IN VITRO FERTILIZATION

(IVF)

IN VITRO FERTILIZATIONSTEPS:

•Suppress the endocrine(hormonal) system•Baseline visit•Stimulate Ovaries + monitoring•Egg Retrieval•Fertilize eggs in laboratory•Embryo Transfer to uterus

IVF Protocols

• Agonist• Antagonist• Microdose Flare• Minimal Stimulation IVF

• With or without birth control pills

Step One: Suppression

• Birth Control Pills for 2-3 weeks, then stop

• Day one of menstrual cycle

• Birth control pills + lupron

• Lupron only

Suppression (cont.)

• Birth Control pills– Begin day one of

period– Take daily, same

time– Skip placebo pills

• Menstrual cycle– Call day 1– Monitoring will be

day 2 or 3– Weekend

instructions

Suppression (cont.)Birth control pills + lupron

• Pills for 2-3 weeks-• Overlap pills + lupron for 2 days• May have vaginal bleeding after starting

lupron• Lupron stops early ovulation, may recruit

more follicles. Given with small subcutaneous shot.

• Continue lupron during stimulation.

1. Wash hands thoroughly.

2. With new bottle, flip off plastic cover. Use alcohol swab; cleanse metal ring and rubber stopper every day, just before use.

3. Remove outer wrapping from one syringe.

4. Pull syringeplunger back until tip is at proper mark.

5. Uncover needle. Do not touch needle.

6. Place bottle on flat surface, push needle through rubber stopper. Push plunger to inject air into bottle.

7. Keep needle in bottle. Lift bottle, turn straight upside down. Check to see that needle tip is in liquid.

8. Pull back plunger until syringe fills to proper mark. Remove bubbles by pushing plunger up slowly. With needle tip still in liquid, pull the plunger until at proper mark.

9. Cleanse injection site with alcohol swab. Stretch skin.Slide needle through skin, into subcutaneous tissue, at 90° angle.

10. Push plunger to inject medication. Withdraw needle.Wipe skin with alcohol swab.

11. Dispose of syringe.

Remember! Use disposable syringe only once

Baseline Visit

• Arrive with a full bladder• Estrogen blood test• Follicular Ultrasound (vaginal)• Trial Transfer (abdominal ultrasound)• Payment• Sign Consent

Monitor your Cycle using thePATIENT PORTAL

• Username and password

• View lab results and medication instructions

• Results are ready by 1PM each day

• Schedule next appointment with front desk

GONAL F and FOLLISTIM:

Used for 9-13 days to stimulate ovaries (grow eggs). Given just under skin with small needles. Potent drugs; so monitoring with ultrasound and blood draws and potential changes in dosing will occur.

FOLLICLES NEAR TRIGGER DAY:

Trigger Shot: Ovidrel or Lupron

Given when eggs mature (several measure about 20 mm in size). Given just under skin with small needle.

IMPORTANT TO TAKE THIS ONE AT EXACTLY CORRECT TIME!

Egg Retrieval

OOCYTE

CONVENTIONAL FERTILIZATION

ICSI FERTILIZATION

Medicines to start Day of RETRIEVAL (Day Zero):

Doxycycline: 1 tablet orally, twice daily, 5 days.Estrace: 1 tablet orally, three times daily*Progesterone: 1mL shot (Intramuscular) same time daily or 1 suppository vaginally 2x daily* Continued until 11 weeks gestation

LUTEAL PHASE SUPPORTINTERMUSCULAR PROGESTERONE:

LUTEAL PHASE SUPPORTINTERMUSCULAR PROGESTERONE:

LUTEAL PHASE SUPPORTINTERMUSCULAR PROGESTERONE:

LUTEAL PHASE SUPPORTINTERMUSCULAR PROGESTERONE:

LUTEAL PHASE SUPPORTINTERMUSCULAR PROGESTERONE:

LUTEAL PHASE SUPPORTINTERMUSCULAR PROGESTERONE:

LUTEAL PHASE SUPPORTINTERMUSCULAR PROGESTERONE:

LUTEAL PHASE SUPPORTINTERMUSCULAR PROGESTERONE:

After the Retrieval

• The day after the retrieval, you will start 1 low dose, 81 mg aspirin daily

• Daily phone calls between 1-3 PM with embryo updates

FERTILIZED OOCYTE

ASSISTED HATCHING:

•A Laboratory Technique That ‘hatches’ an Area In Outer Coating of Embryo (Chemical vs. Laser)•May Improve Implantation•Indications:

Age 38 or greater

Prior Failed IVF CyclesICSI Embryos (Intracytoplasmic Sperm Injection)

Assisted HatchingAssisted Hatching

Pre-ImplantationPre-ImplantationGenetic DiagnosisGenetic Diagnosis

Day 5: Blastocyst

2, 3 or 5 Days after Retrieval:2, 3 or 5 Days after Retrieval:Embryo TransferEmbryo Transfer

Arrive with full or partially full bladder.Bring Valium/Diazepam tablet.Transfer performed, 30 minutes of rest.Low activity for next few days.Bedrest not recommended.Normal activity within 3 days.

Pregnancy Testing

• Approx 2 ½ weeks after trigger (ovidrel or lupron) shot

• Blood test for hCG in our office– With a positive ultrasound 3 weeks later

• Then, off to OB provider– With a negative follow up with physician

• Frozen Embryos