Dear
You have now had an ultrasound scan and are ready to start your hormone treatment with FSH.
FSH: (follicle stimulating hormone)
You must start your stimulation treatment with FSH, which stimulates growth of the follicles in your ovaries.
_______________________________, __________ IE, from the _________ to the __________
_______________________________, __________ IE, from the _________ to the __________
You must take the medicine as an injection into the stomach, every evening around 10 p.m.
Ovulation inhibitor: (Antagonist)
To prevent a spontaneous ovulation signal from the pituitary gland in the brain, you must take the ovulation inhibitor injection:
__ Ganirelix 0.25 mg (pre-mixed syringe), from the __________ to the __________
You will take the medicine, as an injection into the stomach, every morning (before 8 am) at __________
the time-point is fixed and must not deviate by more than +/- 5 minutes.
You must attend a new scan:
__________ day on the _________, at __________
The course of treatment:
How the medicine works: With the hormone treatment, we imitate the natural hormones in the female cycle. The purpose of stimulation is to mature a suitable number of follicles (preferably 8-10) in the ovaries. To mature more than one egg, the amount of FSH is increased compared to the natural level, whereby more follicles will be stimulated to reach the ovulatory stage. By maturing several eggs, we increase the chances of obtaining a good egg for transfer back into the uterus.
You will be scanned a few times during your stimulation period for us to follow the development of your ovarian follicles.
As the follicles grow, they produce the hormone estrogen. Estrogen stimulates and helps building up the mucous membrane layer in the uterus and prepare the uterus to receive a fertilized egg.
Estrogen also affects the pituitary gland in the brain. When estrogen levels become high enough it triggers the ovulation signal, LH, from the pituitary gland. To block this signal, it is important that you take the ovulation inhibitor syringe in the latter part of the stimulation period. With spontaneous ovulation, we will not be able to retrieve your eggs.
When the follicles have the right size, we will plan when you should take the ovulation trigger syringe. This is usually between stimulation day 8 and 12.
Egg retrieval is performed 1 ½ days after the ovulation trigger injection and the eggs are fertilized with sperm later that day.
Post-treatment with the hormone progesterone (the pregnancy hormone) begins two days after your egg retrieval.
If you end up having an egg transferred back, the progesterone treatment must continue for a total of 14 days until the pregnancy blood test is taken.
Side effects: The most common side effects are discomfort at the injection site, headache, bloating and heaviness. Other side effects may be nausea, diarrhea, constipation, weight gain, breast tenderness and acne. However, most women do not experience any strong discomfort during their stimulation period.
Prescriptions:
At the beginning of your treatment, the doctor will provide you with a medication package for your entire treatment course.
Only buy the medicine you have planned with the nurse.
The package contains:
FSH, ovulation inhibitor, ovulation trigger syringe, Progesterone
Other: ______________________________
If you need new prescriptions, you must talk with the doctor.
On rare occasions, it may be necessary to terminate or change your treatment. This can be due to that none of your eggs have developed as expected or if too many eggs are retrieved, so that you are at risk of being overstimulated. This may also become relevant if one of you become ill with a high fever during the course.
Fish oil: If you take fish oil, it is important that you take a break while you are in treatment. Fish oil has a blood-thinning effect, which can increase the risk of severe bleeding during egg retrieval.
Aids: Fertility medicines are eligible for aids on an equal basis with other medicines.
‘Danmark’: Provides support for medicine for fertility treatment.
Medical passport: When traveling in Europe, a medical passport is not necessary. The medicine is carried as hand luggage. If you travel outside Europe, you can obtain documentation from the secretaries for the needles.
Leftovers of medication: This can be handed in at the pharmacy.
Useseful websites and apps:
www.medicininstruktion.dk
On this website you will find instructions on how to inject yourself.
Under ‘Behandlingsområder’ choose ‘Fertilitet’ and you will find help for:
Bemfola, Fyremadel, Gonal-f, Menopur, Ovitrelle, Pergoveris and Rekovelle (Ganirelix, Gonapeptyl has the same instruction as Fyremadel).
MinLæge and MinSundhed: (App) Here you are always able to see which active prescriptions you have. It is recommended to check this before you leave the department. If you need new prescriptions, you must talk to the doctor.
Apoteket (App) Here you can choose your preferred pharmacy and then you can check if that pharmacy has the medicine in stock that you need. You can also find a medication reminder where you can type your type of medication and the time and then set an alarm for this.
If you have any questions, you are always welcome to contact us.
With best regards
The Fertility Department, Rigshospitalet