abdominal pain or bloating, nausea or vomiting, shortness of breath, rapid weight gain, or you are passing much less urine than usual. These can be signs of ovarian hyperstimulation syndrome, an overreaction to the stimulation medicines that needs prompt review.

What medicines come after egg collection?

Once your eggs are collected, the focus moves to your uterus. Most people start progesterone, the hormone that thickens and maintains the lining so an embryo can implant. It is commonly given as a vaginal pessary or gel, and sometimes as an injection. It usually starts around the time of collection and continues until your pregnancy test, and often for several weeks after a positive result.

Never stop progesterone early unless your clinic tells you to, even if you are worried the cycle has not worked. Frozen embryo transfer cycles look different again. Some use oestrogen tablets followed by progesterone, while others follow your natural cycle with very little medicine at all.

Are IVF medicines covered by the PBS?

Many are. IVF medicines are subsidised through a dedicated PBS program, and only fertility specialists working with an accredited IVF clinic can prescribe them. You pay the standard PBS copayment for each item, and those payments count towards your PBS Safety Net.

Some medicines in your protocol may not be covered, so ask your clinic for a list of what you will need and roughly what each item will cost before your cycle starts. It is far easier to plan for than to discover at the pharmacy counter.

How Ace can help

IVF schedules change at short notice, and several of these medicines need to be kept between 2°C and 8°C. Ace dispenses fertility medicines with cold chain packaging and coordinates delivery around your cycle, so a dose change does not turn into a scramble. Our pharmacists can also talk you through your calendar before your first injection. Get started with Ace.

References

Better Health Channel. Assisted reproductive technology: IVF and ICSI.

Pharmaceutical Benefits Scheme. Section 100 IVF medicines factsheet.

healthdirect. Infertility.

Your Fertility. yourfertility.org.au.

This article is for general information only and does not constitute medical advice. Always follow the medication schedule provided by your fertility clinic.