At the beginning of each cycle, a screening ultrasound is done to check for ovarian cysts. This ultrasound needs to be done on day 2 or 3 of your suppression cycle (Lupron). If no cysts are found, you will continue the medication and have another ultrasound day 28. At your ultrasound on day 28 of Lupron the stimulation cycle will be explained to you. You will be given a schedule/diary to help track your progress.

Serial ultrasounds are done to confirm egg development and measure growth of the follicles. These are usually done on days 7, 9 and 11 of your cycle; but, timing is individualized based on the growth rate of your follicles. As you reach the end of a stimulation cycle (day 11), the timing becomes critical and often is not negotiable.

When four or more ovarian follicles have reached maturity based on ultrasound measurements, your blood will be drawn for two tests:

--Estrogen (a mature follicle produces 100-300 peakograms or more)

--LH (rises to signal the ovary to release eggs)

and a "trigger" shot of HCG is given. HCG mimics the natural LH surge and signals the ovaries to release the eggs in 38 hours. If both blood tests are in the appropriate range, surgery is scheduled approximately 36 hours after the HCG "trigger" is given. 

The timing of the laparoscopy is critical to insure that the eggs have not been spontaneously released from the ovaries before they can be surgically retrieved. After the eggs are aspirated from the ovaries, they are transferred to a special laboratory in the operating room for examination to assess maturity and quality. Four or five of the best eggs are selected, mixed with specially prepared sperm (washed to separate the semen), and transferred into one fallopian tube. The transfer catheter is removed, the laparoscopy incisions are repaired, and the procedure is complete. After about one hour in the recovery room, you will be able to go home.

Progesterone injections need to be started twelve hours after surgery. Instructions for the progesterone injections and surgery itself will be reviewed the day you are "triggered."

The chance of achieving a pregnancy in any one natural cycle with intercourse is 20%-30% therefore, it should be realized that more than one attempt at LTT may be needed to achieve a pregnancy.

If you have any questions, please call us. We want you to understand what is expected so you are comfortable with your treatment plan.