By this stage, you and your doctor have already considered the possibilities and mapped out a treatment plan specially tailored to your individual needs to give you the best chance of achieving a healthy pregnancy.

Once you are ready to start, we wait for 'day one' which is the first day of your period. At this time, you need to contact the nurse.

The nurse will then provide you with instructions based on the plan your doctor has specified for you.  You can read more about the process here.

At Fertility Associates, work as a team. Each Fertility Associates location is under the supervision of a Medical Director who is responsible for the important decisions, supported by a team of highly trained and skilled specialist doctors, fertility nurses and embryologists. That means that there will be a number of doctors, nurses and embryologists that you will meet during your care.

Next, we stimulate your ovaries to produce eggs with a course of FSH (follicle stimulating hormones).

• Injections of FSH encourage the development of multiple small cysts within the ovary (follicles), each housing an egg. As the follicles grow, the egg within should develop too. Once they're large enough, a final stage of egg development is 'triggered' with a separate injection.
• We individually tailor FSH doses to predict your expected response. and aim to stimulate between 6-12 eggs for retrieval. An AMH (anti mullerian hormone) blood test is used in conjunction with your age to formulate this dose. On average, 10-11 days worth of FSH injections are required.
• The most common form of FSH medication we use is Gonal-F. Other types include Puregon. Elonva and Menopur.
• Additional injections (Cetrotide, Orgalutran, Lucrin, or Buserelin) are used to prevent premature release of the eggs.
• The most common medications used for the 'trigger' injection are Ovidrel and Buserelin.
• Blood tests and scans will be required during stimulation until you are ready for egg collection. You can get your blood tests done at these locations.

If too many eggs are stimulated there is a risk of illness and in rare cases Ovarian Hyperstimulation Syndrome (OHSS).

If we have concerns about OHSS, we have several preventative strategies to reduce the risk of it occurring. One of these is to not replace the embryo immediately.

This is termed a 'freeze-all' cycle.  See more about freeze-all here.

The embryo can usually be replaced the following month, allowing time for the ovaries to normalise. It is important to note that a 'freeze-all' cycle does not reduce your overall chances of achieving pregnancy. We are aware that a further wait to replace an embryo is frustrating, and we only use a freeze-all cycle when deemed necessary for safety.

Your nurse will provide your egg collection appointment time.

This is time critical and has been arranged to align with your 'trigger' injection - it is very important that you arrive on time and do not postpone or move this appointment.

You'll be given pain relief and mild sedation, then an ultrasound will be placed inside the vagina and a needle gently inserted into each ovary so we can extract the fluid in the follicles - hopefully along with the egg.

If a fresh embryo is to be replaced, progesterone is started after egg collection. This comes in the form of 'pessaries', or small tablets that are placed into the vagina, which will be taken up to the time of your pregnancy test. If you have a positive test, the medication is often continued - our nurses can provide additional instructions at this point.

You're welcome to bring your partner or a support person into the procedure room with you. Once you are fully recovered (usually 2-3 hours later) you can head home.

• In some situations, it's difficult to accurately predict an individual's response to a drug. Some people respond poorly to the medication, resulting in under-response. This means that we might obtain fewer eggs than predicted but this does not necessarily mean a lower chance of success as the best quality eggs tend to grow first.  Additionally, while we try to obtain an egg from every follicule, this is not always possible - in some cases the egg may be immature, of poor quality, or difficult to retrieve.
• Following egg collection, bleeding may occur from the vagina which in a majority of cases can be stopped by simple pressure using a swab. Occasionally 'bruising’ of the ovaries may occur, for which simple pain relief (Panadol) may be required for the next 24-48 hours. Other injuries are very rare.
• There is more information about egg collection here.

Sperm is required on the same day as your egg collection. We usually time this within 1 hour of the egg collection procedure.

A sperm analysis takes place prior to treatment commencing, to assess male fertility and determine which treatments are technically appropriate.

There is more information about giving your sample here.

There are two possible ways in which fertilisation can occur:

• IVF: If the semen sample provided is of suitable quality, sperm will be placed in a petri dish with your eggs and left to fertilise.
• ICSI: If the sperm are not of suitable quality or quantity, individual sperm will be selected under a microscope and injected into the eggs.

The lab staff will then carefully monitor your embryos in the incubator for the next 2-6 days. Unfortunately, not all eggs will fertilise. Some may be immature or of suboptimal quality.

We will replace the embryo into the uterus at some point between days two to five of development, depending on the quality and quantity available.

The embryo will be replaced into the uterus through the vagina in most cases, using ultrasound guidance and an embryo catheter.

The procedure is very quick and in most cases people can go back to daily activities. You will be asked to drink 1-2 glasses of water one hour before your procedure.

If more than one good quality embryo is available on day 5 or day 6 of development, they will be frozen and may be replaced at a later date. It is always our aim to have embryos available to freeze. but in more than 50% of cycles this is not possible. We will almost always only replace one embryo.

Some cycles will require all embryos to be frozen with a thawed embryo replaced at a later date.  This is known as a freeze-all, as discussed above.

Approximately 14 days after egg collection we will perform a blood pregnancy test (serum hCG measurement). Our nurses will contact you 7 to 14 days after egg collection to see how you are feeling.

The wait for pregnancy test results can be stressful - we recommend that you create a support network of friends and family to help you through this time. Fertility Associates have counsellors available - please contact your clinic reception if you would like to arrange an appointment. You can also find some support through our wellness space, which helps you develop coping strategies and ways to boost resilience as you go through your treatment programme.

Keep eating well, get some mild exercise and plenty of sleep, and look after yourself.

Our team will provide more information on proceeding with the pregnancy, and we'll carry out a pregnancy scan at your post-lVF review (approximately 4-6 weeks after egg collection).

Unfortunately, some patients who become pregnant will suffer a miscarriage. When this occurs, it is nearly always due to a problem with the embryo (please remember, it's extremely uncommon for the miscarriage to be caused by an issue with the uterus or the woman herself).  If the initial pregnancy blood test (hCG) is very low and then falls, this is called a biochemical pregnancy. While uncommon, ectopic pregnancy can also occur following IVF treatment.

If any of these issues occur, Fertility Associates will guide you through this difficult time. You might also find You can also find some support through our wellness space useful.

We'll talk through your options at your post-lVF review appointment (approximately 4-6 weeks after egg collection). and help you plan the next steps.

Some people feel that they need to take a break and take it easy for a month or two before trying again, others are keen to get right back into it. Talk to your doctor about your options.

IVF treatment involves many complex variables, and in all treatment cycles we do our very best to account for and control these variables. While rare, unexpected events can occur. These include failure to retrieve eggs at egg collection; failure of the eggs to fertilise and therefore not having an embryo to replace. If this occurs we will endeavour to get in touch urgently to discuss.