Your Treatment Cycle Timeline – EF Long Protocol with BCP

This is a general guide that will take you through what to expect during your upcoming treatment cycle. Please note that your personalized treatment cycle and timeline will depend on how your body responds throughout your cycle. According to your protocol, your treatment cycle will take approximately 6-8 weeks. Please note that monitoring appointments will be scheduled between 7:00 a.m. and 9:00 a.m. during your treatment cycle. This ensures that there is enough time to process your tests within our lab so that your doctor can review your test results and provide you with same-day instructions.

1) Reporting Your Day 1

Your Day 1 is considered the first day of full flow (not spotting) of your period. When you are ready to report your Day 1, please email the Day 1 Team at day1@triofertility.com with the following information:

• Your Full Name (as it appears on your Health Card)
• Your Date of Birth
• The Date of Your Day 1
• Your TRIO Physician
• Your Treatment Type (Egg Freezing)
• Your Monitoring Location (Downtown, Thornhill, North York)
• Any days you will be unavailable to come to the clinic

Please note: TRIO requires all patients and applicable partners to have up-to-date infectious diseases bloodwork on file in order to proceed with treatment. Up-to-date means within one year.

2) Receiving Your Initial Appointment Details

Within 48 hours of reporting your Day 1, you will receive an email from the Day 1 Team,\ which will include your:

• Appointment Details for Initial Tests on Day 2-5 of your cycle
• App Instructions
• Electronic Consent Form Instructions

Please Note: Consent forms must be completed and returned to TRIO prior to your Assessment Day in order for your cycle to start

3) Attending Your Initial Appointment

When you arrive at TRIO for your scheduled appointment time, you will sign in for your tests and to speak with your nurse.

After your appointment, please visit the pharmacy to pick up your medication.

Please check your iMineIVF app after 2:15 pm on the day of your appointment, as it will be updated with instructions for taking medication (if required) and when to return to the clinic for further monitoring.

4) Recording BMI & BP Measurements

Please be advised that due to The College of Physicians & Surgeons of Ontario Out of Hospital safety policies, TRIO cannot perform egg or sperm retrievals with conscious sedation on any person with a Body Mass Index (BMI) greater than 40.

At your Initial Appointment, you will meet with your nurse to record the following measurements:

• Weight
• Height
• Blood Pressure

If your BMI is greater than 40, please discuss this with your physician prior to starting treatment.

5) Starting Pre-Treatment Medication

If the results of your Day 2-5 tests are within the normal range and your Engaged MD videos have been watched, then you will be starting birth control pills for approximately 1-3 weeks.
You may experience some bleeding while on the birth control pill. Please note that this is normal, and you do not need to report this bleed.

Just before you have finished taking the birth control pill, you will be instructed to start GnRH Agonist injections (such as Suprefact or Decapeptyl) for approximately 2 weeks before returning to the clinic for your Assessment Day. The birth control pill will continue for approximately 5 days after injections begin.

6) Receiving Your Personalized Treatment Calendar

While you are taking pre-treatment medication, you will receive the following from our scheduling coordinator:

• Your Personalized Treatment Calendar with specific details about your cycle
• Invoice (if applicable)
• Next Steps (including your Assessment Day details)

Please note that it may take up to 11 days to receive this information via email and the iMineIVF app.

7) Assessment Day

Your Assessment Day appointment includes both a full bladder abdominal ultrasound and a transvaginal ultrasound. You will also sign up to see your nurse to review your ultrasound results and see how your cycle is progressing.

Please note that your invoice (if applicable) will be due in full on your Assessment Day in order to proceed with your treatment cycle.

After your appointment, please visit the pharmacy to pick up your stimulation medication.

If your Assessment Day test results are within the normal range, you will receive an update on your app after 2:15 pm with instructions for starting your stimulation medication.

8) Starting Stimulation Medication

You will be taking the stimulation injections for approximately 8-13 days depending on how your body responds to the medications.

9) Monitoring Appointments

While taking stimulation injections, you will return to the clinic for bloodwork and transvaginal ultrasounds between 4-6 times until you are ready for trigger medication. The nurses will be providing you with instructions regarding your specific dosing and follow up monitoring appointments.

10) Taking Your Trigger Medication

When you are ready for your egg retrieval, your nurse will advise you to pick up your trigger medication from the pharmacy. You will take this medication at a specific time, which will be 35-36 hours prior to your egg retrieval. At this time, you will also receive detailed instructions about this procedure.

11) Returning for Bloodwork

The day after you are triggered, you will return to the clinic for one final bloodwork appointment and to speak with your nurse. If your results are within the expected range, your egg retrieval procedure will take place the following day. An egg retrieval is also known as an Ovum Pick-up or OPU.

12) Egg Retrieval Day

During the egg retrieval, you will be given medications that can cause drowsiness and it would not be safe for you to drive. Please ensure you have someone to take you home after the procedure and to stay with you for the rest of the day.

13) Post-Egg Retrieval

After your egg retrieval, the OR nurses will assist you to the Recovery Room.

Before you leave, the nurse will provide you with detailed discharge instructions, including the administration of post-egg retrieval medication.

14) Receiving Lab Updates

The day after your OPU, you will receive a call from your TRIO nurse to tell you the number of retrieved eggs that were mature, frozen, and stored.

15) Next Steps

Once your cycle is complete, you will need to arrange a follow-up appointment with your TRIO physician to discuss your results and next steps.

Example Egg Freezing Treatment Cycle

Please note that this calendar is intended for example purposes only. Your personalized treatment cycle and timeline will depend on how your body responds throughout your cycle.