You will be asked to contact the clinic on day one of your period – this is how you start your IVF cycle. If your period starts in the morning, then that is your day one. If it starts in the afternoon, then the next day is your day one. You should call the clinic before 2pm on your day one – leave a message for the nurses if the phones are busy and they’ll get back to you.

Once we receive the day one call, we double-check a number of things, including the doctor’s plan for your IVF cycle; check that screening tests are up-to-date; as well as the key dates for your treatment.

We will then provide you with a summary that covers:

• dates for starting medications, first blood test and first scan, and the likely week of egg collection
• a cost estimate based on the doctor’s plan
• information on payment options
• the consent process. This must be completed before we can begin, and before medications are issued. You are able to change your consent later, if you need to.

Your doctor writes an individualised management plan for each IVF cycle which includes the types and doses of each medication; whether or not ICSI is required; the planned number of embryos that will be transferred; the stage at which embryos will be transferred; as well as any other special instructions.

We will give you a cost estimate based on your doctor’s plan when you start your IVF cycle. You are invoiced in three stages:

• medications and monitoring when you first pick up your medication
• when we confirm your egg collection time - for egg collection and embryology
• when we confirm your transfer time - for embryo transfer.

Our ‘Treatment costs and payment options’ web page has more information, and you can call us with questions at any time.

You will have a ‘drug teach’ session with a nurse who will explain to you all about the medications and how to take them. Many of the medications we use must be kept cool, so it’s very important to pay particular attention to the storage instructions – the nurses will advise you on how to store them properly.

Generally, you will be issued with a sufficient quantity of medication up until your next blood test or scan – we do it this way try to minimise the cost as medications cannot be returned once they are issued to patients.

When medications are taken daily – usually in the evening – it is important to take these at the same time each day. We use the Salve app to remind you when to take your medications.

Sometimes you may have some ‘breakthrough bleeding’ if you are on a stimulation regimen using the contraceptive pill. This will not affect your response to the medications used later on to stimulate the ovaries. Bleeding is also common with Gonal F, Puregon or Menopur.

We will give you containers to store any used needles and syringes. You can bring them back to the clinic for disposal at the time of egg collection. Please ensure that you lock the container before returning it, to prevent injuries to our team.

Once you start medications, we will advise you when to have your first blood test and when your first scan will be. We use the results of your blood tests and scans to tell how your follicles are growing and, later on, when to time your egg collection. We might amend the doses of medication, depending on the results.

The blood tests we ask you to have are a bit different from other blood tests – we have special arrangements to make sure that we get the results in time for making decisions each day. This is why we ask you to have your tests done before 9am each day while in treatment.

Ultrasound scans are usually done between 8am – 9am, although we can sometimes arrange times later in the morning. The scan involves an ultrasound probe placed in the vagina. An empty bladder is best for us to get the best possible view of your ovaries and the follicles growing there.

Find out where to get your bloods done here.

Each day that you have a blood test or a scan, we will get back to you with an instruction on what to do next. A team of doctors, nurses and embryologists meets to review results around lunchtime to make decisions and then we inform you, generally through the Salve app. Look out for the afternoon messages - usually before 4pm (2pm on weekends) - they contain important instructions that could be regarding medication changes, or time to trigger ovulation. Please contact the clinic if you have not heard from us by 4.30pm (2pm on weekends).

We need to be able to contact you once you start a GnRH agonist (such as Decapeptyl or Lucrin) or a GnRH antagonist (such as Cetrotide or Orgalutran) and you must keep taking it every day until your hCG trigger injection.

If you are not available between 2pm and 4.30pm we need to know how we can reach you or leave a confidential message for you.

If only one or two follicles develop, or if the hormone levels from the blood tests are low, it may be better to stop and try again later using more medications. Occasionally treatment may be stopped for too great a response to the medications. If you have a low response during a publicly-funded cycle, we will make the decision whether to stop and whether we can offer you another publicly-funded cycle.

We will always discuss options with you before any decision is made. Although it is very disappointing to have to stop treatment, you will benefit from what has been learned for future treatment.

The final maturation of the eggs is induced by a trigger injection of the hormone hCG. This is given 36 hours before egg collection is planned, usually betwwwn8pm and midnight. We can tell you the time for your egg collection when we arrange the time for your trigger injection. We will give you some specific information before egg collection, such as:

• the trigger injection instructions;
• preparing for the egg collection.

We ask you to arrive at the clinic 30 to 45 minutes before egg collection is planned. We encourage you to bring a support person, such as your partner or a friend. You will also need to arrange childcare to cover the duration of the egg collection and any recovery time afterwards – the clinic’s treatment and recovery areas are not suitable for children. You will probably be at the clinic for about two to three hours.

Guidance for egg collection:

• do not have anything to eat for six hours before egg collection is scheduled and do not have anything to drink for two hours beforehand
• have a shower before you arrive and do not wear any deodorants or perfumes, as eggs, sperm and embryos are very sensitive
• you are not able to drive or use machinery for 24 hours following egg collection. The analgesic medications used during egg collection affect your ability to drive safely, so you will need to arrange transport home.
• someone must take you home and be with you for 24 hours following the procedure.

Some bleeding from the vagina is common after egg collection. If bleeding is heavy, or lasts longer than a day, contact the clinic. Cramping is normal in the first few hours after egg collection. We recommend taking Panadol every four hours and you can use Panadeine (paracetamol and codeine) if you need more relief. Contact us if this is not enough for your pain.

Egg collection is usually performed under a light narcotic analgesia. You will be awake, although you may not remember much about the procedure afterwards. Some women only feel a mild discomfort, whilst others feel a bit more pain. Women who anticipate or have experienced painful egg collection may want to consider using heavier sedation. This involves us arranging an anaesthetist who will charge a separate fee. Public funding may cover extra sedation if there is a medical reason for it.

To be fully briefed, you should also be aware of the other risks and side-effects around IVF.

Hormone support

Following egg collection, the nurse will talk to you about taking progesterone as vaginal pessaries or gel over the following two weeks to maintain the lining of the uterus. They might be called Utrogestan or Crinone, and are likely to cause a slight discharge. Tell us if you suffer any irritation from these.

You will be given some fact sheets about looking after yourself following the egg collection, and possibly also about hormone support and Ovarian Hyper-stimulation Syndrome (OHSS), if applicable.

Sperm quality is best if the sample is collected within 30 minutes of giving it to the embryology staff. At the time of the egg collection, it is preferable for you to provide the sample at the clinic – we have rooms available at each clinic for this. However you can produce the sample at home if required – talk to our nurses about this. Please tell us where you are going to be during the day in case we need to contact you about the quality of your sample.

Good to know:

• we advise one to two days of abstinence to optimise the number and quality of sperm. Periods of abstinence longer than this can be detrimental because of the accumulation of aged sperm
• shower before you come to the clinic or before you produce your sample at home and ensure your genitals and hands are very clean. We need to ensure that the sample remains uncontaminated
• do not wear any deodorants or perfumes, as eggs, sperm and embryos are very sensitive
• do not use lubricants when producing your sample, as even small amounts can be toxic to sperm.

If you are concerned that you may not be able to produce a sample on the day, we may be able to freeze a back-up sample. This needs to be done well in advance so we can see how the sperm survives freezing and thawing. There is a separate charge for sperm freezing unless it is done for medical reasons as part of publicly-funded treatment. There is also a consent process for freezing sperm and using frozen sperm.

Although your doctor will have specified in the management plan whether to use conventional IVF or ICSI, sometime sperm quality on the day of egg collection is different than expected. The embryologist may then suggest ICSI to give the best chance of fertilisation. The consent form covers this possibility and reminds you that if we need to do ICSI on the day then an ICSI fee will be charged. We will only do ICSI on the day if you have consented for us to do this and we will try to contact you beforehand.

At the time of egg collection the embryologist will arrange a time for you to find out how many eggs have fertilised and, sometimes, to confirm a time for embryo transfer. Embryo transfer may be done between days three to five after egg collection, depending on the number and quality of the embryos.

You need to come to the clinic 15-30 minutes before the embryo transfer is scheduled. It is helpful if you drink enough beforehand to come with a full bladder – this can help make the transfer easier, as we use ultrasound to help place the embryos. The transfer itself is usually painless, very seldom needs any medications, and usually takes about 15 minutes. This is a special time for most people and you will probably want to have your partner or a support person with you. You may even be able to see a photograph of your embryo.

Afterwards you can continue your normal activities – the embryos will not drop out! You can have sex if you want to – it won’t harm the embryo. Try to avoid hot baths, saunas or excessive heat, though.

Sometimes your doctor will recommend freezing all suitable embryos rather than having a fresh embryo transfer – this is commonly known as a ‘freeze-all’.

Freeze-all is recommended when the lining of the uterus may not be optimal for the embryo to implant in the fresh IVF cycle, or when the risk of OHSS would be increased if you became pregnant in the fresh IVF cycle. The overall chance of having a child from your IVF cycle is not reduced with freeze-all, it just means that your first transfer is delayed. A thawed embryo cycle can often start immediately after your IVF cycle.

Sometimes women have some bleeding before their pregnancy test is due – this does not mean that you are not going to be pregnant. Keep taking all medication as advised until the nursing staff tell you to stop.

Most people say that waiting to see whether they are pregnant is the most stressful part of treatment. If you are feeling stressed, perhaps make an appointment to speak to one of our counsellors who can help you with some extra support at this time.

Take it easy on yourself – take some time out to do things that will make you feel good and spend time with people who support you. You can also find some really helpful resources in our patient Wellness space.