About UWH
Summary of IVF treatments, medications and procedures
Before egg (oocyte) retrieval:
1) Physician consultation will take
place before any treatment is begun.
2) You must meet with the financial counselor to evaluate any insurance
that may apply. Financial obligation must be met before the consultation
with the IVF nurse.
3) Please schedule a Uterine Mapping Procedure.
4) If you need instructions on administering fertility medication, please view the injection training videos from Freedom Fertility Pharmacy. If you need more instruction on how to give an injection, you may attend a class. Fee for the class is $100.
5) During the month before you use IVF fertility drugs, you will follow one of the three regimens described below. These regimens quiet the hormonal messages that the pituitary gland ordinarily sends to the ovaries.
If you are following protocol 1 or 2, you must have a blood test on cycle day 2 of your menstrual period to measure your estrogen levels. You must also have an ultrasound. Results of these tests must be forwarded to the Fertility Center on the day they are performed. Once the IVF nurse has received your test results, she will tell you whether it is all right to begin your fertility drugs.
All fertility drugs used in this process contain either FSH (follicle
stimulating hormone) alone or FSH plus LH (luteinizing hormone).
PROTOCOL
- Gonadotropin releasing hormone analogue (GnRHa) or Lupron is taken on days 19, 20, 21, 22, 23 of the menstrual cycle preceding the actual IVF cycle. Call the IVF nurse on cycle day 1
- Birth control pills and a gonadotropin releasing hormone agonist (GnRHa, Lupron) are started with the menstrual period preceding the actual IVF cycle
- Birth control pills (BCPs) are started after menstrual cycle day 1. After about three weeks of suppression, the BCPs are stopped on a Sunday. On Thursday or Friday before stopping the BCPs, obtain a blood test for estrogen and an ultrasound. Start the gonadotropins on day 5 after the last BCP, Friday, even if you have vaginal bleeding or spotting. After four days of medication, check estrogen, LH, and progesterone levels and obtain an ultrasound. Begin your medication when instructed by the physician.
6) You will inject the fertility medications once or twice a day. If you are following protocol 1 or 2, you will have another blood estrogen test after five days of fertility medications. This test must be scheduled early enough for results to be available to the Fertility Center by 3:00 PM. If you are following protocol 3, you will return to the Fertility Center for tests after four days of medications.
7) In all protocols, your medications will be adjusted intermittently after the initial stimulation. You will be instructed daily about future ultrasound and blood testing and given information on how much medication to inject.
8) When your follicles are large enough to contain mature eggs (usually after 9 to 11 days of medication), you will inject human choriogonadotropin (hCG) to induce ovulation. This injection is usually given 34 hours before the time of your egg retrieval.
9) The morning after your hCG injection you will have one final blood estrogen test.
RESTRICTIONS: While on the IVF cycle, you should decrease or quit smoking, refrain from alcohol, drink only one or two caffeine beverages a day, and eat a low-fat diet. You should not take any medication or herbal medicine except Tylenol or Advil unless approved by our physicians. You may pursue your normal exercise routine unless enlargement of your ovaries causes discomfort. You may have intercourse, but your partner should abstain from ejaculation after the hCG injection. If the IVF cycle is being done for male factor infertility, this timing may be changed.
Day of Oocyte (Egg) Retrieval:
When the eggs are mature, you and your partner will come to the Fertility Center one hour before your scheduled retrieval time. At the Center, a nurse will review the procedure with you. The anesthesiologist will start an intravenous (IV) line in your arm and discuss how much sedation you would prefer.
You will be taken to the egg retrieval room where you will be given the sedative through your IV. Using a vaginal probe attached to an ultrasound machine, the attending physician will remove your eggs.
After you wake up from the sedation, one of the lab staff will discuss the potential for insemination of your eggs with you and your partner. A semen sample should be collected, evaluated, and processed. Sperm will be placed with each healthy, mature egg four to six hours after the retrieval.
One to two hours after the retrieval you will be discharged from the Center. You will need someone to drive you home. For about 24 hours you may experience pelvic cramping, abdominal bloating, and/or light vaginal bleeding.
Upon discharge, you will be given a prescription for a mild pain pill. You may use this medication, Tylenol, or Advil for discomfort. If you experience heavy vaginal bleeding, pain that is not easily controlled, or a temperature higher than 100.4°F, you should call University OB/GYN Associates and describe your symptoms to the physician on call.
You will begin intramuscular progesterone injections on the evening after your egg retrieval.
After Egg Retrieval:
Day 1 - On the morning after the retrieval, your eggs will be evaluated for fertilization, and someone will call you to report the results. Typically about 2/3 of the eggs will be fertilized.
Day 2 - Each fertilized egg, now called a pre-embryo, should have two to four cells. You will be given a time to return to the center the next day to have embryos placed in your uterus.
Day 3 - Before coming to the Center, drink four to six glasses of tap water. You will be asked to arrive at the Center about 30 minutes before the embryos are placed. When you arrive a nurse will get your weight and give you Advil. Occasionally, a mild sedative (Valium) is also given.
Someone from the lab will tell you about your embryo quality. You, the physician, and the Embryologist will talk together about the number of embryos to be transferred. You will continue intramuscular progesterone injections.
NOTE: You should take progesterone daily until you have a negative pregnancy test or you have been advised to stop. If you have a positive pregnancy test, daily progesterone should be continued for ten more weeks or until you are instructed to stop. Once the pregnancy test is positive you may switch to a vaginal form of progesterone.
The embryo transfer will take place in the egg retrieval room with ultrasound guidance. A speculum is placed in the vagina, the cervix is rinsed with a culture medium. The embryos, in a narrow catheter, are placed into the uterus through the cervix. This procedure feels like a pap smear.
You will remain in bed for 10 to 15 minutes and should plan to limit your activities for the next 48 hours. You should have someone with you to drive you home.
