Wisconsin Fertility Institute: Injection Class 2011

IN VITRO FERTILIZATION (IVF)

Suppress the endocrine(hormonal) system
Baseline visit
Stimulate Ovaries + monitoring
Egg Retrieval
Fertilize eggs in laboratory
Embryo Transfer to uterus
IN VITRO FERTILIZATION STEPS:

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 syringe plunger 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 the PATIENT PORTAL
Username and password
View lab results and medication instructions
Results are ready by 1PM each day
Schedule next appointment with front desk

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. GONAL F and FOLLISTIM:

FOLLICLES NEAR TRIGGER DAY:

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! Trigger Shot: Ovidrel or Lupron

Egg Retrieval

OOCYTE

CONVENTIONAL FERTILIZATION

ICSI FERTILIZATION

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 Medicines to start Day of RETRIEVAL (Day Zero):

LUTEAL PHASE SUPPORT INTERMUSCULAR 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 Cycles ICSI Embryos (Intracytoplasmic Sperm Injection)

Assisted Hatching

Pre-Implantation Genetic Diagnosis

Day 5: Blastocyst

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 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

Wisconsin Fertility Institute: Injection Class 2011

by WisFertility on Jun 08, 2011

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Wisconsin Fertility Institute: Injection Class 2011 — Presentation Transcript

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