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Follicle-stimulating hormone ( FSH )
Once your period has started , this will be considered Day 1 of your treatment plan . At a time determined by your clinic , you will begin self-administering FSH daily via subcutaneous injection ( Figure 7 ) [ 13 ] . This medication encourages the body to produce mature follicles and as many eggs as possible for collection . Although I have administered many injections in my professional capacity , I still found it difficult to get my head around giving myself one ( into the lower abdomen below the belly button , or into the upper thigh ). However , I iced the area prior to injection , ensured the needle was bevel up , and it got easier with each one I administered – much like when I was training to give injections to patients !
Changes to the fertility treatment plan
Sometimes , medication may need to be adjusted during the course of the treatment plan , or the collection of eggs may be brought forward , depending on a person ' s response to the medications . I was required to take medication for a few days longer than originally anticipated , to allow my body to grow more mature follicles . This meant that I administered the trigger injection on Day 13 and not Day 11 as originally forecast . It is also worth noting that ovarian hyperstimulation may mean that you need to take medications after the eggs have been collected ; I had to do so for a week .
Egg collection
On average , 7 – 14 eggs are collected from a woman , although this can vary drastically among individuals [ 2 ] . The collection procedure takes 15 – 30 minutes . I had an intravenous line in my hand , through which my sedation was managed using propofol , and pain relief was provided through fentanyl and an ibuprofen suppository ( administered after the procedure ). In the room with me during the procedure were the operating consultant , anaesthesiologist , two nurses and one of the embryology team . Sedation can feel somewhat overwhelming , even to a veterinary professional , and it reminded me how important it is to create a calm , quiet space for induction procedures for animal patients .
Egg freezing and storage
Figure 7 . FSH injection device [ 13 ] .
Gonadotropin-releasing hormone ( GnRH ) antagonist
After several days ( again , as determined by the clinic ), you will be required to begin injections of an additional medication , a GnRH antagonist . In my case , this was on the sixth day . In an ordinary menstrual cycle , luteinising hormone ( LH ) is released to stimulate the ovulation of an egg . However , in order to collect eggs for freezing , you do not want the eggs to ovulate ; you want all the eggs to remain within the ovary for collection . The GnRH antagonist is required to block the release of LH and thereby prevent ovulation and the escape of eggs into the fallopian tube .
Trigger injection
One subcutaneous self-administered trigger injection will be required exactly 36 hours before the egg collection procedure , which will stimulate the final maturation of the oocytes . The optimal time for the trigger injection will be determined by intravaginal ultrasound scans , during which the number of follicles and their size can be determined and measured .
Once the eggs have been collected , recovery from the sedative usually takes 1 – 2 hours , after which someone can take you home . The embryology team will examine the eggs to determine which ones are mature , or viable . The viable and semi-viable eggs will then be frozen , for you to use whenever you wish . The first year of storage is free , after which there is a yearly charge – which I will need to pay if I want my eggs to stay in their ice hotel .
Work-related legislation
The Advisory , Conciliation and Arbitration Service ( ACAS ) [ 14 ] states : “ There ' s no legal right for time off work for IVF treatment or related sickness . But your employer should treat your IVF appointments and any sickness the same as any other medical appointment or sickness .”
However , time off can be difficult to navigate when going through fertility treatment , as it is subject to change . You are beholden to your period , the timing of ultrasound scans , the duration of the treatment and the date of the egg collection .
As ACAS [ 14 ] refers to the appointments being treated as medical appointments , the policy for sickness and time off should be included in an employee ' s contract . However , the Equality and Human Rights Commission
Volume 39 ( 1 ) • February 2024
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