FAQs on medication & stimulation

Ovulation is a prerequisite for obtaining pregnancy. To accomplish this, a follicle containing the ovum is formed in the first days of the monthly cycle. In some cases, a hormonal stimulation of the ovaries is required because:

• There is a hormonal disorder which prevents ovulation
• A higher pregnancy rate can be obtained when more than one ovum is released in the Ovulation

To this end, either pills (e.g. Clomiphen) or injections (e.g. Puregon, Gonal-F or Menopur resp. Merional) can be used.

In general you need to inject the medication on a daily basis between 9-16 days - according to your individual stimulation protocol. During these days you need to administer 1-2 injections subcutaneously (under the skin), in a few cases it can be 3-4 injections as well. Thanks to the modern injection systems you can easily inject the medication at home by yourself.

The stimulation should be conducted as it is stated on the stimulation plan so that your treatment runs smoothly. In most cases we recommend injection the medication in the evening. Seldomly we issue stimulation plans which require injections in the morning. You will receive training by our qualified nurses on how and when to set the injections.

We understand that the injections are a bit intimidating and a completely new experience for you. Because of this you will receive an injection training by our graduate nurses on the day on which you receive the medication from us.

Our nursing team will show you how to prepare the medication, set the right dosage and finally how to conduct the injection itself. It is no problem that your partner issues the injection if you feel more comfortable that way. Should you not feel ready on the 1st day of the stimulation we can set the first injection at the Kinderwunschzentrum. However it is our aim that the patients can inject themselves as the injection time is usually in the evening.

Here you can see videos presented by our graduate nurse Lisa Pangan who is demonstrating how the injections work.

We kindly ask you to collect the syringes and injection needles in a solid and firmly closed container (e.g. plastic detergent containers). The container can then be handed over to a pharmacy or a collection center for hazardous household wastes.

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Before starting the stimulation an ultrasound should be conducted in the cycle before you start the treatment. During this, the medication you will receive is decided and if required an injection training will be offered by our nursing team.

During the stimulation phase (as soon as the daily injections start) you can expect 2-4 ultrasound appointments during which the size and number of the follicles are measured. Depending on the results you will receive the next appointment. Please understand that for this reason we can only arrange appointments on short notice. Altogether you calculate a time period of approximately 12-14 days from the first stimulation day until the day of the ovum pick-up.

The timing of ultrasound appointments is dependent on your respective treatment. We distinguish between the following types of appointments:

Ultrasound before stimulation
This appointment takes place in the pre-cycle (the month before the actual treatment) between the 5th - 20th day of your cycle. During this appointment we check whether all requirements for the stimulation start are fulfilled and that no disturbing factors (e.g. cysts) are present.

Ultrasounds during the stimulation phase
During the complete stimulation phase you can expect 2-4 ultrasound appointments during which the size and number of the follicles is measured. Depending on the results your next appointment will be scheduled.
Insemination: The first ultrasound takes place according to your individual stimulation plan between the 3rd - 10th day of your cycle.
IVF: The first ultrasound takes place between the 4th - 7th day of stimulation.
Cryo-cycle: The first ultrasound takes place between the 8th - 10th day of your cycle.

Pregnancy ultrasounds
These two ultrasounds take place after a positive pregnancy test. During this appointment we check whether the pregnancy is proceeding as planned. The first pregnancy ultrasound takes place approximately 29 days after the embryo transfer and the second pregnancy ultrasound will be calculated directly by our doctors during the previous appointment.

Nutrition:

• Try to implement a healthy & balanced diet into your daily life. We recommend the intake of vitamins, micronutrients and folic acid (Femibion / Pregnavit).
• It is essential to drink sufficient amounts of fluid (2-3 liters) and to ensure an adequate intake of vegetables, whole wheat products and healthy fats.
• Reduce your daily caffeine consumption! (max. 1-2 cups of coffee or 1 energy drink / coca cola)

Drugs, smoking & alcohol:

• Alcohol has a negative influence on the fertility of women and men. The time until pregnancy occurs is significantly prolonged and the risk of miscarriage increases greatly. This already has an effect with a consumption of one or more alcoholic drinks per day or seven alcoholic drinks per week. It has been shown that alcohol, even in small amounts, can lead to a disturbance of the child's development and to pregnancy complications. We therefore advise you to avoid alcohol during fertility treatment, pregnancy and breastfeeding.

• If you quit smoking it can take months to achieve an improvement in fertility and so our recommendation can only be: the sooner, the better!
• Please also consider the particle pollution in your immediate environment (living space) and ensure that the curtains, carpets, sofas and pillows are cleaned. The negative impacts of passive smoking can be significant.
• Please refrain from using nicotine substitutes such as chewing gum or plasters as these also contain nicotine and can be harmful.

Psych:

• Try different relaxation techniques such as meditation, yoga, Tai Chi or relaxing music.
• Spend quality time with your partner and do things which make you both happy. Give your partner the necessary support and also accept the help and support of others. Remember that at the end of a treatment your relationship should prosper even if you do not achieve pregnancy. Never stop communicating with each other.
• The fertility treatment with its diverse appointments and individual treatment stages can be very demanding. Please do not underestimate this fact and plan enough time for the treatment as well as for relaxation.
• Positive thoughts are helpful. Try to visualize what is happening with your body during treatment: follicles are growing, an oocyte is forming, an embryo is attaching itself to the uterus wall. It is not only about having unrealistic and optimistic ideas und reciting them. It is much more about seeing the chances and possibilities which lead to success.

Generally restrictions in daily life are not necessary during treatment. You can go about your regular activities such as work, sports and hobbies in a moderate form.

The optimum time for the ovulation is determined during the final ultrasound appointment. In order to achieve the final maturation process of the ovocytes a special injection has to take place 34-37 hours (depending on stimulation plan) before the ovum pick-up.

In case you missed the timing of this injection by several hours or even a day: please let us know BEFORE the ovum pick-up (!!!) as it could mean that no ovocytes can be retrieved!

In the 2 days before delivery, ejaculation should occur once again, as this is the only way to ensure optimal semen quality.

Storage in the refridgerator: Elonva, Decapeptyl, Decapeptyl Depot, Gonal-F, Ovitrelle, Pregnyl, Puregon

Storage at room temperature: Arefam, Aprednisolon, Bravelle, Cetrotide, Estrofem, Fostimon, Lovenox, Menopur, Merional, Menopur, Orgalutran, Progedex, Proluton, Thrombo ASS, Utrogestan

Utrogestan / Arefam is administered vaginally. Please insert the medication deep into the vagina. Don't be concerned that the official package insert states to take the medication orally. We made the conscious decision to prescribe the medication for a vaginal application, since you would get really tired when taking the medication orally. It is normal when a part of the medication comes off as vaginal discharge. Please don't be concerned that the official package insert states not to use Utrogestan / Arefam during pregnancy. We see a promising effect for the early pregnancy in prescribing it. Please take the medication until the pregnancy test and - if the test is positive - until the 12th week of pregnancy.