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Reproductive Endocrinology & Infertility
| About Us The Johns Hopkins Fertility Center and IVF Program operates continuously and is structured to meet the patient's needs to start IVF with the menses of her choice. There is not a waiting list to enter the program. To participate in the program, each patient must first schedule an initial consultation with one of the reproductive endocrinology specialists. This consultation will review the patient's fertility, gynecological, medical and surgical history and will include a complete gynecological exam. Based on this information, the doctor will develop a treatment plan that will address the fertility issues that are identified. What You Need To Do Approximately six weeks before your cycle begins, please call one of our financial counselors to make financial and insurance arrangements, and to make sure that, if needed a pre-authorization has been sent to your insurance company. If the pre-authorization is not done, delay of your cycle may occur. For each IVF cycle, you will need to complete and sign the appropriate consent forms. Please verify with the nurses exactly which consent forms you will need for that cycle.If your medications come from a a mail-order pharmacy, you must call at least 2-4 weeks in advance of your cycle (depending on the pharmacy, some pharmacies offer next day delivery). If your medications do not arrive by the start of your cycle, you will need to purchase the medications yourself. Please let one of the nurses know when your supply of medications is running low, so we can order more. Do not wait until you are completely our to get a prescription, especially if it is on a weekend.It is crucial that you be on time for your morning blood work, in order for the physician to receive the lab results early in the afternoon. These results are reviewed and medication dosages are determined daily. Please return all signed consent forms by cycle day 3. What You Can Expect  Blood Test On cycle day 2, you will have blood drawn to determine your FSH and Estradiol levels. If your FSH level is elevated (>10) you will not be able to initiate a cycle that month. A high FSH level indicates a low ovarian reserve, and experience has taught us that patients suffering from this condition do not respond well to the medications. You will be asked to try again the next month, as the FSH level can fluctuate from month to month. Your estradiol level should ideally be less that 40, however, this level is judged in conjunction with the ultrasound and FSH level.Over the course of your cycle you will have many blood tests. All testing is done in the lab in Pavillion I at Johns Hopkins Greenspring Station. If you are taking Lupron, all blood tests are to be done before you receive your injection. (back to top)
(back to top) Lupron Lupron is a drug that decreases the hormones FSH and LH after 5 days. The FSH and LH hormones control the growth of the follicles, and are produced in a gland located in the brain (pituitary). With the introduction of the Lupron, ovulation will not occur before the retrieval of the eggs from the ovaries. Injections of Lupron are administered in the fatty tissue of your abdomen below the navel. A small needle is used for the injection, so not much discomfort is experienced. Our office used two protocols
Progesterone Progesterone is a hormone naturally produced by the remains of the ruptured follicle (corpus luteum). Progesterone helps the lining of your uterus to become thick; therefore, added Progesterone supplementation helps with this function. You will be given written instructions telling you when to begin taking Progesterone. All patients will require supplementation. There are different forms of Progesterone (i.e. capsules, suppositories, and gel). Your physician will decide which type you will use. You will continue taking the progesterone until the results of your pregnancy test are received.
Retrieval
All retrievals are done at the Johns Hopkins Outpatient Center on North Caroline Street. You will be given specific times and instructions on when and where to go prior to this day. For a vaginal ultrasound-guided aspiration, you will be given small doses of neuroleptic analgesia (twilight sleep). Recovery from these drugs for most patients is rapid and generally with minimal nausea. The retrieval begins in the same fashion as a vaginal ultrasound. In the operating room you will be prepped and draped to provide a germ-free environment. The vaginal probe is inserted into your vagina and the eggs are retrieved with a needle that is attached to the probe. Each follicle seen will be aspirated. The follicular fluid will be scanned by the embryologist to identify each egg. Your physician will notify you of the total number of eggs retrieved. Rarely will a laparoscopic retrieval be necessary. Your physician will notify you if this procedure is indicated. Note: Patients are not allowed to drive themselves home after a retrieval so please make arrangements to have someone available. (back to top) Semen Collection Your husband or partner will need to provide a fresh semen sample on the day of surgery, unless other arrangements have been made (i.e. frozen, donor, testicular biopsy, etc.). The time for your husband to report to Andrology will be determined the day before surgery. If you need to make any special requests regarding semen collection, please call the Andrology Lab the day before surgery. Report any of the following symptoms to us:
(back to top) Ultrasounds Ultrasound examinations are done at the Johns Hopkins Greenspring Station office. They are done in the morning between 7:30 and 9:00. During a typical cycle ultrasounds are done on cycle day 2 to make sure that the ovaries do not contain any cysts. On cycle day 9 another ultrasound is done to check your response to the medications, after that they are done periodically to assess follicular development. You will be advised as to when it is necessary for you to have an ultrasound.During an ultrasound, there is no radiation exposure. High frequency sound waves are transmitted through your tissues. A white image is projected on the screen when the waves strike the tissue. Since follicles are round, fluid-filled sacs within the ovaries, they appear as dark circles on the screen. Some follicles contain an egg, which cannot be seen. Other follicles can be empty or contain more than one egg. We will be monitoring the number of follicles you are producing. We will measure the size and count the number of follicles. When they are of appropriate size, you will be given an injection of hCG which will help to further mature them. Surgery for retrieval of the eggs will occur approximately 36 hours after the administration of the hCG. Avoid gas producing foods and carbonated beverages, as they interfere with the ultrasound pictures. Caffeine intake should be kept to a minimum during your IVF cycle.All ultrasounds for follicular monitoring are done transvaginally. This required an empty bladder. You will be placed in an exam room and asked to undress from the waist down. A vaginal probe will be inserted into your vagina. This should not hurt; however, some patients do experience slight discomfort towards the end of a stimulation due to the enlargement of the ovaries. Some transmission gel is used on the probe, so you may experience some discharge after the procedure. If you are allergic to latex, please let the nurse know before your ultrasound. The vaginal probes are covered with latex condoms. Note: For your peace of mind, it is important that you do not compare your estradiol levels with those of other patients. Each patient will experience variations with each cycle. We are looking for a correlation between your blood results and your ultrasounds. A physician will review your results daily and you will be the first to know if there is any problem with the findings. Please remember we are always available for any further questions or concerns and can be contacted at 410-847-3650. (back to top) |
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