Dr. Springer has a saying, “all IVF begins on day 3”. By this he means that in order to get the maximum stimulation (and thus the maximum number of quality eggs), the stimulatory phase of an IVF cycle must begin on the third day of the menstrual cycle. This can present a problem, however, in order to allow for time to clean the lab, maintain quality control and give some “down time” for personnel, the IVF lab is only “up” for about 2 to 3 weeks out of every month, which limits our start dates to about 7 days each month. Obviously, everybody’s day 3 is not going to fall in the right ”window” to match those 7 days, and worse, in women whose cycles are not perfectly regular, we can’t even reliably calculate the start of their next menstrual cycle.

Fortunately, there is a simple way to alleviate this problem. By having our patients start birth control pills on or near day three of any menstrual cycle, we are able to “hold” them at this stage for as long as needed. When the timing is perfect for them to enter a stimulation cycle, we simply have them stop their pills on the appropriate date.

There is a special group of patients, those with polycystic ovarian syndrome or those who respond very vigorously to stimulation, in whom we need to arrive at day 3 in a slightly different way. To minimize the chance of hyper stimulation and improve egg quality, we not only put these patients on birth control pills, we also add a medication called Lupron. Lupron is given by injection on a daily basis usually starting 10 days before the anticipated start of stimulation.