IN VITRO FERTILIZATION

(IVF)

IN VITRO FERTILIZATIONSTEPS:

Controlled Ovarian Stimulation (Lupron, Injectable Drugs)Egg Retrieval from ovariesFertilization In VitroEmbryo Transfer to uterus

LUPRON:

Taken either 10 days or 2 days before stimulation drugs. Stops early ovulation, can help grow more eggs. Given with small needle just under skin.

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• Follicular Ultrasound• Trial Transfer• 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, FOLLISTIM, OR BRAVELLE:

Used for 7-12 days to 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:

OVIDREL:

Given when eggs mature (several measure about 20 mm in size). This marks last day of Lupron and Follistim, Gonal F or Bravelle.Given just under skin with small needle.

IMPORTANT TO TAKE THIS ONE AT EXACTLY CORRECT TIME!

OVA ASPIRATION 35 HOURS LATER:

OOCYTE

OOCYTE & SPERM

ICSI

FERTILIZED OOCYTE

Medicines to start Day of RETRIEVAL:

Doxycycline: 1 tablet orally, twice daily, 5 days.Estrace: 1 tablet orally, twice daily*Progesterone: 1mL shot same time 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:

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 Hatching

Pre-ImplantationGenetic Diagnosis

2, 3 or 5 Days after Retrieval:Embryo 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 Ovidrel shot• Blood test for hCG in our office• With a positive ultrasound 3 weeks later• With bleeding or other problems repeat hCG• With a negative follow up with physician