Slideshows for Tag: enhancing http://www.slideshare.net/ http://www.slideshare.net/images/logo.gif Slideshows for Tag: enhancing http://www.slideshare.net/ Sat, 26 Sep 2009 11:20:15 GMT SlideShare feed for Slideshows for Tag: enhancing Breast Augmentation Surgery In India With Cosmetic Surgery Loans http://www.slideshare.net/healthcoordinators/breast-augmentation-surgery-in-india-with-cosmetic-surgery-loans
Now financing companies in India often offer cosmetic surgery loans for breast augmentation surgery as a procedure This may allow many women to obtain an application for financing over the internet.]]>
Now financing companies in India often offer cosmetic surgery loans for breast augmentation surgery as a procedure This may allow many women to obtain an application for financing over the internet.]]> Sat, 26 Sep 2009 11:20:15 GMT http://www.slideshare.net/healthcoordinators/breast-augmentation-surgery-in-india-with-cosmetic-surgery-loans healthcoordinators@slideshare.net(healthcoordinators) Breast Augmentation Surgery In India With Cosmetic Surgery Loans healthcoordinators Now financing companies in India often offer cosmetic surgery loans for breast augmentation surgery as a procedure This may allow many women to obtain an application for financing over the internet. <img src="http://cdn.slidesharecdn.com/breastaugmentationsurgeryinindiawithcosmeticsurgeryloans-090926062037-phpapp02-thumbnail-2?1253964112" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Now financing companies in India often offer cosmetic surgery loans for breast augmentation surgery as a procedure This may allow many women to obtain an application for financing over the internet. Breast Augmentation Surgery In India With Cosmetic Surgery Loans
View more documents from Dr. Dheeraj Bojwani.
]]> 130 0 http://cdn.slidesharecdn.com/breastaugmentationsurgeryinindiawithcosmeticsurgeryloans-090926062037-phpapp02-thumbnail-2?1253964112 document http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Stay Away From People With Negative Energy http://www.slideshare.net/barnesdorf/stay-away-from-people-with-negative-energy
Harrison believes that in every organization, there are various employees who resent people who work hard, complain about just everything around them, blame other people for their lack of success, and do not take interest in enhancing their skills. These people are generally older employees, working with the company for years, who view the world in a negative way and are not enthusiastic about their jobs.]]>
Harrison believes that in every organization, there are various employees who resent people who work hard, complain about just everything around them, blame other people for their lack of success, and do not take interest in enhancing their skills. These people are generally older employees, working with the company for years, who view the world in a negative way and are not enthusiastic about their jobs.]]> Tue, 09 Jun 2009 12:19:55 GMT http://www.slideshare.net/barnesdorf/stay-away-from-people-with-negative-energy barnesdorf@slideshare.net(barnesdorf) Stay Away From People With Negative Energy barnesdorf Harrison believes that in every organization, there are various employees who resent people who work hard, complain about just everything around them, blame other people for their lack of success, and do not take interest in enhancing their skills. These people are generally older employees, working with the company for years, who view the world in a negative way and are not enthusiastic about their jobs. <img src="http://cdn.slidesharecdn.com/dmarketingbiswakesanm2009-assignmentcrossings-combinedwebinar0520090528-powerpoint-090609072001-phpapp01-thumbnail-2?1244550132" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Harrison believes that in every organization, there are various employees who resent people who work hard, complain about just everything around them, blame other people for their lack of success, and do not take interest in enhancing their skills. These people are generally older employees, working with the company for years, who view the world in a negative way and are not enthusiastic about their jobs. Stay Away From People With Negative Energy
View more presentations from Employment Crossing.
]]> 291 0 http://cdn.slidesharecdn.com/dmarketingbiswakesanm2009-assignmentcrossings-combinedwebinar0520090528-powerpoint-090609072001-phpapp01-thumbnail-2?1244550132 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Melaleuca Ppt Kellys Version http://www.slideshare.net/kellygreen4life/melaleucapptkellysversion
Enhancing The Lives of Those We Touch by Helping People Reach Their Goals!]]>
Enhancing The Lives of Those We Touch by Helping People Reach Their Goals!]]> Wed, 08 Apr 2009 20:48:58 GMT http://www.slideshare.net/kellygreen4life/melaleucapptkellysversion kellygreen4life@slideshare.net(kellygreen4life) Melaleuca Ppt Kellys Version kellygreen4life Enhancing The Lives of Those We Touch by Helping People Reach Their Goals! <img src="http://cdn.slidesharecdn.com/melaleucapptkellysversion-123922351729-phpapp01-thumbnail-2?1239223831" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Enhancing The Lives of Those We Touch by Helping People Reach Their Goals! Melaleuca Ppt Kellys Version
View more presentations from kellygreen4life.
]]> 174 0 http://cdn.slidesharecdn.com/melaleucapptkellysversion-123922351729-phpapp01-thumbnail-2?1239223831 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Enhancing Teaching and Learning in Geography using ICT http://www.slideshare.net/RCha/enhancing-teaching-and-learning-in-geography-using-ict
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]]> Wed, 25 Mar 2009 21:25:43 GMT http://www.slideshare.net/RCha/enhancing-teaching-and-learning-in-geography-using-ict RCha@slideshare.net(RCha) Enhancing Teaching and Learning in Geography using ICT RCha <img src="http://cdn.slidesharecdn.com/join-the-online-revolution-march-09slideshare-090325162545-phpapp01-thumbnail-2?1238019952" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Enhancing Teaching and Learning in Geography using ICT
View more presentations from RCha.
]]> 1516 0 http://cdn.slidesharecdn.com/join-the-online-revolution-march-09slideshare-090325162545-phpapp01-thumbnail-2?1238019952 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Panchayati Raj Institutions - Enhancing Delivery Of Information &amp; Services To Rural Citizens http://www.slideshare.net/siddharth4mba/panchayati-raj-institutions-enhancing-delivery-of-information-services-to-rural-citizens
Panchayati Raj Institutions - Enhancing Delivery Of Information & Services To Rural Citizens]]>
Panchayati Raj Institutions - Enhancing Delivery Of Information & Services To Rural Citizens]]> Sat, 31 Jan 2009 20:53:07 GMT http://www.slideshare.net/siddharth4mba/panchayati-raj-institutions-enhancing-delivery-of-information-services-to-rural-citizens siddharth4mba@slideshare.net(siddharth4mba) Panchayati Raj Institutions - Enhancing Delivery Of Information &amp; Services To Rural Citizens siddharth4mba Panchayati Raj Institutions - Enhancing Delivery Of Information &amp; Services To Rural Citizens <img src="http://cdn.slidesharecdn.com/panchayati-raj-institutions-enhancing-delivery-of-information-services-to-rural-citizens-1233434916711205-1-thumbnail-2?1233435200" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Panchayati Raj Institutions - Enhancing Delivery Of Information &amp; Services To Rural Citizens Panchayati Raj Institutions - Enhancing Delivery Of Information & Services To Rural Citizens
View more documents from Siddharth Nath.
]]> 663 0 http://cdn.slidesharecdn.com/panchayati-raj-institutions-enhancing-delivery-of-information-services-to-rural-citizens-1233434916711205-1-thumbnail-2?1233435200 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted R&amp;D today: Addressing and enhancing Research &amp; Development’s effectiveness http://www.slideshare.net/kennyong/rd-today-addressing-and-enhancing-research-developments-effectiveness-presentation
ABF Research & Development 2009, Singapore *Applying theory to practice *Matching R&D to Business Strategy and Organization’s Goals *Enhancing R&D efficiency by selecting a key component criteria *Keeping R&D close to where strategic decisions are made]]>
ABF Research & Development 2009, Singapore *Applying theory to practice *Matching R&D to Business Strategy and Organization’s Goals *Enhancing R&D efficiency by selecting a key component criteria *Keeping R&D close to where strategic decisions are made]]> Thu, 22 Jan 2009 04:18:33 GMT http://www.slideshare.net/kennyong/rd-today-addressing-and-enhancing-research-developments-effectiveness-presentation kennyong@slideshare.net(kennyong) R&amp;D today: Addressing and enhancing Research &amp; Development’s effectiveness kennyong ABF Research &amp; Development 2009, Singapore *Applying theory to practice *Matching R&amp;D to Business Strategy and Organization’s Goals *Enhancing R&amp;D efficiency by selecting a key component criteria *Keeping R&amp;D close to where strategic decisions are made <img src="http://cdn.slidesharecdn.com/abf-singapore-rd-seminar-by-kenny-ong-v2-1232597754009866-1-thumbnail-2?1232599481" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> ABF Research &amp; Development 2009, Singapore *Applying theory to practice *Matching R&amp;D to Business Strategy and Organization’s Goals *Enhancing R&amp;D efficiency by selecting a key component criteria *Keeping R&amp;D close to where strategic decisions are made R&D today: Addressing and enhancing Research & Development’s effectiveness
View more presentations from Kenny Ong.
]]> 1099 0 http://cdn.slidesharecdn.com/abf-singapore-rd-seminar-by-kenny-ong-v2-1232597754009866-1-thumbnail-2?1232599481 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted The Fight agains Immune Deficiency Disorders . http://www.slideshare.net/strauss127/the-fight-agains-immune-deficiency-disorders-presentation
3 billion people worldwide are suffering from malnutrition and immune deficiencies - Global Alliance For Improved Nutrition (GAIN) 15 million people in Southern Africa are affected by malnutrition and poverty 26 million people in the SADC region are infected with HIV and AIDS]]>
3 billion people worldwide are suffering from malnutrition and immune deficiencies - Global Alliance For Improved Nutrition (GAIN) 15 million people in Southern Africa are affected by malnutrition and poverty 26 million people in the SADC region are infected with HIV and AIDS]]> Mon, 01 Dec 2008 12:50:38 GMT http://www.slideshare.net/strauss127/the-fight-agains-immune-deficiency-disorders-presentation strauss127@slideshare.net(strauss127) The Fight agains Immune Deficiency Disorders . strauss127 3 billion people worldwide are suffering from malnutrition and immune deficiencies - Global Alliance For Improved Nutrition (GAIN) 15 million people in Southern Africa are affected by malnutrition and poverty 26 million people in the SADC region are infected with HIV and AIDS <img src="http://cdn.slidesharecdn.com/the-fight-against-idd-1228140633085863-8-thumbnail-2?1228136745" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> 3 billion people worldwide are suffering from malnutrition and immune deficiencies - Global Alliance For Improved Nutrition (GAIN) 15 million people in Southern Africa are affected by malnutrition and poverty 26 million people in the SADC region are infected with HIV and AIDS The Fight agains Immune Deficiency Disorders .
View more presentations from Jacob Bornman.
]]> 997 0 http://cdn.slidesharecdn.com/the-fight-against-idd-1228140633085863-8-thumbnail-2?1228136745 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Quality of Life Trials (anecdotal) http://www.slideshare.net/strauss127/quality-of-life-trials-anecdotal-presentation
QUALITY OF LIFE (QOL) TRIALS ON PEOPLE LIVING WITH AIDS The IMUNITI Wellness Pack has been used on thousands of sick individuals (HIV positive with or without full blown AIDS and other disorders e.g., TB, diabetes, chronic fatigue, wasting) in 4 countries in Southern Africa, namely, South Africa, Namibia, Botswana and Lesotho, with outstanding results with respect to health improvement. One Quality of Life (QOL) Pilot study was performed in Namibia on 36 patients with a 100% success rate in the adult individuals in terms of mass gain (6 – 10 kg on average after 4 weeks).]]>
QUALITY OF LIFE (QOL) TRIALS ON PEOPLE LIVING WITH AIDS The IMUNITI Wellness Pack has been used on thousands of sick individuals (HIV positive with or without full blown AIDS and other disorders e.g., TB, diabetes, chronic fatigue, wasting) in 4 countries in Southern Africa, namely, South Africa, Namibia, Botswana and Lesotho, with outstanding results with respect to health improvement. One Quality of Life (QOL) Pilot study was performed in Namibia on 36 patients with a 100% success rate in the adult individuals in terms of mass gain (6 – 10 kg on average after 4 weeks).]]> Mon, 01 Dec 2008 12:50:38 GMT http://www.slideshare.net/strauss127/quality-of-life-trials-anecdotal-presentation strauss127@slideshare.net(strauss127) Quality of Life Trials (anecdotal) strauss127 QUALITY OF LIFE (QOL) TRIALS ON PEOPLE LIVING WITH AIDS The IMUNITI Wellness Pack has been used on thousands of sick individuals (HIV positive with or without full blown AIDS and other disorders e.g., TB, diabetes, chronic fatigue, wasting) in 4 countries in Southern Africa, namely, South Africa, Namibia, Botswana and Lesotho, with outstanding results with respect to health improvement. One Quality of Life (QOL) Pilot study was performed in Namibia on 36 patients with a 100% success rate in the adult individuals in terms of mass gain (6 – 10 kg on average after 4 weeks). <img src="http://cdn.slidesharecdn.com/trials-1228140926242556-9-thumbnail-2?1228136175" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> QUALITY OF LIFE (QOL) TRIALS ON PEOPLE LIVING WITH AIDS The IMUNITI Wellness Pack has been used on thousands of sick individuals (HIV positive with or without full blown AIDS and other disorders e.g., TB, diabetes, chronic fatigue, wasting) in 4 countries in Southern Africa, namely, South Africa, Namibia, Botswana and Lesotho, with outstanding results with respect to health improvement. One Quality of Life (QOL) Pilot study was performed in Namibia on 36 patients with a 100% success rate in the adult individuals in terms of mass gain (6 – 10 kg on average after 4 weeks). Quality of Life Trials (anecdotal)
View more presentations from Jacob Bornman.
]]> 607 0 http://cdn.slidesharecdn.com/trials-1228140926242556-9-thumbnail-2?1228136175 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Enhancing the Business Performance Management System for More Effective Business and Talent Management http://www.slideshare.net/kennyong/enhancing-the-business-performance-management-system-for-more-effective-business-and-talent-management-presentation
MEF National Conference 2008, MANAGING PERFORMANCE FOR BUSINESS EXCELLENCE, KL]]>
MEF National Conference 2008, MANAGING PERFORMANCE FOR BUSINESS EXCELLENCE, KL]]> Fri, 07 Nov 2008 01:15:29 GMT http://www.slideshare.net/kennyong/enhancing-the-business-performance-management-system-for-more-effective-business-and-talent-management-presentation kennyong@slideshare.net(kennyong) Enhancing the Business Performance Management System for More Effective Business and Talent Management kennyong MEF National Conference 2008, MANAGING PERFORMANCE FOR BUSINESS EXCELLENCE, KL <img src="http://cdn.slidesharecdn.com/mef-by-kenny-ong-enhancing-the-business-performance-management-system-for-more-effective-business-and-talent-management-1226027729869724-8-thumbnail-2?1226020531" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> MEF National Conference 2008, MANAGING PERFORMANCE FOR BUSINESS EXCELLENCE, KL Enhancing the Business Performance Management System for More Effective Business and Talent Management
View more presentations from Kenny Ong.
]]> 2373 0 http://cdn.slidesharecdn.com/mef-by-kenny-ong-enhancing-the-business-performance-management-system-for-more-effective-business-and-talent-management-1226027729869724-8-thumbnail-2?1226020531 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Blog Enhancing through Extensions http://www.slideshare.net/gandalfar/blog-enhancing-through-extensions-presentation
My Presentation at Widget Web Expo ’08 London, where I discussed some issues regarding building blog enhancing widgets like Zemanta and what are its effects on interface decisions.]]>
My Presentation at Widget Web Expo ’08 London, where I discussed some issues regarding building blog enhancing widgets like Zemanta and what are its effects on interface decisions.]]> Tue, 21 Oct 2008 15:19:10 GMT http://www.slideshare.net/gandalfar/blog-enhancing-through-extensions-presentation gandalfar@slideshare.net(gandalfar) Blog Enhancing through Extensions gandalfar My Presentation at Widget Web Expo &rsquo;08 London, where I discussed some issues regarding building blog enhancing widgets like Zemanta and what are its effects on interface decisions. <img src="http://cdn.slidesharecdn.com/blogenhancingcuhalev2-1224151841391330-9-thumbnail-2?1224602351" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> My Presentation at Widget Web Expo &rsquo;08 London, where I discussed some issues regarding building blog enhancing widgets like Zemanta and what are its effects on interface decisions. Blog Enhancing through Extensions
View more presentations from Jure Cuhalev.
]]> 871 0 http://cdn.slidesharecdn.com/blogenhancingcuhalev2-1224151841391330-9-thumbnail-2?1224602351 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Ivf clinics http://www.slideshare.net/ivfworld/ivf-clinics
info@shivaniscientific.com http://www.shivaniscientific.com Infertility Treatment - Overview, IVF, GIFT, TET, Microsurgical Tubal Reanastomosis, Frequently Asked Questions, Women Over 40, PCOS, Assisted Hatching, Microsurgery, Immunological Testing and Treatment, Donor Egg, ICSI, Hysterectomy, Laparoscopic Procedures, Sex Selection You need information about IVF, ICSI, infertility clinics, donor egg and surrogacy services (e.g., surrogate mothers), tubal reversal doctors, vasectomy reversal doctors, natural infertility treatment, male infertility services, sperm banks, pharmacies, infertility books and videotapes, sperm testing, infertility support, and drugs and medications, such as Metrodin, Pergonal, Clomid. Infertility News and Announcements Infertility Service Providers 1. Infertility IVF clinics 9. Lawyers 2. Egg donor programs 10. Pharmacies 3. Tubal reversal doctors 11. Surrogacy programs 4. Vasectomy reversal doctors 12. Counselors & consultants 5. Financial assistance 13. Egg Freezing 6. Natural treatment 13. PGD programs 7. Sperm banks 14. Embryo adoption 8. Male infertility doctors 15. Adoption Agencies Infertility Products 1. Women - fertility monitors, etc. 5. Conception products 2. Women - fertility supplements 6. Fertility product stores 3. Men - sperm testing 7. Infertility books 4. Men - fertility supplements 8. Infertility videos and CDs Education 1. Main 8. Financial and Insurance 2. Diagnosis 9. Legal Rights 3. Male Factor 10. Psychological and Social 4. Treatment 11. Infertility Photos 5. Egg Donation and Egg Donors 12. Miscellaneous 6. Drugs and Medications MORE ON IVF: Glossary adhesions Bands of scar tissue attached to organ surfaces and capable of connecting, covering, or distorting organs, such as tubes, ovaries or uterus. AID (artificial insemination, donor) A procedure introducing sperm from an anonymous donor into a woman’s uterus in order to achieve a pregnancy. AIH (artificial insemination, husband or homologous) A special insemination procedure used to introduce sperm collected from a woman’s partner into the woman’s uterus. Also referred to as intrauterine insemination (IUI). antisperm antibodies Antibodies that may be produced by either a female or male which may damage sperm or cause them to adhere to each other, thus limiting their fertility potential. azoospermia The absence of sperm in the ejaculate. cervical mucus Mucus produced by the cervix which changes in thickness and quantity at the time of ovulation. cervix The lower section of the uterus which protrudes into the vagina and serves as a passageway for sperm into the uterus. Corpus Luteum A structure in the ovary that develops after the egg is released, which secretes progesterone. cryopreservation The preservation of sperm or embryos by freezing, usually by immersion in liquid nitrogen. endometriosis The presence of endometrial tissue in abnormal locations, such as the fallopian tubes, ovaries and abdominal cavity. The condition frequently causes pain and discomfort during menstruation, or even chronic pelvic pain, and may also cause infertility. endometrium The inner lining of the uterus. estrogen The primary female hormone produced mainly by the ovaries from puberty to menopause. fallopian tube The tube that connects the uterus and ovary. It allows the egg to pass from the ovary to the uterus and the spermatozoa from the uterus toward the ovary. fibroids Smooth muscle tumors of the muscular wall of the uterus which are almost always benign but may cause infertility or recurrent miscarriages. follicle A cystic structure in the ovary which contains and nurtures the ovum (egg). It enlarges to a diameter of 18 - 28 mm (3/4 - 1 inch) before ovulation, at which point it releases the egg. FSH (follicle stimulating hormone) A hormone that recruits and then stimulates growth of the follicle in the ovary, as well as the formation of spermatozoa in the testes. GIFT (gamete intrafallopian transfer) A procedure in which eggs are removed from a ripened follicle and via laparoscopy are placed with sperm into the fallopian tube, where fertilization takes place. gonadotropin A hormone (FSH, LH, hMG, hCG) which stimulates the gonads (ovaries or testes). GnRH (gonadotropin releasing hormone) A small hormone produced by the brain which causes the pituitary gland to manufacture and release FSH and LH. GnRH agonist (Lupron) Differs from GnRH at 2 amino-acid positions. Used to stop production of FSH and LH from the pituitary gland. Gonal-F The brand name of a new recombinant FSH used to stimulate the ovaries to produce follicles. Follistim is the brand name of another recombinant FSH on the market. hCG (human chorionic gonadotropin) A hormone produced by the placenta. Detection of its presence in urine or blood is the basis of the pregnancy test. Also used to trigger final maturation and ovulation of the egg. hMG (human menopausal gonadotropin) A hormone (Pergonal or Humegon) used to stimulate follicle production. Equal parts of FSH and LH are present. hysteroscopy An endoscopic (fiber-optic tube) procedure used primarily to visualize the interior of the uterus. implantation The embedding of the embryo in the uterine wall. in-vitro fertilization/embryo transfer A procedure in which an egg is removed from a ripe follicle and fertilized with sperm outside the body. The resulting embryo is inserted into the woman’s uterus. laparoscopy An abdominal surgical procedure using an endoscopic instrument (fiber-optic tube) to view the fallopian tubes, ovaries, uterus, and other abdominal structures. The laparoscope may also be used to perform surgical procedures, employing the use of lasers and other specialized equipment. LH (luteinizing hormone) A hormone produced and released by the pituitary gland. In the female, it is responsible for maturation and then the release of the ovum. In the male, it stimulates testosterone production. Lutrepulse The trade name for a gonadotropin releasing hormone (GnRH) used to induce ovulation in some patients. It is administered through an infusion pump in a pulsatile fashion. oligospermia The presence of a low number of sperm in the ejaculate. ovum The egg cell (gamete) produced in a woman’s ovaries during each menstrual cycle. ovulation The release of a mature egg from the surface of the ovary. pituitary gland A gland at the base of the brain which produces many hormones, including FSH and LH. polyps Small, benign growths protruding from the lining of the endometrium or endocervix. progesterone A hormone produced and released during the second half of a woman’s ovulatory cycle. It is necessary in the preparation of the uterine lining for implantation of the fertilized egg. semen The sperm and seminal secretions ejaculated by the male during orgasm. sperm Male reproductive cells contained in the seminal fluid. testosterone The most potent male sex hormone, produced in the testes. uterus The reproductive organ which protects and nourishes the developing embryo/fetus. It is a hollow, muscular structure that is part of the female reproductive tract, and it is the source of a woman’s menses. vagina A tubular passageway in the female which connects the external sex organs with the cervix and uterus. IVF: In Vitro Fertilization(IVF) In vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy. In order to reach this potential, your participation and that of your physician (reproductive endocrinologist), nurses and embryologists require close coordination. Precise timing of medications is critical, and close monitoring with ultrasound is required. This reproductive journey is detailed and involved, but we are here to guide you and help ease as many of the complexities that may occur along the way. Please feel free to ask our nurses and physicians any questions you may have. IVF (In Vitro Fertilization) Overview With IVF, oocytes (eggs) are retrieved from the ovary and placed in a Petri dish with active, motile sperm. Because fertilization occurs in the Petri dish rather than in the woman’s body, this process has been called “in vitro.” The eggs and sperm are maintained in a special culture media (nutrient fluid) within a controlled environment (incubator). If a fertilized egg is developing properly, it will consist of 6-8 cells at 3 days after egg retrieval. If an embryo is continuing develop appropriately, it will form a blastocyst by 5-6 days after egg retrieval. After embryos have developed in the laboratory for several days, one or more are selected for transfer into your uterus and if additional embryos are developing, they may be frozen to be transferred at a future time. Step by step guide to IVF Although the details of individual cycles will vary, all of the assisted reproductive technologies have similar steps. 1. Pretreatment preparation 2. Ovulation induction 3. Oocyte retrieval 4. Fertilization of eggs in the laboratory 5. Embryo transfer 6. Luteal phase 7. Pregnancy test and pregnancy follow-up 1. Pretreatment preparation After the decision is made to proceed with IVF, you will meet with a Registered Nurse and will receive a medication log and a calendar outlining the treatment. In many cases, oral contraceptive pills (OCPs) will be prescribed in the cycle, prior to active treatment. The purpose of the OCP is to reduce the chance that an ovarian cyst will be present at the time when we plan to start treatment and to allow flexibility in the timing of the cycle (the number of days on OCP can be varied). Ultrasound. While you are on the OCP, you will have a Transvaginal ultrasound to assess whether there are any cysts present in the ovaries. In one commonly used protocol, you will begin a medication called Lupron (a GnRH agonist) while you are still taking the OCP. Your individual protocol may vary, and you may be prescribed a medicine other than Lupron (such as a GnRH antagonist called Ganirelix or Cetrotide) to prevent premature release of the eggs. Uterine screening. If you have not had an evaluation of your uterus within the last year, your MD may recommend a screening test as a hysteroscopy or a saline infusion sonography to be done while you are taking the OCP. You will be given more information about any procedure that will be recommended. Backup semen sample. In some cases a semen sample is obtained, frozen, and stored as a “back-up” specimen available on the day of egg retrieval. Please inform your MD or RN if you anticipate any difficulty in collecting a sample on the day of the retrieval so that you can arrange to have a back-sample frozen ahead of time. 2. Ovulation induction Success rates with reproductive technologies (ART) are improved if multiple mature oocytes are available for retrieval. In order to mature a group of eggs, medications are administered by subcutaneous injection on a daily basis. The medications are in a class called gonadotropins. Some of the commercial names are Follistim, Gonal-F, Menopur and Repronex. Baseline Ultrasound. Your baseline ultrasound will be performed before starting the gonadotropin. Occasionally you may have an ovarian cyst at this time. If you have a cyst, it often disappears with continued Lupron treatment, or less commonly your MD might recommend aspiration of the cyst. If the baseline ultrasound is normal, you will begin gonadrotropin injections. This medication will promote a group of several follicles (the sacs of fluid which contain the microscopic eggs) to develop together. Ideally about 10-12 follicles develop, but the response is quite variable and you may produce only 2-3 follicles, or as many as 20-30. The dose of medication you will receive is based on a prediction of how your ovaries will respond based on your age, your baseline FSH and estradiol levels, and any previous ovulation induction experience. When you begin the gonadotropin medication, it is important to not pursue intense physical exercise (kick boxing, jumping, etc.) because such activity could cause discomfort and twisting of the ovaries. The gonadotropin injections have some risks and side effects which are discussed in detail in the medication information and in consent forms that you will be given. Most women taking gonadotropin injections for IVF will feel a sense of fullness in their ovaries. Risks include ovarian hyperstimulation syndrome (OHSS) and multiple birth (particularly if multiple embryos are transferred). There has been some concern regarding the possibility of increased risk of ovarian cancer with the use of fertility medications. However, more recent studies have overall been reassuring. Timing of hCG. When ultrasound examination suggest that the eggs are mature (usually when the lead follicle size is about 18 mm in diameter), you will be asked to take an injection of human chorionic gonadotropin (hCG). The timing of the hCG is critical, so you need to take it precisely at the time given to you on the schedule. Once you take hCG, your gonadotropin and GnRH agonist or GnRH antagonist will stop. 3. Oocyte retrieval Approximately 35 hours after the hCG injection, the egg retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval. If you are taking medications for any other reason, talk to your MD or RN about taking medication prior to retrieval. Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the IVF laboratory. The egg retrieval takes approximately 20-30 minutes. After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small. On the day of egg retrieval, you will need to have someone available to drive you home (you cannot drive on the day of egg retrieval due to the intravenous medications that you will be receiving). You should not plan to do any work on the day of egg retrieval. Many women do return to work the next day, while others also rest the day following the retrieval. You may feel some pelvic heaviness or soreness and cramping. It is okay to take Tylenol, but you should avoid ibuprofen (i.e. Advil, Motrin). Often there is a small amount of spotting. Your bleeding should be less than a normal period. We recommend that you avoid immersing yourself in water (avoid swimming, take showers rather than baths, avoid vaginal intercourse) from the day of the retrieval for several days to allow the vagina to heal. After the procedure, you will be given complete written instructions and phone numbers. It is important to know that your ovaries are still enlarged immediately after the egg retrieval and that they remain enlarged for the next several weeks. For this reason, avoid heavy lifting or vigorous exertion such as running or aerobics until they return to normal size (which occurs either at 6-10 weeks into the pregnancy or with menses if pregnancy does not occur). It is okay to take stairs slowly, and walk short distances, less than a mile. Avoid any vaginal creams, lubricants, or spermicides other than the progesterone that is prescribed. Avoid hot tubs and Jacuzzis. Avoid intercourse until advised by your physician. If you travel, give yourself twice as much time as usual and minimize stress. Semen sample. Your partner will give a sperm sample the day of the egg retrieval. It is recommended that he abstain from ejaculation for 2 days (48 hours) to 5 days before giving the sample. 4. Fertilization of eggs Once the eggs are retrieved and placed in the incubator, they rest for several hours before the sperm is added, usually in the afternoon of the egg retrieval. Addition of sperm to the culture media is called insemination, and is followed by fertilization, when the sperm enters the egg. Fertilization can also be accomplished by ICSI (intracytoplasmatic sperm injection). ICSI will be recommended if your physician suspects that there will be a significant chance of no fertilization or a low rate of fertilization with conventional insemination of the oocytes in the laboratory. We will call you the day after retrieval to let you know how many eggs have fertilized. It is important to understand that all the embryos may not be able to be observed on that day and that of those that are seen, they may not continue to grow. The embryo can begin cleaving, or dividing, first into two cells, then into four. Cleavage to four cells generally takes 36-48 hours or more after the egg retrieval. After 3 days, an embryo which is growing properly will have 6-8 cells. An embryo should reach a blastocyst stage at 5-6 days after retrieval. 5. Embryo transfer Three to five days after the oocyte retrieval you will be scheduled for your embryo transfer. Your physician will recommend which day is most appropriate for you. In general, blastocyst transfer is recommended when there are a large number of embryos of good quality, or for couples desiring only a single embryo to be transferred. Your physician will give you a recommendation regarding the number of embryos to be transferred based on your age, your history if you have had IVF performed in the past, and the quality of the embryos. Abdominal ultrasound is used to guide the transfer. To perform the transfer, your physician will place a speculum in the vagina and the cervix will be rinsed with a sterile solution. The embryologist in the laboratory will load the embryos into a small catheter and your physician will ease the tip of the catheter through the cervix into the uterus. You may have a sensation or twinge as the catheter passes through your cervix or you may not feel anything. For this reason, anesthesia is not used for the transfer. On the day of your transfer wear comfortable clothing and socks to keep your feet warm. Your bladder should feel full, but not very uncomfortable. A partially full bladder often will allow the transfer to be completed more easily and will allow a better picture on the abdominal ultrasound. We suggest that you rest the day after the transfer, to allow yourself time to relax as much as possible. Also, your ovaries will still be enlarged and activity should be minimized as described above to prevent ovarian discomfort. However, it is important to know that nothing you will do, such as walking or going to the bathroom will cause the embryos to dislodge from the uterine wall. The main factors that determine whether an embryo will implant are the viability (“health”) of the embryo and the quality of the uterine lining. Healthy embryos will be much more likely to implant and develop than embryos which are not viable. 6. Luteal phase You will take progesterone by injection and/or vaginal suppository gel because it has been shown that progesterone supplementation increases the chance of success with IVF. Progesterone is the natural hormone that your body produces to support the uterine lining and maintain an early pregnancy. Although the FDA requires the drug manufacturer to include warnings about using progesterone in early pregnancy, this is due to the fact that progestins (a synthetic progesterone-like substance) or high doses of progesterone in animal experienced have raised concerns. However, you will only receive progesterone, the same natural hormone your ovaries produce, in a dose that is not excessive. After the egg retrieval, you will receive your first dose of progesterone. You will continue this daily for the next two weeks according to a schedule you will receive. This schedule will include the dose you should take. As noted above, it is common to have a sensation of heaviness or cramping in your pelvis 4-10 days after egg retrieval. Your ovaries frequently enlarge at this time. If you are gaining weight rapidly (more than a pound a day) which can occur due to fluid retention, or if you are not urinating the normal amount for you, or if you have any other concerns, please call. Light bleeding sometimes occurs in the weeks following egg retrieval, even if there is a normally developing pregnancy. A pregnancy test will be performed approximately two weeks after your egg retrieval. Waiting for your pregnancy test is a difficult time. It is not unusual to have symptoms of pregnancy that come and go due to the hormonal changes with IVF. The only way to know whether or not you are pregnant is by the pregnancy test done two weeks after egg retrieval. Bleeding may occur even if a pregnancy is developing normally. Please continue to take the progesterone that is prescribed until your pregnancy test, even if you think you may not be pregnant. Because the hormones that you are taking may confuse the symptoms that you have come to recognize as signs that you may or may not be pregnant, try not to guess or do home pregnancy tests before the blood test. They may not be accurate. If the first test is positive, you will be asked to return for a follow-up test 2-3 days later to see that the level of the hormone hCG is rising appropriately. Hopefully you will receive good news and find out that the pregnancy test is positive and have follow-up as described below. If unfortunately you are not pregnant, you will be instructed to stop the progesterone and expect a period within 2-5 days (you should call us if a menses does not occur within about 5 days of stopping progesterone). If you do not conceive, you may find it helpful to schedule a follow-up visit with the MD to occur about 2 weeks after your pregnancy test results. This visit is important so we can counsel you regarding your next steps. Another cycle of treatment can begin as soon as one month after a failed cycle. Pregnancy Hopefully, you will be pregnant, and an ultrasound will be scheduled 4-5 weeks after your egg retrieval. The ultrasound will be done again 2 weeks later (6-7 weeks from retrieval). We will then refer you to your obstetrician for the remainder of the pregnancy. You will remain on progesterone until 8-10 weeks from your retrieval. We truly look forward to hearing from you when you deliver your child. Evaluation for Fertility,Preconception Care, Ovulation Induction/IUI,In Vitro Fertilization (IVF),Third Party Program,REI Laboratory,IVF Laboratory,Reproductive Surgery,Recurrent Pregnancy Loss,Fertility Preservation,Emotional Support,Patient Resources,Financial Services,Fertility Statistics,]]>
info@shivaniscientific.com http://www.shivaniscientific.com Infertility Treatment - Overview, IVF, GIFT, TET, Microsurgical Tubal Reanastomosis, Frequently Asked Questions, Women Over 40, PCOS, Assisted Hatching, Microsurgery, Immunological Testing and Treatment, Donor Egg, ICSI, Hysterectomy, Laparoscopic Procedures, Sex Selection You need information about IVF, ICSI, infertility clinics, donor egg and surrogacy services (e.g., surrogate mothers), tubal reversal doctors, vasectomy reversal doctors, natural infertility treatment, male infertility services, sperm banks, pharmacies, infertility books and videotapes, sperm testing, infertility support, and drugs and medications, such as Metrodin, Pergonal, Clomid. Infertility News and Announcements Infertility Service Providers 1. Infertility IVF clinics 9. Lawyers 2. Egg donor programs 10. Pharmacies 3. Tubal reversal doctors 11. Surrogacy programs 4. Vasectomy reversal doctors 12. Counselors & consultants 5. Financial assistance 13. Egg Freezing 6. Natural treatment 13. PGD programs 7. Sperm banks 14. Embryo adoption 8. Male infertility doctors 15. Adoption Agencies Infertility Products 1. Women - fertility monitors, etc. 5. Conception products 2. Women - fertility supplements 6. Fertility product stores 3. Men - sperm testing 7. Infertility books 4. Men - fertility supplements 8. Infertility videos and CDs Education 1. Main 8. Financial and Insurance 2. Diagnosis 9. Legal Rights 3. Male Factor 10. Psychological and Social 4. Treatment 11. Infertility Photos 5. Egg Donation and Egg Donors 12. Miscellaneous 6. Drugs and Medications MORE ON IVF: Glossary adhesions Bands of scar tissue attached to organ surfaces and capable of connecting, covering, or distorting organs, such as tubes, ovaries or uterus. AID (artificial insemination, donor) A procedure introducing sperm from an anonymous donor into a woman’s uterus in order to achieve a pregnancy. AIH (artificial insemination, husband or homologous) A special insemination procedure used to introduce sperm collected from a woman’s partner into the woman’s uterus. Also referred to as intrauterine insemination (IUI). antisperm antibodies Antibodies that may be produced by either a female or male which may damage sperm or cause them to adhere to each other, thus limiting their fertility potential. azoospermia The absence of sperm in the ejaculate. cervical mucus Mucus produced by the cervix which changes in thickness and quantity at the time of ovulation. cervix The lower section of the uterus which protrudes into the vagina and serves as a passageway for sperm into the uterus. Corpus Luteum A structure in the ovary that develops after the egg is released, which secretes progesterone. cryopreservation The preservation of sperm or embryos by freezing, usually by immersion in liquid nitrogen. endometriosis The presence of endometrial tissue in abnormal locations, such as the fallopian tubes, ovaries and abdominal cavity. The condition frequently causes pain and discomfort during menstruation, or even chronic pelvic pain, and may also cause infertility. endometrium The inner lining of the uterus. estrogen The primary female hormone produced mainly by the ovaries from puberty to menopause. fallopian tube The tube that connects the uterus and ovary. It allows the egg to pass from the ovary to the uterus and the spermatozoa from the uterus toward the ovary. fibroids Smooth muscle tumors of the muscular wall of the uterus which are almost always benign but may cause infertility or recurrent miscarriages. follicle A cystic structure in the ovary which contains and nurtures the ovum (egg). It enlarges to a diameter of 18 - 28 mm (3/4 - 1 inch) before ovulation, at which point it releases the egg. FSH (follicle stimulating hormone) A hormone that recruits and then stimulates growth of the follicle in the ovary, as well as the formation of spermatozoa in the testes. GIFT (gamete intrafallopian transfer) A procedure in which eggs are removed from a ripened follicle and via laparoscopy are placed with sperm into the fallopian tube, where fertilization takes place. gonadotropin A hormone (FSH, LH, hMG, hCG) which stimulates the gonads (ovaries or testes). GnRH (gonadotropin releasing hormone) A small hormone produced by the brain which causes the pituitary gland to manufacture and release FSH and LH. GnRH agonist (Lupron) Differs from GnRH at 2 amino-acid positions. Used to stop production of FSH and LH from the pituitary gland. Gonal-F The brand name of a new recombinant FSH used to stimulate the ovaries to produce follicles. Follistim is the brand name of another recombinant FSH on the market. hCG (human chorionic gonadotropin) A hormone produced by the placenta. Detection of its presence in urine or blood is the basis of the pregnancy test. Also used to trigger final maturation and ovulation of the egg. hMG (human menopausal gonadotropin) A hormone (Pergonal or Humegon) used to stimulate follicle production. Equal parts of FSH and LH are present. hysteroscopy An endoscopic (fiber-optic tube) procedure used primarily to visualize the interior of the uterus. implantation The embedding of the embryo in the uterine wall. in-vitro fertilization/embryo transfer A procedure in which an egg is removed from a ripe follicle and fertilized with sperm outside the body. The resulting embryo is inserted into the woman’s uterus. laparoscopy An abdominal surgical procedure using an endoscopic instrument (fiber-optic tube) to view the fallopian tubes, ovaries, uterus, and other abdominal structures. The laparoscope may also be used to perform surgical procedures, employing the use of lasers and other specialized equipment. LH (luteinizing hormone) A hormone produced and released by the pituitary gland. In the female, it is responsible for maturation and then the release of the ovum. In the male, it stimulates testosterone production. Lutrepulse The trade name for a gonadotropin releasing hormone (GnRH) used to induce ovulation in some patients. It is administered through an infusion pump in a pulsatile fashion. oligospermia The presence of a low number of sperm in the ejaculate. ovum The egg cell (gamete) produced in a woman’s ovaries during each menstrual cycle. ovulation The release of a mature egg from the surface of the ovary. pituitary gland A gland at the base of the brain which produces many hormones, including FSH and LH. polyps Small, benign growths protruding from the lining of the endometrium or endocervix. progesterone A hormone produced and released during the second half of a woman’s ovulatory cycle. It is necessary in the preparation of the uterine lining for implantation of the fertilized egg. semen The sperm and seminal secretions ejaculated by the male during orgasm. sperm Male reproductive cells contained in the seminal fluid. testosterone The most potent male sex hormone, produced in the testes. uterus The reproductive organ which protects and nourishes the developing embryo/fetus. It is a hollow, muscular structure that is part of the female reproductive tract, and it is the source of a woman’s menses. vagina A tubular passageway in the female which connects the external sex organs with the cervix and uterus. IVF: In Vitro Fertilization(IVF) In vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy. In order to reach this potential, your participation and that of your physician (reproductive endocrinologist), nurses and embryologists require close coordination. Precise timing of medications is critical, and close monitoring with ultrasound is required. This reproductive journey is detailed and involved, but we are here to guide you and help ease as many of the complexities that may occur along the way. Please feel free to ask our nurses and physicians any questions you may have. IVF (In Vitro Fertilization) Overview With IVF, oocytes (eggs) are retrieved from the ovary and placed in a Petri dish with active, motile sperm. Because fertilization occurs in the Petri dish rather than in the woman’s body, this process has been called “in vitro.” The eggs and sperm are maintained in a special culture media (nutrient fluid) within a controlled environment (incubator). If a fertilized egg is developing properly, it will consist of 6-8 cells at 3 days after egg retrieval. If an embryo is continuing develop appropriately, it will form a blastocyst by 5-6 days after egg retrieval. After embryos have developed in the laboratory for several days, one or more are selected for transfer into your uterus and if additional embryos are developing, they may be frozen to be transferred at a future time. Step by step guide to IVF Although the details of individual cycles will vary, all of the assisted reproductive technologies have similar steps. 1. Pretreatment preparation 2. Ovulation induction 3. Oocyte retrieval 4. Fertilization of eggs in the laboratory 5. Embryo transfer 6. Luteal phase 7. Pregnancy test and pregnancy follow-up 1. Pretreatment preparation After the decision is made to proceed with IVF, you will meet with a Registered Nurse and will receive a medication log and a calendar outlining the treatment. In many cases, oral contraceptive pills (OCPs) will be prescribed in the cycle, prior to active treatment. The purpose of the OCP is to reduce the chance that an ovarian cyst will be present at the time when we plan to start treatment and to allow flexibility in the timing of the cycle (the number of days on OCP can be varied). Ultrasound. While you are on the OCP, you will have a Transvaginal ultrasound to assess whether there are any cysts present in the ovaries. In one commonly used protocol, you will begin a medication called Lupron (a GnRH agonist) while you are still taking the OCP. Your individual protocol may vary, and you may be prescribed a medicine other than Lupron (such as a GnRH antagonist called Ganirelix or Cetrotide) to prevent premature release of the eggs. Uterine screening. If you have not had an evaluation of your uterus within the last year, your MD may recommend a screening test as a hysteroscopy or a saline infusion sonography to be done while you are taking the OCP. You will be given more information about any procedure that will be recommended. Backup semen sample. In some cases a semen sample is obtained, frozen, and stored as a “back-up” specimen available on the day of egg retrieval. Please inform your MD or RN if you anticipate any difficulty in collecting a sample on the day of the retrieval so that you can arrange to have a back-sample frozen ahead of time. 2. Ovulation induction Success rates with reproductive technologies (ART) are improved if multiple mature oocytes are available for retrieval. In order to mature a group of eggs, medications are administered by subcutaneous injection on a daily basis. The medications are in a class called gonadotropins. Some of the commercial names are Follistim, Gonal-F, Menopur and Repronex. Baseline Ultrasound. Your baseline ultrasound will be performed before starting the gonadotropin. Occasionally you may have an ovarian cyst at this time. If you have a cyst, it often disappears with continued Lupron treatment, or less commonly your MD might recommend aspiration of the cyst. If the baseline ultrasound is normal, you will begin gonadrotropin injections. This medication will promote a group of several follicles (the sacs of fluid which contain the microscopic eggs) to develop together. Ideally about 10-12 follicles develop, but the response is quite variable and you may produce only 2-3 follicles, or as many as 20-30. The dose of medication you will receive is based on a prediction of how your ovaries will respond based on your age, your baseline FSH and estradiol levels, and any previous ovulation induction experience. When you begin the gonadotropin medication, it is important to not pursue intense physical exercise (kick boxing, jumping, etc.) because such activity could cause discomfort and twisting of the ovaries. The gonadotropin injections have some risks and side effects which are discussed in detail in the medication information and in consent forms that you will be given. Most women taking gonadotropin injections for IVF will feel a sense of fullness in their ovaries. Risks include ovarian hyperstimulation syndrome (OHSS) and multiple birth (particularly if multiple embryos are transferred). There has been some concern regarding the possibility of increased risk of ovarian cancer with the use of fertility medications. However, more recent studies have overall been reassuring. Timing of hCG. When ultrasound examination suggest that the eggs are mature (usually when the lead follicle size is about 18 mm in diameter), you will be asked to take an injection of human chorionic gonadotropin (hCG). The timing of the hCG is critical, so you need to take it precisely at the time given to you on the schedule. Once you take hCG, your gonadotropin and GnRH agonist or GnRH antagonist will stop. 3. Oocyte retrieval Approximately 35 hours after the hCG injection, the egg retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval. If you are taking medications for any other reason, talk to your MD or RN about taking medication prior to retrieval. Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the IVF laboratory. The egg retrieval takes approximately 20-30 minutes. After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small. On the day of egg retrieval, you will need to have someone available to drive you home (you cannot drive on the day of egg retrieval due to the intravenous medications that you will be receiving). You should not plan to do any work on the day of egg retrieval. Many women do return to work the next day, while others also rest the day following the retrieval. You may feel some pelvic heaviness or soreness and cramping. It is okay to take Tylenol, but you should avoid ibuprofen (i.e. Advil, Motrin). Often there is a small amount of spotting. Your bleeding should be less than a normal period. We recommend that you avoid immersing yourself in water (avoid swimming, take showers rather than baths, avoid vaginal intercourse) from the day of the retrieval for several days to allow the vagina to heal. After the procedure, you will be given complete written instructions and phone numbers. It is important to know that your ovaries are still enlarged immediately after the egg retrieval and that they remain enlarged for the next several weeks. For this reason, avoid heavy lifting or vigorous exertion such as running or aerobics until they return to normal size (which occurs either at 6-10 weeks into the pregnancy or with menses if pregnancy does not occur). It is okay to take stairs slowly, and walk short distances, less than a mile. Avoid any vaginal creams, lubricants, or spermicides other than the progesterone that is prescribed. Avoid hot tubs and Jacuzzis. Avoid intercourse until advised by your physician. If you travel, give yourself twice as much time as usual and minimize stress. Semen sample. Your partner will give a sperm sample the day of the egg retrieval. It is recommended that he abstain from ejaculation for 2 days (48 hours) to 5 days before giving the sample. 4. Fertilization of eggs Once the eggs are retrieved and placed in the incubator, they rest for several hours before the sperm is added, usually in the afternoon of the egg retrieval. Addition of sperm to the culture media is called insemination, and is followed by fertilization, when the sperm enters the egg. Fertilization can also be accomplished by ICSI (intracytoplasmatic sperm injection). ICSI will be recommended if your physician suspects that there will be a significant chance of no fertilization or a low rate of fertilization with conventional insemination of the oocytes in the laboratory. We will call you the day after retrieval to let you know how many eggs have fertilized. It is important to understand that all the embryos may not be able to be observed on that day and that of those that are seen, they may not continue to grow. The embryo can begin cleaving, or dividing, first into two cells, then into four. Cleavage to four cells generally takes 36-48 hours or more after the egg retrieval. After 3 days, an embryo which is growing properly will have 6-8 cells. An embryo should reach a blastocyst stage at 5-6 days after retrieval. 5. Embryo transfer Three to five days after the oocyte retrieval you will be scheduled for your embryo transfer. Your physician will recommend which day is most appropriate for you. In general, blastocyst transfer is recommended when there are a large number of embryos of good quality, or for couples desiring only a single embryo to be transferred. Your physician will give you a recommendation regarding the number of embryos to be transferred based on your age, your history if you have had IVF performed in the past, and the quality of the embryos. Abdominal ultrasound is used to guide the transfer. To perform the transfer, your physician will place a speculum in the vagina and the cervix will be rinsed with a sterile solution. The embryologist in the laboratory will load the embryos into a small catheter and your physician will ease the tip of the catheter through the cervix into the uterus. You may have a sensation or twinge as the catheter passes through your cervix or you may not feel anything. For this reason, anesthesia is not used for the transfer. On the day of your transfer wear comfortable clothing and socks to keep your feet warm. Your bladder should feel full, but not very uncomfortable. A partially full bladder often will allow the transfer to be completed more easily and will allow a better picture on the abdominal ultrasound. We suggest that you rest the day after the transfer, to allow yourself time to relax as much as possible. Also, your ovaries will still be enlarged and activity should be minimized as described above to prevent ovarian discomfort. However, it is important to know that nothing you will do, such as walking or going to the bathroom will cause the embryos to dislodge from the uterine wall. The main factors that determine whether an embryo will implant are the viability (“health”) of the embryo and the quality of the uterine lining. Healthy embryos will be much more likely to implant and develop than embryos which are not viable. 6. Luteal phase You will take progesterone by injection and/or vaginal suppository gel because it has been shown that progesterone supplementation increases the chance of success with IVF. Progesterone is the natural hormone that your body produces to support the uterine lining and maintain an early pregnancy. Although the FDA requires the drug manufacturer to include warnings about using progesterone in early pregnancy, this is due to the fact that progestins (a synthetic progesterone-like substance) or high doses of progesterone in animal experienced have raised concerns. However, you will only receive progesterone, the same natural hormone your ovaries produce, in a dose that is not excessive. After the egg retrieval, you will receive your first dose of progesterone. You will continue this daily for the next two weeks according to a schedule you will receive. This schedule will include the dose you should take. As noted above, it is common to have a sensation of heaviness or cramping in your pelvis 4-10 days after egg retrieval. Your ovaries frequently enlarge at this time. If you are gaining weight rapidly (more than a pound a day) which can occur due to fluid retention, or if you are not urinating the normal amount for you, or if you have any other concerns, please call. Light bleeding sometimes occurs in the weeks following egg retrieval, even if there is a normally developing pregnancy. A pregnancy test will be performed approximately two weeks after your egg retrieval. Waiting for your pregnancy test is a difficult time. It is not unusual to have symptoms of pregnancy that come and go due to the hormonal changes with IVF. The only way to know whether or not you are pregnant is by the pregnancy test done two weeks after egg retrieval. Bleeding may occur even if a pregnancy is developing normally. Please continue to take the progesterone that is prescribed until your pregnancy test, even if you think you may not be pregnant. Because the hormones that you are taking may confuse the symptoms that you have come to recognize as signs that you may or may not be pregnant, try not to guess or do home pregnancy tests before the blood test. They may not be accurate. If the first test is positive, you will be asked to return for a follow-up test 2-3 days later to see that the level of the hormone hCG is rising appropriately. Hopefully you will receive good news and find out that the pregnancy test is positive and have follow-up as described below. If unfortunately you are not pregnant, you will be instructed to stop the progesterone and expect a period within 2-5 days (you should call us if a menses does not occur within about 5 days of stopping progesterone). If you do not conceive, you may find it helpful to schedule a follow-up visit with the MD to occur about 2 weeks after your pregnancy test results. This visit is important so we can counsel you regarding your next steps. Another cycle of treatment can begin as soon as one month after a failed cycle. Pregnancy Hopefully, you will be pregnant, and an ultrasound will be scheduled 4-5 weeks after your egg retrieval. The ultrasound will be done again 2 weeks later (6-7 weeks from retrieval). We will then refer you to your obstetrician for the remainder of the pregnancy. You will remain on progesterone until 8-10 weeks from your retrieval. We truly look forward to hearing from you when you deliver your child. Evaluation for Fertility,Preconception Care, Ovulation Induction/IUI,In Vitro Fertilization (IVF),Third Party Program,REI Laboratory,IVF Laboratory,Reproductive Surgery,Recurrent Pregnancy Loss,Fertility Preservation,Emotional Support,Patient Resources,Financial Services,Fertility Statistics,]]> Tue, 03 Jun 2008 02:26:34 GMT http://www.slideshare.net/ivfworld/ivf-clinics ivfworld@slideshare.net(ivfworld) Ivf clinics ivfworld info@shivaniscientific.com http://www.shivaniscientific.com Infertility Treatment - Overview, IVF, GIFT, TET, Microsurgical Tubal Reanastomosis, Frequently Asked Questions, Women Over 40, PCOS, Assisted Hatching, Microsurgery, Immunological Testing and Treatment, Donor Egg, ICSI, Hysterectomy, Laparoscopic Procedures, Sex Selection You need information about IVF, ICSI, infertility clinics, donor egg and surrogacy services (e.g., surrogate mothers), tubal reversal doctors, vasectomy reversal doctors, natural infertility treatment, male infertility services, sperm banks, pharmacies, infertility books and videotapes, sperm testing, infertility support, and drugs and medications, such as Metrodin, Pergonal, Clomid. Infertility News and Announcements Infertility Service Providers 1. Infertility IVF clinics 9. Lawyers 2. Egg donor programs 10. Pharmacies 3. Tubal reversal doctors 11. Surrogacy programs 4. Vasectomy reversal doctors 12. Counselors &amp; consultants 5. Financial assistance 13. Egg Freezing 6. Natural treatment 13. PGD programs 7. Sperm banks 14. Embryo adoption 8. Male infertility doctors 15. Adoption Agencies Infertility Products 1. Women - fertility monitors, etc. 5. Conception products 2. Women - fertility supplements 6. Fertility product stores 3. Men - sperm testing 7. Infertility books 4. Men - fertility supplements 8. Infertility videos and CDs Education 1. Main 8. Financial and Insurance 2. Diagnosis 9. Legal Rights 3. Male Factor 10. Psychological and Social 4. Treatment 11. Infertility Photos 5. Egg Donation and Egg Donors 12. Miscellaneous 6. Drugs and Medications MORE ON IVF: Glossary adhesions Bands of scar tissue attached to organ surfaces and capable of connecting, covering, or distorting organs, such as tubes, ovaries or uterus. AID (artificial insemination, donor) A procedure introducing sperm from an anonymous donor into a woman&rsquo;s uterus in order to achieve a pregnancy. AIH (artificial insemination, husband or homologous) A special insemination procedure used to introduce sperm collected from a woman&rsquo;s partner into the woman&rsquo;s uterus. Also referred to as intrauterine insemination (IUI). antisperm antibodies Antibodies that may be produced by either a female or male which may damage sperm or cause them to adhere to each other, thus limiting their fertility potential. azoospermia The absence of sperm in the ejaculate. cervical mucus Mucus produced by the cervix which changes in thickness and quantity at the time of ovulation. cervix The lower section of the uterus which protrudes into the vagina and serves as a passageway for sperm into the uterus. Corpus Luteum A structure in the ovary that develops after the egg is released, which secretes progesterone. cryopreservation The preservation of sperm or embryos by freezing, usually by immersion in liquid nitrogen. endometriosis The presence of endometrial tissue in abnormal locations, such as the fallopian tubes, ovaries and abdominal cavity. The condition frequently causes pain and discomfort during menstruation, or even chronic pelvic pain, and may also cause infertility. endometrium The inner lining of the uterus. estrogen The primary female hormone produced mainly by the ovaries from puberty to menopause. fallopian tube The tube that connects the uterus and ovary. It allows the egg to pass from the ovary to the uterus and the spermatozoa from the uterus toward the ovary. fibroids Smooth muscle tumors of the muscular wall of the uterus which are almost always benign but may cause infertility or recurrent miscarriages. follicle A cystic structure in the ovary which contains and nurtures the ovum (egg). It enlarges to a diameter of 18 - 28 mm (3/4 - 1 inch) before ovulation, at which point it releases the egg. FSH (follicle stimulating hormone) A hormone that recruits and then stimulates growth of the follicle in the ovary, as well as the formation of spermatozoa in the testes. GIFT (gamete intrafallopian transfer) A procedure in which eggs are removed from a ripened follicle and via laparoscopy are placed with sperm into the fallopian tube, where fertilization takes place. gonadotropin A hormone (FSH, LH, hMG, hCG) which stimulates the gonads (ovaries or testes). GnRH (gonadotropin releasing hormone) A small hormone produced by the brain which causes the pituitary gland to manufacture and release FSH and LH. GnRH agonist (Lupron) Differs from GnRH at 2 amino-acid positions. Used to stop production of FSH and LH from the pituitary gland. Gonal-F The brand name of a new recombinant FSH used to stimulate the ovaries to produce follicles. Follistim is the brand name of another recombinant FSH on the market. hCG (human chorionic gonadotropin) A hormone produced by the placenta. Detection of its presence in urine or blood is the basis of the pregnancy test. Also used to trigger final maturation and ovulation of the egg. hMG (human menopausal gonadotropin) A hormone (Pergonal or Humegon) used to stimulate follicle production. Equal parts of FSH and LH are present. hysteroscopy An endoscopic (fiber-optic tube) procedure used primarily to visualize the interior of the uterus. implantation The embedding of the embryo in the uterine wall. in-vitro fertilization/embryo transfer A procedure in which an egg is removed from a ripe follicle and fertilized with sperm outside the body. The resulting embryo is inserted into the woman&rsquo;s uterus. laparoscopy An abdominal surgical procedure using an endoscopic instrument (fiber-optic tube) to view the fallopian tubes, ovaries, uterus, and other abdominal structures. The laparoscope may also be used to perform surgical procedures, employing the use of lasers and other specialized equipment. LH (luteinizing hormone) A hormone produced and released by the pituitary gland. In the female, it is responsible for maturation and then the release of the ovum. In the male, it stimulates testosterone production. Lutrepulse The trade name for a gonadotropin releasing hormone (GnRH) used to induce ovulation in some patients. It is administered through an infusion pump in a pulsatile fashion. oligospermia The presence of a low number of sperm in the ejaculate. ovum The egg cell (gamete) produced in a woman&rsquo;s ovaries during each menstrual cycle. ovulation The release of a mature egg from the surface of the ovary. pituitary gland A gland at the base of the brain which produces many hormones, including FSH and LH. polyps Small, benign growths protruding from the lining of the endometrium or endocervix. progesterone A hormone produced and released during the second half of a woman&rsquo;s ovulatory cycle. It is necessary in the preparation of the uterine lining for implantation of the fertilized egg. semen The sperm and seminal secretions ejaculated by the male during orgasm. sperm Male reproductive cells contained in the seminal fluid. testosterone The most potent male sex hormone, produced in the testes. uterus The reproductive organ which protects and nourishes the developing embryo/fetus. It is a hollow, muscular structure that is part of the female reproductive tract, and it is the source of a woman&rsquo;s menses. vagina A tubular passageway in the female which connects the external sex organs with the cervix and uterus. IVF: In Vitro Fertilization(IVF) In vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy. In order to reach this potential, your participation and that of your physician (reproductive endocrinologist), nurses and embryologists require close coordination. Precise timing of medications is critical, and close monitoring with ultrasound is required. This reproductive journey is detailed and involved, but we are here to guide you and help ease as many of the complexities that may occur along the way. Please feel free to ask our nurses and physicians any questions you may have. IVF (In Vitro Fertilization) Overview With IVF, oocytes (eggs) are retrieved from the ovary and placed in a Petri dish with active, motile sperm. Because fertilization occurs in the Petri dish rather than in the woman’s body, this process has been called “in vitro.” The eggs and sperm are maintained in a special culture media (nutrient fluid) within a controlled environment (incubator). If a fertilized egg is developing properly, it will consist of 6-8 cells at 3 days after egg retrieval. If an embryo is continuing develop appropriately, it will form a blastocyst by 5-6 days after egg retrieval. After embryos have developed in the laboratory for several days, one or more are selected for transfer into your uterus and if additional embryos are developing, they may be frozen to be transferred at a future time. Step by step guide to IVF Although the details of individual cycles will vary, all of the assisted reproductive technologies have similar steps. 1. Pretreatment preparation 2. Ovulation induction 3. Oocyte retrieval 4. Fertilization of eggs in the laboratory 5. Embryo transfer 6. Luteal phase 7. Pregnancy test and pregnancy follow-up 1. Pretreatment preparation After the decision is made to proceed with IVF, you will meet with a Registered Nurse and will receive a medication log and a calendar outlining the treatment. In many cases, oral contraceptive pills (OCPs) will be prescribed in the cycle, prior to active treatment. The purpose of the OCP is to reduce the chance that an ovarian cyst will be present at the time when we plan to start treatment and to allow flexibility in the timing of the cycle (the number of days on OCP can be varied). Ultrasound. While you are on the OCP, you will have a Transvaginal ultrasound to assess whether there are any cysts present in the ovaries. In one commonly used protocol, you will begin a medication called Lupron (a GnRH agonist) while you are still taking the OCP. Your individual protocol may vary, and you may be prescribed a medicine other than Lupron (such as a GnRH antagonist called Ganirelix or Cetrotide) to prevent premature release of the eggs. Uterine screening. If you have not had an evaluation of your uterus within the last year, your MD may recommend a screening test as a hysteroscopy or a saline infusion sonography to be done while you are taking the OCP. You will be given more information about any procedure that will be recommended. Backup semen sample. In some cases a semen sample is obtained, frozen, and stored as a “back-up” specimen available on the day of egg retrieval. Please inform your MD or RN if you anticipate any difficulty in collecting a sample on the day of the retrieval so that you can arrange to have a back-sample frozen ahead of time. 2. Ovulation induction Success rates with reproductive technologies (ART) are improved if multiple mature oocytes are available for retrieval. In order to mature a group of eggs, medications are administered by subcutaneous injection on a daily basis. The medications are in a class called gonadotropins. Some of the commercial names are Follistim, Gonal-F, Menopur and Repronex. Baseline Ultrasound. Your baseline ultrasound will be performed before starting the gonadotropin. Occasionally you may have an ovarian cyst at this time. If you have a cyst, it often disappears with continued Lupron treatment, or less commonly your MD might recommend aspiration of the cyst. If the baseline ultrasound is normal, you will begin gonadrotropin injections. This medication will promote a group of several follicles (the sacs of fluid which contain the microscopic eggs) to develop together. Ideally about 10-12 follicles develop, but the response is quite variable and you may produce only 2-3 follicles, or as many as 20-30. The dose of medication you will receive is based on a prediction of how your ovaries will respond based on your age, your baseline FSH and estradiol levels, and any previous ovulation induction experience. When you begin the gonadotropin medication, it is important to not pursue intense physical exercise (kick boxing, jumping, etc.) because such activity could cause discomfort and twisting of the ovaries. The gonadotropin injections have some risks and side effects which are discussed in detail in the medication information and in consent forms that you will be given. Most women taking gonadotropin injections for IVF will feel a sense of fullness in their ovaries. Risks include ovarian hyperstimulation syndrome (OHSS) and multiple birth (particularly if multiple embryos are transferred). There has been some concern regarding the possibility of increased risk of ovarian cancer with the use of fertility medications. However, more recent studies have overall been reassuring. Timing of hCG. When ultrasound examination suggest that the eggs are mature (usually when the lead follicle size is about 18 mm in diameter), you will be asked to take an injection of human chorionic gonadotropin (hCG). The timing of the hCG is critical, so you need to take it precisely at the time given to you on the schedule. Once you take hCG, your gonadotropin and GnRH agonist or GnRH antagonist will stop. 3. Oocyte retrieval Approximately 35 hours after the hCG injection, the egg retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval. If you are taking medications for any other reason, talk to your MD or RN about taking medication prior to retrieval. Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the IVF laboratory. The egg retrieval takes approximately 20-30 minutes. After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small. On the day of egg retrieval, you will need to have someone available to drive you home (you cannot drive on the day of egg retrieval due to the intravenous medications that you will be receiving). You should not plan to do any work on the day of egg retrieval. Many women do return to work the next day, while others also rest the day following the retrieval. You may feel some pelvic heaviness or soreness and cramping. It is okay to take Tylenol, but you should avoid ibuprofen (i.e. Advil, Motrin). Often there is a small amount of spotting. Your bleeding should be less than a normal period. We recommend that you avoid immersing yourself in water (avoid swimming, take showers rather than baths, avoid vaginal intercourse) from the day of the retrieval for several days to allow the vagina to heal. After the procedure, you will be given complete written instructions and phone numbers. It is important to know that your ovaries are still enlarged immediately after the egg retrieval and that they remain enlarged for the next several weeks. For this reason, avoid heavy lifting or vigorous exertion such as running or aerobics until they return to normal size (which occurs either at 6-10 weeks into the pregnancy or with menses if pregnancy does not occur). It is okay to take stairs slowly, and walk short distances, less than a mile. Avoid any vaginal creams, lubricants, or spermicides other than the progesterone that is prescribed. Avoid hot tubs and Jacuzzis. Avoid intercourse until advised by your physician. If you travel, give yourself twice as much time as usual and minimize stress. Semen sample. Your partner will give a sperm sample the day of the egg retrieval. It is recommended that he abstain from ejaculation for 2 days (48 hours) to 5 days before giving the sample. 4. Fertilization of eggs Once the eggs are retrieved and placed in the incubator, they rest for several hours before the sperm is added, usually in the afternoon of the egg retrieval. Addition of sperm to the culture media is called insemination, and is followed by fertilization, when the sperm enters the egg. Fertilization can also be accomplished by ICSI (intracytoplasmatic sperm injection). ICSI will be recommended if your physician suspects that there will be a significant chance of no fertilization or a low rate of fertilization with conventional insemination of the oocytes in the laboratory. We will call you the day after retrieval to let you know how many eggs have fertilized. It is important to understand that all the embryos may not be able to be observed on that day and that of those that are seen, they may not continue to grow. The embryo can begin cleaving, or dividing, first into two cells, then into four. Cleavage to four cells generally takes 36-48 hours or more after the egg retrieval. After 3 days, an embryo which is growing properly will have 6-8 cells. An embryo should reach a blastocyst stage at 5-6 days after retrieval. 5. Embryo transfer Three to five days after the oocyte retrieval you will be scheduled for your embryo transfer. Your physician will recommend which day is most appropriate for you. In general, blastocyst transfer is recommended when there are a large number of embryos of good quality, or for couples desiring only a single embryo to be transferred. Your physician will give you a recommendation regarding the number of embryos to be transferred based on your age, your history if you have had IVF performed in the past, and the quality of the embryos. Abdominal ultrasound is used to guide the transfer. To perform the transfer, your physician will place a speculum in the vagina and the cervix will be rinsed with a sterile solution. The embryologist in the laboratory will load the embryos into a small catheter and your physician will ease the tip of the catheter through the cervix into the uterus. You may have a sensation or twinge as the catheter passes through your cervix or you may not feel anything. For this reason, anesthesia is not used for the transfer. On the day of your transfer wear comfortable clothing and socks to keep your feet warm. Your bladder should feel full, but not very uncomfortable. A partially full bladder often will allow the transfer to be completed more easily and will allow a better picture on the abdominal ultrasound. We suggest that you rest the day after the transfer, to allow yourself time to relax as much as possible. Also, your ovaries will still be enlarged and activity should be minimized as described above to prevent ovarian discomfort. However, it is important to know that nothing you will do, such as walking or going to the bathroom will cause the embryos to dislodge from the uterine wall. The main factors that determine whether an embryo will implant are the viability (“health”) of the embryo and the quality of the uterine lining. Healthy embryos will be much more likely to implant and develop than embryos which are not viable. 6. Luteal phase You will take progesterone by injection and/or vaginal suppository gel because it has been shown that progesterone supplementation increases the chance of success with IVF. Progesterone is the natural hormone that your body produces to support the uterine lining and maintain an early pregnancy. Although the FDA requires the drug manufacturer to include warnings about using progesterone in early pregnancy, this is due to the fact that progestins (a synthetic progesterone-like substance) or high doses of progesterone in animal experienced have raised concerns. However, you will only receive progesterone, the same natural hormone your ovaries produce, in a dose that is not excessive. After the egg retrieval, you will receive your first dose of progesterone. You will continue this daily for the next two weeks according to a schedule you will receive. This schedule will include the dose you should take. As noted above, it is common to have a sensation of heaviness or cramping in your pelvis 4-10 days after egg retrieval. Your ovaries frequently enlarge at this time. If you are gaining weight rapidly (more than a pound a day) which can occur due to fluid retention, or if you are not urinating the normal amount for you, or if you have any other concerns, please call. Light bleeding sometimes occurs in the weeks following egg retrieval, even if there is a normally developing pregnancy. A pregnancy test will be performed approximately two weeks after your egg retrieval. Waiting for your pregnancy test is a difficult time. It is not unusual to have symptoms of pregnancy that come and go due to the hormonal changes with IVF. The only way to know whether or not you are pregnant is by the pregnancy test done two weeks after egg retrieval. Bleeding may occur even if a pregnancy is developing normally. Please continue to take the progesterone that is prescribed until your pregnancy test, even if you think you may not be pregnant. Because the hormones that you are taking may confuse the symptoms that you have come to recognize as signs that you may or may not be pregnant, try not to guess or do home pregnancy tests before the blood test. They may not be accurate. If the first test is positive, you will be asked to return for a follow-up test 2-3 days later to see that the level of the hormone hCG is rising appropriately. Hopefully you will receive good news and find out that the pregnancy test is positive and have follow-up as described below. If unfortunately you are not pregnant, you will be instructed to stop the progesterone and expect a period within 2-5 days (you should call us if a menses does not occur within about 5 days of stopping progesterone). If you do not conceive, you may find it helpful to schedule a follow-up visit with the MD to occur about 2 weeks after your pregnancy test results. This visit is important so we can counsel you regarding your next steps. Another cycle of treatment can begin as soon as one month after a failed cycle. Pregnancy Hopefully, you will be pregnant, and an ultrasound will be scheduled 4-5 weeks after your egg retrieval. The ultrasound will be done again 2 weeks later (6-7 weeks from retrieval). We will then refer you to your obstetrician for the remainder of the pregnancy. You will remain on progesterone until 8-10 weeks from your retrieval. We truly look forward to hearing from you when you deliver your child. 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Drugs and Medications MORE ON IVF: Glossary adhesions Bands of scar tissue attached to organ surfaces and capable of connecting, covering, or distorting organs, such as tubes, ovaries or uterus. AID (artificial insemination, donor) A procedure introducing sperm from an anonymous donor into a woman&rsquo;s uterus in order to achieve a pregnancy. AIH (artificial insemination, husband or homologous) A special insemination procedure used to introduce sperm collected from a woman&rsquo;s partner into the woman&rsquo;s uterus. Also referred to as intrauterine insemination (IUI). antisperm antibodies Antibodies that may be produced by either a female or male which may damage sperm or cause them to adhere to each other, thus limiting their fertility potential. azoospermia The absence of sperm in the ejaculate. cervical mucus Mucus produced by the cervix which changes in thickness and quantity at the time of ovulation. cervix The lower section of the uterus which protrudes into the vagina and serves as a passageway for sperm into the uterus. Corpus Luteum A structure in the ovary that develops after the egg is released, which secretes progesterone. cryopreservation The preservation of sperm or embryos by freezing, usually by immersion in liquid nitrogen. endometriosis The presence of endometrial tissue in abnormal locations, such as the fallopian tubes, ovaries and abdominal cavity. The condition frequently causes pain and discomfort during menstruation, or even chronic pelvic pain, and may also cause infertility. endometrium The inner lining of the uterus. estrogen The primary female hormone produced mainly by the ovaries from puberty to menopause. fallopian tube The tube that connects the uterus and ovary. It allows the egg to pass from the ovary to the uterus and the spermatozoa from the uterus toward the ovary. fibroids Smooth muscle tumors of the muscular wall of the uterus which are almost always benign but may cause infertility or recurrent miscarriages. follicle A cystic structure in the ovary which contains and nurtures the ovum (egg). It enlarges to a diameter of 18 - 28 mm (3/4 - 1 inch) before ovulation, at which point it releases the egg. FSH (follicle stimulating hormone) A hormone that recruits and then stimulates growth of the follicle in the ovary, as well as the formation of spermatozoa in the testes. GIFT (gamete intrafallopian transfer) A procedure in which eggs are removed from a ripened follicle and via laparoscopy are placed with sperm into the fallopian tube, where fertilization takes place. gonadotropin A hormone (FSH, LH, hMG, hCG) which stimulates the gonads (ovaries or testes). GnRH (gonadotropin releasing hormone) A small hormone produced by the brain which causes the pituitary gland to manufacture and release FSH and LH. GnRH agonist (Lupron) Differs from GnRH at 2 amino-acid positions. Used to stop production of FSH and LH from the pituitary gland. Gonal-F The brand name of a new recombinant FSH used to stimulate the ovaries to produce follicles. Follistim is the brand name of another recombinant FSH on the market. hCG (human chorionic gonadotropin) A hormone produced by the placenta. Detection of its presence in urine or blood is the basis of the pregnancy test. Also used to trigger final maturation and ovulation of the egg. hMG (human menopausal gonadotropin) A hormone (Pergonal or Humegon) used to stimulate follicle production. Equal parts of FSH and LH are present. hysteroscopy An endoscopic (fiber-optic tube) procedure used primarily to visualize the interior of the uterus. implantation The embedding of the embryo in the uterine wall. in-vitro fertilization/embryo transfer A procedure in which an egg is removed from a ripe follicle and fertilized with sperm outside the body. The resulting embryo is inserted into the woman&rsquo;s uterus. laparoscopy An abdominal surgical procedure using an endoscopic instrument (fiber-optic tube) to view the fallopian tubes, ovaries, uterus, and other abdominal structures. The laparoscope may also be used to perform surgical procedures, employing the use of lasers and other specialized equipment. LH (luteinizing hormone) A hormone produced and released by the pituitary gland. In the female, it is responsible for maturation and then the release of the ovum. In the male, it stimulates testosterone production. Lutrepulse The trade name for a gonadotropin releasing hormone (GnRH) used to induce ovulation in some patients. It is administered through an infusion pump in a pulsatile fashion. oligospermia The presence of a low number of sperm in the ejaculate. ovum The egg cell (gamete) produced in a woman&rsquo;s ovaries during each menstrual cycle. ovulation The release of a mature egg from the surface of the ovary. pituitary gland A gland at the base of the brain which produces many hormones, including FSH and LH. polyps Small, benign growths protruding from the lining of the endometrium or endocervix. progesterone A hormone produced and released during the second half of a woman&rsquo;s ovulatory cycle. It is necessary in the preparation of the uterine lining for implantation of the fertilized egg. semen The sperm and seminal secretions ejaculated by the male during orgasm. sperm Male reproductive cells contained in the seminal fluid. testosterone The most potent male sex hormone, produced in the testes. uterus The reproductive organ which protects and nourishes the developing embryo/fetus. It is a hollow, muscular structure that is part of the female reproductive tract, and it is the source of a woman&rsquo;s menses. vagina A tubular passageway in the female which connects the external sex organs with the cervix and uterus. IVF: In Vitro Fertilization(IVF) In vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy. In order to reach this potential, your participation and that of your physician (reproductive endocrinologist), nurses and embryologists require close coordination. Precise timing of medications is critical, and close monitoring with ultrasound is required. This reproductive journey is detailed and involved, but we are here to guide you and help ease as many of the complexities that may occur along the way. Please feel free to ask our nurses and physicians any questions you may have. IVF (In Vitro Fertilization) Overview With IVF, oocytes (eggs) are retrieved from the ovary and placed in a Petri dish with active, motile sperm. Because fertilization occurs in the Petri dish rather than in the woman’s body, this process has been called “in vitro.” The eggs and sperm are maintained in a special culture media (nutrient fluid) within a controlled environment (incubator). If a fertilized egg is developing properly, it will consist of 6-8 cells at 3 days after egg retrieval. If an embryo is continuing develop appropriately, it will form a blastocyst by 5-6 days after egg retrieval. After embryos have developed in the laboratory for several days, one or more are selected for transfer into your uterus and if additional embryos are developing, they may be frozen to be transferred at a future time. Step by step guide to IVF Although the details of individual cycles will vary, all of the assisted reproductive technologies have similar steps. 1. Pretreatment preparation 2. Ovulation induction 3. Oocyte retrieval 4. Fertilization of eggs in the laboratory 5. Embryo transfer 6. Luteal phase 7. Pregnancy test and pregnancy follow-up 1. Pretreatment preparation After the decision is made to proceed with IVF, you will meet with a Registered Nurse and will receive a medication log and a calendar outlining the treatment. In many cases, oral contraceptive pills (OCPs) will be prescribed in the cycle, prior to active treatment. The purpose of the OCP is to reduce the chance that an ovarian cyst will be present at the time when we plan to start treatment and to allow flexibility in the timing of the cycle (the number of days on OCP can be varied). Ultrasound. While you are on the OCP, you will have a Transvaginal ultrasound to assess whether there are any cysts present in the ovaries. In one commonly used protocol, you will begin a medication called Lupron (a GnRH agonist) while you are still taking the OCP. Your individual protocol may vary, and you may be prescribed a medicine other than Lupron (such as a GnRH antagonist called Ganirelix or Cetrotide) to prevent premature release of the eggs. Uterine screening. If you have not had an evaluation of your uterus within the last year, your MD may recommend a screening test as a hysteroscopy or a saline infusion sonography to be done while you are taking the OCP. You will be given more information about any procedure that will be recommended. Backup semen sample. In some cases a semen sample is obtained, frozen, and stored as a “back-up” specimen available on the day of egg retrieval. Please inform your MD or RN if you anticipate any difficulty in collecting a sample on the day of the retrieval so that you can arrange to have a back-sample frozen ahead of time. 2. Ovulation induction Success rates with reproductive technologies (ART) are improved if multiple mature oocytes are available for retrieval. In order to mature a group of eggs, medications are administered by subcutaneous injection on a daily basis. The medications are in a class called gonadotropins. Some of the commercial names are Follistim, Gonal-F, Menopur and Repronex. Baseline Ultrasound. Your baseline ultrasound will be performed before starting the gonadotropin. Occasionally you may have an ovarian cyst at this time. If you have a cyst, it often disappears with continued Lupron treatment, or less commonly your MD might recommend aspiration of the cyst. If the baseline ultrasound is normal, you will begin gonadrotropin injections. This medication will promote a group of several follicles (the sacs of fluid which contain the microscopic eggs) to develop together. Ideally about 10-12 follicles develop, but the response is quite variable and you may produce only 2-3 follicles, or as many as 20-30. The dose of medication you will receive is based on a prediction of how your ovaries will respond based on your age, your baseline FSH and estradiol levels, and any previous ovulation induction experience. When you begin the gonadotropin medication, it is important to not pursue intense physical exercise (kick boxing, jumping, etc.) because such activity could cause discomfort and twisting of the ovaries. The gonadotropin injections have some risks and side effects which are discussed in detail in the medication information and in consent forms that you will be given. Most women taking gonadotropin injections for IVF will feel a sense of fullness in their ovaries. Risks include ovarian hyperstimulation syndrome (OHSS) and multiple birth (particularly if multiple embryos are transferred). There has been some concern regarding the possibility of increased risk of ovarian cancer with the use of fertility medications. However, more recent studies have overall been reassuring. Timing of hCG. When ultrasound examination suggest that the eggs are mature (usually when the lead follicle size is about 18 mm in diameter), you will be asked to take an injection of human chorionic gonadotropin (hCG). The timing of the hCG is critical, so you need to take it precisely at the time given to you on the schedule. Once you take hCG, your gonadotropin and GnRH agonist or GnRH antagonist will stop. 3. Oocyte retrieval Approximately 35 hours after the hCG injection, the egg retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval. If you are taking medications for any other reason, talk to your MD or RN about taking medication prior to retrieval. Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the IVF laboratory. The egg retrieval takes approximately 20-30 minutes. After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small. On the day of egg retrieval, you will need to have someone available to drive you home (you cannot drive on the day of egg retrieval due to the intravenous medications that you will be receiving). You should not plan to do any work on the day of egg retrieval. Many women do return to work the next day, while others also rest the day following the retrieval. You may feel some pelvic heaviness or soreness and cramping. It is okay to take Tylenol, but you should avoid ibuprofen (i.e. Advil, Motrin). Often there is a small amount of spotting. Your bleeding should be less than a normal period. We recommend that you avoid immersing yourself in water (avoid swimming, take showers rather than baths, avoid vaginal intercourse) from the day of the retrieval for several days to allow the vagina to heal. After the procedure, you will be given complete written instructions and phone numbers. It is important to know that your ovaries are still enlarged immediately after the egg retrieval and that they remain enlarged for the next several weeks. For this reason, avoid heavy lifting or vigorous exertion such as running or aerobics until they return to normal size (which occurs either at 6-10 weeks into the pregnancy or with menses if pregnancy does not occur). It is okay to take stairs slowly, and walk short distances, less than a mile. Avoid any vaginal creams, lubricants, or spermicides other than the progesterone that is prescribed. Avoid hot tubs and Jacuzzis. Avoid intercourse until advised by your physician. If you travel, give yourself twice as much time as usual and minimize stress. Semen sample. Your partner will give a sperm sample the day of the egg retrieval. It is recommended that he abstain from ejaculation for 2 days (48 hours) to 5 days before giving the sample. 4. Fertilization of eggs Once the eggs are retrieved and placed in the incubator, they rest for several hours before the sperm is added, usually in the afternoon of the egg retrieval. Addition of sperm to the culture media is called insemination, and is followed by fertilization, when the sperm enters the egg. Fertilization can also be accomplished by ICSI (intracytoplasmatic sperm injection). ICSI will be recommended if your physician suspects that there will be a significant chance of no fertilization or a low rate of fertilization with conventional insemination of the oocytes in the laboratory. We will call you the day after retrieval to let you know how many eggs have fertilized. It is important to understand that all the embryos may not be able to be observed on that day and that of those that are seen, they may not continue to grow. The embryo can begin cleaving, or dividing, first into two cells, then into four. Cleavage to four cells generally takes 36-48 hours or more after the egg retrieval. After 3 days, an embryo which is growing properly will have 6-8 cells. An embryo should reach a blastocyst stage at 5-6 days after retrieval. 5. Embryo transfer Three to five days after the oocyte retrieval you will be scheduled for your embryo transfer. Your physician will recommend which day is most appropriate for you. In general, blastocyst transfer is recommended when there are a large number of embryos of good quality, or for couples desiring only a single embryo to be transferred. Your physician will give you a recommendation regarding the number of embryos to be transferred based on your age, your history if you have had IVF performed in the past, and the quality of the embryos. Abdominal ultrasound is used to guide the transfer. To perform the transfer, your physician will place a speculum in the vagina and the cervix will be rinsed with a sterile solution. The embryologist in the laboratory will load the embryos into a small catheter and your physician will ease the tip of the catheter through the cervix into the uterus. You may have a sensation or twinge as the catheter passes through your cervix or you may not feel anything. For this reason, anesthesia is not used for the transfer. On the day of your transfer wear comfortable clothing and socks to keep your feet warm. Your bladder should feel full, but not very uncomfortable. A partially full bladder often will allow the transfer to be completed more easily and will allow a better picture on the abdominal ultrasound. We suggest that you rest the day after the transfer, to allow yourself time to relax as much as possible. Also, your ovaries will still be enlarged and activity should be minimized as described above to prevent ovarian discomfort. However, it is important to know that nothing you will do, such as walking or going to the bathroom will cause the embryos to dislodge from the uterine wall. The main factors that determine whether an embryo will implant are the viability (“health”) of the embryo and the quality of the uterine lining. Healthy embryos will be much more likely to implant and develop than embryos which are not viable. 6. Luteal phase You will take progesterone by injection and/or vaginal suppository gel because it has been shown that progesterone supplementation increases the chance of success with IVF. Progesterone is the natural hormone that your body produces to support the uterine lining and maintain an early pregnancy. Although the FDA requires the drug manufacturer to include warnings about using progesterone in early pregnancy, this is due to the fact that progestins (a synthetic progesterone-like substance) or high doses of progesterone in animal experienced have raised concerns. However, you will only receive progesterone, the same natural hormone your ovaries produce, in a dose that is not excessive. After the egg retrieval, you will receive your first dose of progesterone. You will continue this daily for the next two weeks according to a schedule you will receive. This schedule will include the dose you should take. As noted above, it is common to have a sensation of heaviness or cramping in your pelvis 4-10 days after egg retrieval. Your ovaries frequently enlarge at this time. If you are gaining weight rapidly (more than a pound a day) which can occur due to fluid retention, or if you are not urinating the normal amount for you, or if you have any other concerns, please call. Light bleeding sometimes occurs in the weeks following egg retrieval, even if there is a normally developing pregnancy. A pregnancy test will be performed approximately two weeks after your egg retrieval. Waiting for your pregnancy test is a difficult time. It is not unusual to have symptoms of pregnancy that come and go due to the hormonal changes with IVF. The only way to know whether or not you are pregnant is by the pregnancy test done two weeks after egg retrieval. Bleeding may occur even if a pregnancy is developing normally. Please continue to take the progesterone that is prescribed until your pregnancy test, even if you think you may not be pregnant. Because the hormones that you are taking may confuse the symptoms that you have come to recognize as signs that you may or may not be pregnant, try not to guess or do home pregnancy tests before the blood test. They may not be accurate. If the first test is positive, you will be asked to return for a follow-up test 2-3 days later to see that the level of the hormone hCG is rising appropriately. Hopefully you will receive good news and find out that the pregnancy test is positive and have follow-up as described below. If unfortunately you are not pregnant, you will be instructed to stop the progesterone and expect a period within 2-5 days (you should call us if a menses does not occur within about 5 days of stopping progesterone). If you do not conceive, you may find it helpful to schedule a follow-up visit with the MD to occur about 2 weeks after your pregnancy test results. This visit is important so we can counsel you regarding your next steps. Another cycle of treatment can begin as soon as one month after a failed cycle. Pregnancy Hopefully, you will be pregnant, and an ultrasound will be scheduled 4-5 weeks after your egg retrieval. The ultrasound will be done again 2 weeks later (6-7 weeks from retrieval). We will then refer you to your obstetrician for the remainder of the pregnancy. You will remain on progesterone until 8-10 weeks from your retrieval. We truly look forward to hearing from you when you deliver your child. Evaluation for Fertility,Preconception Care, Ovulation Induction/IUI,In Vitro Fertilization (IVF),Third Party Program,REI Laboratory,IVF Laboratory,Reproductive Surgery,Recurrent Pregnancy Loss,Fertility Preservation,Emotional Support,Patient Resources,Financial Services,Fertility Statistics, Ivf clinics
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info@shivaniscientific.com http://www.shivaniscientific.com Infertility Treatment - Overview, IVF, GIFT, TET, Microsurgical Tubal Reanastomosis, Frequently Asked Questions, Women Over 40, PCOS, Assisted Hatching, Microsurgery, Immunological Testing and Treatment, Donor Egg, ICSI, Hysterectomy, Laparoscopic Procedures, Sex Selection You need information about IVF, ICSI, infertility clinics, donor egg and surrogacy services (e.g., surrogate mothers), tubal reversal doctors, vasectomy reversal doctors, natural infertility treatment, male infertility services, sperm banks, pharmacies, infertility books and videotapes, sperm testing, infertility support, and drugs and medications, such as Metrodin, Pergonal, Clomid. Infertility News and Announcements Infertility Service Providers 1. Infertility IVF clinics 9. Lawyers 2. Egg donor programs 10. Pharmacies 3. Tubal reversal doctors 11. Surrogacy programs 4. Vasectomy reversal doctors 12. Counselors & consultants 5. Financial assistance 13. Egg Freezing 6. Natural treatment 13. PGD programs 7. Sperm banks 14. Embryo adoption 8. Male infertility doctors 15. Adoption Agencies Infertility Products 1. Women - fertility monitors, etc. 5. Conception products 2. Women - fertility supplements 6. Fertility product stores 3. Men - sperm testing 7. Infertility books 4. Men - fertility supplements 8. Infertility videos and CDs Education 1. Main 8. Financial and Insurance 2. Diagnosis 9. Legal Rights 3. Male Factor 10. Psychological and Social 4. Treatment 11. Infertility Photos 5. Egg Donation and Egg Donors 12. Miscellaneous 6. Drugs and Medications MORE ON IVF: Glossary adhesions Bands of scar tissue attached to organ surfaces and capable of connecting, covering, or distorting organs, such as tubes, ovaries or uterus. AID (artificial insemination, donor) A procedure introducing sperm from an anonymous donor into a woman’s uterus in order to achieve a pregnancy. AIH (artificial insemination, husband or homologous) A special insemination procedure used to introduce sperm collected from a woman’s partner into the woman’s uterus. Also referred to as intrauterine insemination (IUI). antisperm antibodies Antibodies that may be produced by either a female or male which may damage sperm or cause them to adhere to each other, thus limiting their fertility potential. azoospermia The absence of sperm in the ejaculate. cervical mucus Mucus produced by the cervix which changes in thickness and quantity at the time of ovulation. cervix The lower section of the uterus which protrudes into the vagina and serves as a passageway for sperm into the uterus. Corpus Luteum A structure in the ovary that develops after the egg is released, which secretes progesterone. cryopreservation The preservation of sperm or embryos by freezing, usually by immersion in liquid nitrogen. endometriosis The presence of endometrial tissue in abnormal locations, such as the fallopian tubes, ovaries and abdominal cavity. The condition frequently causes pain and discomfort during menstruation, or even chronic pelvic pain, and may also cause infertility. endometrium The inner lining of the uterus. estrogen The primary female hormone produced mainly by the ovaries from puberty to menopause. fallopian tube The tube that connects the uterus and ovary. It allows the egg to pass from the ovary to the uterus and the spermatozoa from the uterus toward the ovary. fibroids Smooth muscle tumors of the muscular wall of the uterus which are almost always benign but may cause infertility or recurrent miscarriages. follicle A cystic structure in the ovary which contains and nurtures the ovum (egg). It enlarges to a diameter of 18 - 28 mm (3/4 - 1 inch) before ovulation, at which point it releases the egg. FSH (follicle stimulating hormone) A hormone that recruits and then stimulates growth of the follicle in the ovary, as well as the formation of spermatozoa in the testes. GIFT (gamete intrafallopian transfer) A procedure in which eggs are removed from a ripened follicle and via laparoscopy are placed with sperm into the fallopian tube, where fertilization takes place. gonadotropin A hormone (FSH, LH, hMG, hCG) which stimulates the gonads (ovaries or testes). GnRH (gonadotropin releasing hormone) A small hormone produced by the brain which causes the pituitary gland to manufacture and release FSH and LH. GnRH agonist (Lupron) Differs from GnRH at 2 amino-acid positions. Used to stop production of FSH and LH from the pituitary gland. Gonal-F The brand name of a new recombinant FSH used to stimulate the ovaries to produce follicles. Follistim is the brand name of another recombinant FSH on the market. hCG (human chorionic gonadotropin) A hormone produced by the placenta. Detection of its presence in urine or blood is the basis of the pregnancy test. Also used to trigger final maturation and ovulation of the egg. hMG (human menopausal gonadotropin) A hormone (Pergonal or Humegon) used to stimulate follicle production. Equal parts of FSH and LH are present. hysteroscopy An endoscopic (fiber-optic tube) procedure used primarily to visualize the interior of the uterus. implantation The embedding of the embryo in the uterine wall. in-vitro fertilization/embryo transfer A procedure in which an egg is removed from a ripe follicle and fertilized with sperm outside the body. The resulting embryo is inserted into the woman’s uterus. laparoscopy An abdominal surgical procedure using an endoscopic instrument (fiber-optic tube) to view the fallopian tubes, ovaries, uterus, and other abdominal structures. The laparoscope may also be used to perform surgical procedures, employing the use of lasers and other specialized equipment. LH (luteinizing hormone) A hormone produced and released by the pituitary gland. In the female, it is responsible for maturation and then the release of the ovum. In the male, it stimulates testosterone production. Lutrepulse The trade name for a gonadotropin releasing hormone (GnRH) used to induce ovulation in some patients. It is administered through an infusion pump in a pulsatile fashion. oligospermia The presence of a low number of sperm in the ejaculate. ovum The egg cell (gamete) produced in a woman’s ovaries during each menstrual cycle. ovulation The release of a mature egg from the surface of the ovary. pituitary gland A gland at the base of the brain which produces many hormones, including FSH and LH. polyps Small, benign growths protruding from the lining of the endometrium or endocervix. progesterone A hormone produced and released during the second half of a woman’s ovulatory cycle. It is necessary in the preparation of the uterine lining for implantation of the fertilized egg. semen The sperm and seminal secretions ejaculated by the male during orgasm. sperm Male reproductive cells contained in the seminal fluid. testosterone The most potent male sex hormone, produced in the testes. uterus The reproductive organ which protects and nourishes the developing embryo/fetus. It is a hollow, muscular structure that is part of the female reproductive tract, and it is the source of a woman’s menses. vagina A tubular passageway in the female which connects the external sex organs with the cervix and uterus. IVF: In Vitro Fertilization(IVF) In vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy. In order to reach this potential, your participation and that of your physician (reproductive endocrinologist), nurses and embryologists require close coordination. Precise timing of medications is critical, and close monitoring with ultrasound is required. This reproductive journey is detailed and involved, but we are here to guide you and help ease as many of the complexities that may occur along the way. Please feel free to ask our nurses and physicians any questions you may have. IVF (In Vitro Fertilization) Overview With IVF, oocytes (eggs) are retrieved from the ovary and placed in a Petri dish with active, motile sperm. Because fertilization occurs in the Petri dish rather than in the woman’s body, this process has been called “in vitro.” The eggs and sperm are maintained in a special culture media (nutrient fluid) within a controlled environment (incubator). If a fertilized egg is developing properly, it will consist of 6-8 cells at 3 days after egg retrieval. If an embryo is continuing develop appropriately, it will form a blastocyst by 5-6 days after egg retrieval. After embryos have developed in the laboratory for several days, one or more are selected for transfer into your uterus and if additional embryos are developing, they may be frozen to be transferred at a future time. Step by step guide to IVF Although the details of individual cycles will vary, all of the assisted reproductive technologies have similar steps. 1. Pretreatment preparation 2. Ovulation induction 3. Oocyte retrieval 4. Fertilization of eggs in the laboratory 5. Embryo transfer 6. Luteal phase 7. Pregnancy test and pregnancy follow-up 1. Pretreatment preparation After the decision is made to proceed with IVF, you will meet with a Registered Nurse and will receive a medication log and a calendar outlining the treatment. In many cases, oral contraceptive pills (OCPs) will be prescribed in the cycle, prior to active treatment. The purpose of the OCP is to reduce the chance that an ovarian cyst will be present at the time when we plan to start treatment and to allow flexibility in the timing of the cycle (the number of days on OCP can be varied). Ultrasound. While you are on the OCP, you will have a Transvaginal ultrasound to assess whether there are any cysts present in the ovaries. In one commonly used protocol, you will begin a medication called Lupron (a GnRH agonist) while you are still taking the OCP. Your individual protocol may vary, and you may be prescribed a medicine other than Lupron (such as a GnRH antagonist called Ganirelix or Cetrotide) to prevent premature release of the eggs. Uterine screening. If you have not had an evaluation of your uterus within the last year, your MD may recommend a screening test as a hysteroscopy or a saline infusion sonography to be done while you are taking the OCP. You will be given more information about any procedure that will be recommended. Backup semen sample. In some cases a semen sample is obtained, frozen, and stored as a “back-up” specimen available on the day of egg retrieval. Please inform your MD or RN if you anticipate any difficulty in collecting a sample on the day of the retrieval so that you can arrange to have a back-sample frozen ahead of time. 2. Ovulation induction Success rates with reproductive technologies (ART) are improved if multiple mature oocytes are available for retrieval. In order to mature a group of eggs, medications are administered by subcutaneous injection on a daily basis. The medications are in a class called gonadotropins. Some of the commercial names are Follistim, Gonal-F, Menopur and Repronex. Baseline Ultrasound. Your baseline ultrasound will be performed before starting the gonadotropin. Occasionally you may have an ovarian cyst at this time. If you have a cyst, it often disappears with continued Lupron treatment, or less commonly your MD might recommend aspiration of the cyst. If the baseline ultrasound is normal, you will begin gonadrotropin injections. This medication will promote a group of several follicles (the sacs of fluid which contain the microscopic eggs) to develop together. Ideally about 10-12 follicles develop, but the response is quite variable and you may produce only 2-3 follicles, or as many as 20-30. The dose of medication you will receive is based on a prediction of how your ovaries will respond based on your age, your baseline FSH and estradiol levels, and any previous ovulation induction experience. When you begin the gonadotropin medication, it is important to not pursue intense physical exercise (kick boxing, jumping, etc.) because such activity could cause discomfort and twisting of the ovaries. The gonadotropin injections have some risks and side effects which are discussed in detail in the medication information and in consent forms that you will be given. Most women taking gonadotropin injections for IVF will feel a sense of fullness in their ovaries. Risks include ovarian hyperstimulation syndrome (OHSS) and multiple birth (particularly if multiple embryos are transferred). There has been some concern regarding the possibility of increased risk of ovarian cancer with the use of fertility medications. However, more recent studies have overall been reassuring. Timing of hCG. When ultrasound examination suggest that the eggs are mature (usually when the lead follicle size is about 18 mm in diameter), you will be asked to take an injection of human chorionic gonadotropin (hCG). The timing of the hCG is critical, so you need to take it precisely at the time given to you on the schedule. Once you take hCG, your gonadotropin and GnRH agonist or GnRH antagonist will stop. 3. Oocyte retrieval Approximately 35 hours after the hCG injection, the egg retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval. If you are taking medications for any other reason, talk to your MD or RN about taking medication prior to retrieval. Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the IVF laboratory. The egg retrieval takes approximately 20-30 minutes. After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small. On the day of egg retrieval, you will need to have someone available to drive you home (you cannot drive on the day of egg retrieval due to the intravenous medications that you will be receiving). You should not plan to do any work on the day of egg retrieval. Many women do return to work the next day, while others also rest the day following the retrieval. You may feel some pelvic heaviness or soreness and cramping. It is okay to take Tylenol, but you should avoid ibuprofen (i.e. Advil, Motrin). Often there is a small amount of spotting. Your bleeding should be less than a normal period. We recommend that you avoid immersing yourself in water (avoid swimming, take showers rather than baths, avoid vaginal intercourse) from the day of the retrieval for several days to allow the vagina to heal. After the procedure, you will be given complete written instructions and phone numbers. It is important to know that your ovaries are still enlarged immediately after the egg retrieval and that they remain enlarged for the next several weeks. For this reason, avoid heavy lifting or vigorous exertion such as running or aerobics until they return to normal size (which occurs either at 6-10 weeks into the pregnancy or with menses if pregnancy does not occur). It is okay to take stairs slowly, and walk short distances, less than a mile. Avoid any vaginal creams, lubricants, or spermicides other than the progesterone that is prescribed. Avoid hot tubs and Jacuzzis. Avoid intercourse until advised by your physician. If you travel, give yourself twice as much time as usual and minimize stress. Semen sample. Your partner will give a sperm sample the day of the egg retrieval. It is recommended that he abstain from ejaculation for 2 days (48 hours) to 5 days before giving the sample. 4. Fertilization of eggs Once the eggs are retrieved and placed in the incubator, they rest for several hours before the sperm is added, usually in the afternoon of the egg retrieval. Addition of sperm to the culture media is called insemination, and is followed by fertilization, when the sperm enters the egg. Fertilization can also be accomplished by ICSI (intracytoplasmatic sperm injection). ICSI will be recommended if your physician suspects that there will be a significant chance of no fertilization or a low rate of fertilization with conventional insemination of the oocytes in the laboratory. We will call you the day after retrieval to let you know how many eggs have fertilized. It is important to understand that all the embryos may not be able to be observed on that day and that of those that are seen, they may not continue to grow. The embryo can begin cleaving, or dividing, first into two cells, then into four. Cleavage to four cells generally takes 36-48 hours or more after the egg retrieval. After 3 days, an embryo which is growing properly will have 6-8 cells. An embryo should reach a blastocyst stage at 5-6 days after retrieval. 5. Embryo transfer Three to five days after the oocyte retrieval you will be scheduled for your embryo transfer. Your physician will recommend which day is most appropriate for you. In general, blastocyst transfer is recommended when there are a large number of embryos of good quality, or for couples desiring only a single embryo to be transferred. Your physician will give you a recommendation regarding the number of embryos to be transferred based on your age, your history if you have had IVF performed in the past, and the quality of the embryos. Abdominal ultrasound is used to guide the transfer. To perform the transfer, your physician will place a speculum in the vagina and the cervix will be rinsed with a sterile solution. The embryologist in the laboratory will load the embryos into a small catheter and your physician will ease the tip of the catheter through the cervix into the uterus. You may have a sensation or twinge as the catheter passes through your cervix or you may not feel anything. For this reason, anesthesia is not used for the transfer. On the day of your transfer wear comfortable clothing and socks to keep your feet warm. Your bladder should feel full, but not very uncomfortable. A partially full bladder often will allow the transfer to be completed more easily and will allow a better picture on the abdominal ultrasound. We suggest that you rest the day after the transfer, to allow yourself time to relax as much as possible. Also, your ovaries will still be enlarged and activity should be minimized as described above to prevent ovarian discomfort. However, it is important to know that nothing you will do, such as walking or going to the bathroom will cause the embryos to dislodge from the uterine wall. The main factors that determine whether an embryo will implant are the viability (“health”) of the embryo and the quality of the uterine lining. Healthy embryos will be much more likely to implant and develop than embryos which are not viable. 6. Luteal phase You will take progesterone by injection and/or vaginal suppository gel because it has been shown that progesterone supplementation increases the chance of success with IVF. Progesterone is the natural hormone that your body produces to support the uterine lining and maintain an early pregnancy. Although the FDA requires the drug manufacturer to include warnings about using progesterone in early pregnancy, this is due to the fact that progestins (a synthetic progesterone-like substance) or high doses of progesterone in animal experienced have raised concerns. However, you will only receive progesterone, the same natural hormone your ovaries produce, in a dose that is not excessive. After the egg retrieval, you will receive your first dose of progesterone. You will continue this daily for the next two weeks according to a schedule you will receive. This schedule will include the dose you should take. As noted above, it is common to have a sensation of heaviness or cramping in your pelvis 4-10 days after egg retrieval. Your ovaries frequently enlarge at this time. If you are gaining weight rapidly (more than a pound a day) which can occur due to fluid retention, or if you are not urinating the normal amount for you, or if you have any other concerns, please call. Light bleeding sometimes occurs in the weeks following egg retrieval, even if there is a normally developing pregnancy. A pregnancy test will be performed approximately two weeks after your egg retrieval. Waiting for your pregnancy test is a difficult time. It is not unusual to have symptoms of pregnancy that come and go due to the hormonal changes with IVF. The only way to know whether or not you are pregnant is by the pregnancy test done two weeks after egg retrieval. Bleeding may occur even if a pregnancy is developing normally. Please continue to take the progesterone that is prescribed until your pregnancy test, even if you think you may not be pregnant. Because the hormones that you are taking may confuse the symptoms that you have come to recognize as signs that you may or may not be pregnant, try not to guess or do home pregnancy tests before the blood test. They may not be accurate. If the first test is positive, you will be asked to return for a follow-up test 2-3 days later to see that the level of the hormone hCG is rising appropriately. Hopefully you will receive good news and find out that the pregnancy test is positive and have follow-up as described below. If unfortunately you are not pregnant, you will be instructed to stop the progesterone and expect a period within 2-5 days (you should call us if a menses does not occur within about 5 days of stopping progesterone). If you do not conceive, you may find it helpful to schedule a follow-up visit with the MD to occur about 2 weeks after your pregnancy test results. This visit is important so we can counsel you regarding your next steps. Another cycle of treatment can begin as soon as one month after a failed cycle. Pregnancy Hopefully, you will be pregnant, and an ultrasound will be scheduled 4-5 weeks after your egg retrieval. The ultrasound will be done again 2 weeks later (6-7 weeks from retrieval). We will then refer you to your obstetrician for the remainder of the pregnancy. You will remain on progesterone until 8-10 weeks from your retrieval. We truly look forward to hearing from you when you deliver your child.]]>
info@shivaniscientific.com http://www.shivaniscientific.com Infertility Treatment - Overview, IVF, GIFT, TET, Microsurgical Tubal Reanastomosis, Frequently Asked Questions, Women Over 40, PCOS, Assisted Hatching, Microsurgery, Immunological Testing and Treatment, Donor Egg, ICSI, Hysterectomy, Laparoscopic Procedures, Sex Selection You need information about IVF, ICSI, infertility clinics, donor egg and surrogacy services (e.g., surrogate mothers), tubal reversal doctors, vasectomy reversal doctors, natural infertility treatment, male infertility services, sperm banks, pharmacies, infertility books and videotapes, sperm testing, infertility support, and drugs and medications, such as Metrodin, Pergonal, Clomid. Infertility News and Announcements Infertility Service Providers 1. Infertility IVF clinics 9. Lawyers 2. Egg donor programs 10. Pharmacies 3. Tubal reversal doctors 11. Surrogacy programs 4. Vasectomy reversal doctors 12. Counselors & consultants 5. Financial assistance 13. Egg Freezing 6. Natural treatment 13. PGD programs 7. Sperm banks 14. Embryo adoption 8. Male infertility doctors 15. Adoption Agencies Infertility Products 1. Women - fertility monitors, etc. 5. Conception products 2. Women - fertility supplements 6. Fertility product stores 3. Men - sperm testing 7. Infertility books 4. Men - fertility supplements 8. Infertility videos and CDs Education 1. Main 8. Financial and Insurance 2. Diagnosis 9. Legal Rights 3. Male Factor 10. Psychological and Social 4. Treatment 11. Infertility Photos 5. Egg Donation and Egg Donors 12. Miscellaneous 6. Drugs and Medications MORE ON IVF: Glossary adhesions Bands of scar tissue attached to organ surfaces and capable of connecting, covering, or distorting organs, such as tubes, ovaries or uterus. AID (artificial insemination, donor) A procedure introducing sperm from an anonymous donor into a woman’s uterus in order to achieve a pregnancy. AIH (artificial insemination, husband or homologous) A special insemination procedure used to introduce sperm collected from a woman’s partner into the woman’s uterus. Also referred to as intrauterine insemination (IUI). antisperm antibodies Antibodies that may be produced by either a female or male which may damage sperm or cause them to adhere to each other, thus limiting their fertility potential. azoospermia The absence of sperm in the ejaculate. cervical mucus Mucus produced by the cervix which changes in thickness and quantity at the time of ovulation. cervix The lower section of the uterus which protrudes into the vagina and serves as a passageway for sperm into the uterus. Corpus Luteum A structure in the ovary that develops after the egg is released, which secretes progesterone. cryopreservation The preservation of sperm or embryos by freezing, usually by immersion in liquid nitrogen. endometriosis The presence of endometrial tissue in abnormal locations, such as the fallopian tubes, ovaries and abdominal cavity. The condition frequently causes pain and discomfort during menstruation, or even chronic pelvic pain, and may also cause infertility. endometrium The inner lining of the uterus. estrogen The primary female hormone produced mainly by the ovaries from puberty to menopause. fallopian tube The tube that connects the uterus and ovary. It allows the egg to pass from the ovary to the uterus and the spermatozoa from the uterus toward the ovary. fibroids Smooth muscle tumors of the muscular wall of the uterus which are almost always benign but may cause infertility or recurrent miscarriages. follicle A cystic structure in the ovary which contains and nurtures the ovum (egg). It enlarges to a diameter of 18 - 28 mm (3/4 - 1 inch) before ovulation, at which point it releases the egg. FSH (follicle stimulating hormone) A hormone that recruits and then stimulates growth of the follicle in the ovary, as well as the formation of spermatozoa in the testes. GIFT (gamete intrafallopian transfer) A procedure in which eggs are removed from a ripened follicle and via laparoscopy are placed with sperm into the fallopian tube, where fertilization takes place. gonadotropin A hormone (FSH, LH, hMG, hCG) which stimulates the gonads (ovaries or testes). GnRH (gonadotropin releasing hormone) A small hormone produced by the brain which causes the pituitary gland to manufacture and release FSH and LH. GnRH agonist (Lupron) Differs from GnRH at 2 amino-acid positions. Used to stop production of FSH and LH from the pituitary gland. Gonal-F The brand name of a new recombinant FSH used to stimulate the ovaries to produce follicles. Follistim is the brand name of another recombinant FSH on the market. hCG (human chorionic gonadotropin) A hormone produced by the placenta. Detection of its presence in urine or blood is the basis of the pregnancy test. Also used to trigger final maturation and ovulation of the egg. hMG (human menopausal gonadotropin) A hormone (Pergonal or Humegon) used to stimulate follicle production. Equal parts of FSH and LH are present. hysteroscopy An endoscopic (fiber-optic tube) procedure used primarily to visualize the interior of the uterus. implantation The embedding of the embryo in the uterine wall. in-vitro fertilization/embryo transfer A procedure in which an egg is removed from a ripe follicle and fertilized with sperm outside the body. The resulting embryo is inserted into the woman’s uterus. laparoscopy An abdominal surgical procedure using an endoscopic instrument (fiber-optic tube) to view the fallopian tubes, ovaries, uterus, and other abdominal structures. The laparoscope may also be used to perform surgical procedures, employing the use of lasers and other specialized equipment. LH (luteinizing hormone) A hormone produced and released by the pituitary gland. In the female, it is responsible for maturation and then the release of the ovum. In the male, it stimulates testosterone production. Lutrepulse The trade name for a gonadotropin releasing hormone (GnRH) used to induce ovulation in some patients. It is administered through an infusion pump in a pulsatile fashion. oligospermia The presence of a low number of sperm in the ejaculate. ovum The egg cell (gamete) produced in a woman’s ovaries during each menstrual cycle. ovulation The release of a mature egg from the surface of the ovary. pituitary gland A gland at the base of the brain which produces many hormones, including FSH and LH. polyps Small, benign growths protruding from the lining of the endometrium or endocervix. progesterone A hormone produced and released during the second half of a woman’s ovulatory cycle. It is necessary in the preparation of the uterine lining for implantation of the fertilized egg. semen The sperm and seminal secretions ejaculated by the male during orgasm. sperm Male reproductive cells contained in the seminal fluid. testosterone The most potent male sex hormone, produced in the testes. uterus The reproductive organ which protects and nourishes the developing embryo/fetus. It is a hollow, muscular structure that is part of the female reproductive tract, and it is the source of a woman’s menses. vagina A tubular passageway in the female which connects the external sex organs with the cervix and uterus. IVF: In Vitro Fertilization(IVF) In vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy. In order to reach this potential, your participation and that of your physician (reproductive endocrinologist), nurses and embryologists require close coordination. Precise timing of medications is critical, and close monitoring with ultrasound is required. This reproductive journey is detailed and involved, but we are here to guide you and help ease as many of the complexities that may occur along the way. Please feel free to ask our nurses and physicians any questions you may have. IVF (In Vitro Fertilization) Overview With IVF, oocytes (eggs) are retrieved from the ovary and placed in a Petri dish with active, motile sperm. Because fertilization occurs in the Petri dish rather than in the woman’s body, this process has been called “in vitro.” The eggs and sperm are maintained in a special culture media (nutrient fluid) within a controlled environment (incubator). If a fertilized egg is developing properly, it will consist of 6-8 cells at 3 days after egg retrieval. If an embryo is continuing develop appropriately, it will form a blastocyst by 5-6 days after egg retrieval. After embryos have developed in the laboratory for several days, one or more are selected for transfer into your uterus and if additional embryos are developing, they may be frozen to be transferred at a future time. Step by step guide to IVF Although the details of individual cycles will vary, all of the assisted reproductive technologies have similar steps. 1. Pretreatment preparation 2. Ovulation induction 3. Oocyte retrieval 4. Fertilization of eggs in the laboratory 5. Embryo transfer 6. Luteal phase 7. Pregnancy test and pregnancy follow-up 1. Pretreatment preparation After the decision is made to proceed with IVF, you will meet with a Registered Nurse and will receive a medication log and a calendar outlining the treatment. In many cases, oral contraceptive pills (OCPs) will be prescribed in the cycle, prior to active treatment. The purpose of the OCP is to reduce the chance that an ovarian cyst will be present at the time when we plan to start treatment and to allow flexibility in the timing of the cycle (the number of days on OCP can be varied). Ultrasound. While you are on the OCP, you will have a Transvaginal ultrasound to assess whether there are any cysts present in the ovaries. In one commonly used protocol, you will begin a medication called Lupron (a GnRH agonist) while you are still taking the OCP. Your individual protocol may vary, and you may be prescribed a medicine other than Lupron (such as a GnRH antagonist called Ganirelix or Cetrotide) to prevent premature release of the eggs. Uterine screening. If you have not had an evaluation of your uterus within the last year, your MD may recommend a screening test as a hysteroscopy or a saline infusion sonography to be done while you are taking the OCP. You will be given more information about any procedure that will be recommended. Backup semen sample. In some cases a semen sample is obtained, frozen, and stored as a “back-up” specimen available on the day of egg retrieval. Please inform your MD or RN if you anticipate any difficulty in collecting a sample on the day of the retrieval so that you can arrange to have a back-sample frozen ahead of time. 2. Ovulation induction Success rates with reproductive technologies (ART) are improved if multiple mature oocytes are available for retrieval. In order to mature a group of eggs, medications are administered by subcutaneous injection on a daily basis. The medications are in a class called gonadotropins. Some of the commercial names are Follistim, Gonal-F, Menopur and Repronex. Baseline Ultrasound. Your baseline ultrasound will be performed before starting the gonadotropin. Occasionally you may have an ovarian cyst at this time. If you have a cyst, it often disappears with continued Lupron treatment, or less commonly your MD might recommend aspiration of the cyst. If the baseline ultrasound is normal, you will begin gonadrotropin injections. This medication will promote a group of several follicles (the sacs of fluid which contain the microscopic eggs) to develop together. Ideally about 10-12 follicles develop, but the response is quite variable and you may produce only 2-3 follicles, or as many as 20-30. The dose of medication you will receive is based on a prediction of how your ovaries will respond based on your age, your baseline FSH and estradiol levels, and any previous ovulation induction experience. When you begin the gonadotropin medication, it is important to not pursue intense physical exercise (kick boxing, jumping, etc.) because such activity could cause discomfort and twisting of the ovaries. The gonadotropin injections have some risks and side effects which are discussed in detail in the medication information and in consent forms that you will be given. Most women taking gonadotropin injections for IVF will feel a sense of fullness in their ovaries. Risks include ovarian hyperstimulation syndrome (OHSS) and multiple birth (particularly if multiple embryos are transferred). There has been some concern regarding the possibility of increased risk of ovarian cancer with the use of fertility medications. However, more recent studies have overall been reassuring. Timing of hCG. When ultrasound examination suggest that the eggs are mature (usually when the lead follicle size is about 18 mm in diameter), you will be asked to take an injection of human chorionic gonadotropin (hCG). The timing of the hCG is critical, so you need to take it precisely at the time given to you on the schedule. Once you take hCG, your gonadotropin and GnRH agonist or GnRH antagonist will stop. 3. Oocyte retrieval Approximately 35 hours after the hCG injection, the egg retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval. If you are taking medications for any other reason, talk to your MD or RN about taking medication prior to retrieval. Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the IVF laboratory. The egg retrieval takes approximately 20-30 minutes. After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small. On the day of egg retrieval, you will need to have someone available to drive you home (you cannot drive on the day of egg retrieval due to the intravenous medications that you will be receiving). You should not plan to do any work on the day of egg retrieval. Many women do return to work the next day, while others also rest the day following the retrieval. You may feel some pelvic heaviness or soreness and cramping. It is okay to take Tylenol, but you should avoid ibuprofen (i.e. Advil, Motrin). Often there is a small amount of spotting. Your bleeding should be less than a normal period. We recommend that you avoid immersing yourself in water (avoid swimming, take showers rather than baths, avoid vaginal intercourse) from the day of the retrieval for several days to allow the vagina to heal. After the procedure, you will be given complete written instructions and phone numbers. It is important to know that your ovaries are still enlarged immediately after the egg retrieval and that they remain enlarged for the next several weeks. For this reason, avoid heavy lifting or vigorous exertion such as running or aerobics until they return to normal size (which occurs either at 6-10 weeks into the pregnancy or with menses if pregnancy does not occur). It is okay to take stairs slowly, and walk short distances, less than a mile. Avoid any vaginal creams, lubricants, or spermicides other than the progesterone that is prescribed. Avoid hot tubs and Jacuzzis. Avoid intercourse until advised by your physician. If you travel, give yourself twice as much time as usual and minimize stress. Semen sample. Your partner will give a sperm sample the day of the egg retrieval. It is recommended that he abstain from ejaculation for 2 days (48 hours) to 5 days before giving the sample. 4. Fertilization of eggs Once the eggs are retrieved and placed in the incubator, they rest for several hours before the sperm is added, usually in the afternoon of the egg retrieval. Addition of sperm to the culture media is called insemination, and is followed by fertilization, when the sperm enters the egg. Fertilization can also be accomplished by ICSI (intracytoplasmatic sperm injection). ICSI will be recommended if your physician suspects that there will be a significant chance of no fertilization or a low rate of fertilization with conventional insemination of the oocytes in the laboratory. We will call you the day after retrieval to let you know how many eggs have fertilized. It is important to understand that all the embryos may not be able to be observed on that day and that of those that are seen, they may not continue to grow. The embryo can begin cleaving, or dividing, first into two cells, then into four. Cleavage to four cells generally takes 36-48 hours or more after the egg retrieval. After 3 days, an embryo which is growing properly will have 6-8 cells. An embryo should reach a blastocyst stage at 5-6 days after retrieval. 5. Embryo transfer Three to five days after the oocyte retrieval you will be scheduled for your embryo transfer. Your physician will recommend which day is most appropriate for you. In general, blastocyst transfer is recommended when there are a large number of embryos of good quality, or for couples desiring only a single embryo to be transferred. Your physician will give you a recommendation regarding the number of embryos to be transferred based on your age, your history if you have had IVF performed in the past, and the quality of the embryos. Abdominal ultrasound is used to guide the transfer. To perform the transfer, your physician will place a speculum in the vagina and the cervix will be rinsed with a sterile solution. The embryologist in the laboratory will load the embryos into a small catheter and your physician will ease the tip of the catheter through the cervix into the uterus. You may have a sensation or twinge as the catheter passes through your cervix or you may not feel anything. For this reason, anesthesia is not used for the transfer. On the day of your transfer wear comfortable clothing and socks to keep your feet warm. Your bladder should feel full, but not very uncomfortable. A partially full bladder often will allow the transfer to be completed more easily and will allow a better picture on the abdominal ultrasound. We suggest that you rest the day after the transfer, to allow yourself time to relax as much as possible. Also, your ovaries will still be enlarged and activity should be minimized as described above to prevent ovarian discomfort. However, it is important to know that nothing you will do, such as walking or going to the bathroom will cause the embryos to dislodge from the uterine wall. The main factors that determine whether an embryo will implant are the viability (“health”) of the embryo and the quality of the uterine lining. Healthy embryos will be much more likely to implant and develop than embryos which are not viable. 6. Luteal phase You will take progesterone by injection and/or vaginal suppository gel because it has been shown that progesterone supplementation increases the chance of success with IVF. Progesterone is the natural hormone that your body produces to support the uterine lining and maintain an early pregnancy. Although the FDA requires the drug manufacturer to include warnings about using progesterone in early pregnancy, this is due to the fact that progestins (a synthetic progesterone-like substance) or high doses of progesterone in animal experienced have raised concerns. However, you will only receive progesterone, the same natural hormone your ovaries produce, in a dose that is not excessive. After the egg retrieval, you will receive your first dose of progesterone. You will continue this daily for the next two weeks according to a schedule you will receive. This schedule will include the dose you should take. As noted above, it is common to have a sensation of heaviness or cramping in your pelvis 4-10 days after egg retrieval. Your ovaries frequently enlarge at this time. If you are gaining weight rapidly (more than a pound a day) which can occur due to fluid retention, or if you are not urinating the normal amount for you, or if you have any other concerns, please call. Light bleeding sometimes occurs in the weeks following egg retrieval, even if there is a normally developing pregnancy. A pregnancy test will be performed approximately two weeks after your egg retrieval. Waiting for your pregnancy test is a difficult time. It is not unusual to have symptoms of pregnancy that come and go due to the hormonal changes with IVF. The only way to know whether or not you are pregnant is by the pregnancy test done two weeks after egg retrieval. Bleeding may occur even if a pregnancy is developing normally. Please continue to take the progesterone that is prescribed until your pregnancy test, even if you think you may not be pregnant. Because the hormones that you are taking may confuse the symptoms that you have come to recognize as signs that you may or may not be pregnant, try not to guess or do home pregnancy tests before the blood test. They may not be accurate. If the first test is positive, you will be asked to return for a follow-up test 2-3 days later to see that the level of the hormone hCG is rising appropriately. Hopefully you will receive good news and find out that the pregnancy test is positive and have follow-up as described below. If unfortunately you are not pregnant, you will be instructed to stop the progesterone and expect a period within 2-5 days (you should call us if a menses does not occur within about 5 days of stopping progesterone). If you do not conceive, you may find it helpful to schedule a follow-up visit with the MD to occur about 2 weeks after your pregnancy test results. This visit is important so we can counsel you regarding your next steps. Another cycle of treatment can begin as soon as one month after a failed cycle. Pregnancy Hopefully, you will be pregnant, and an ultrasound will be scheduled 4-5 weeks after your egg retrieval. The ultrasound will be done again 2 weeks later (6-7 weeks from retrieval). We will then refer you to your obstetrician for the remainder of the pregnancy. You will remain on progesterone until 8-10 weeks from your retrieval. We truly look forward to hearing from you when you deliver your child.]]> Tue, 03 Jun 2008 02:26:33 GMT http://www.slideshare.net/ivfworld/infertility-clinics-fertility-clinics-fertility-doctorsfertility-and-ivf-treatment ivfworld@slideshare.net(ivfworld) Infertility clinics, fertility clinics, fertility doctors,fertility and IVF treatment ivfworld info@shivaniscientific.com http://www.shivaniscientific.com Infertility Treatment - Overview, IVF, GIFT, TET, Microsurgical Tubal Reanastomosis, Frequently Asked Questions, Women Over 40, PCOS, Assisted Hatching, Microsurgery, Immunological Testing and Treatment, Donor Egg, ICSI, Hysterectomy, Laparoscopic Procedures, Sex Selection You need information about IVF, ICSI, infertility clinics, donor egg and surrogacy services (e.g., surrogate mothers), tubal reversal doctors, vasectomy reversal doctors, natural infertility treatment, male infertility services, sperm banks, pharmacies, infertility books and videotapes, sperm testing, infertility support, and drugs and medications, such as Metrodin, Pergonal, Clomid. Infertility News and Announcements Infertility Service Providers 1. Infertility IVF clinics 9. Lawyers 2. Egg donor programs 10. Pharmacies 3. Tubal reversal doctors 11. Surrogacy programs 4. Vasectomy reversal doctors 12. Counselors &amp; consultants 5. Financial assistance 13. Egg Freezing 6. Natural treatment 13. PGD programs 7. Sperm banks 14. Embryo adoption 8. Male infertility doctors 15. Adoption Agencies Infertility Products 1. Women - fertility monitors, etc. 5. Conception products 2. Women - fertility supplements 6. Fertility product stores 3. Men - sperm testing 7. Infertility books 4. Men - fertility supplements 8. Infertility videos and CDs Education 1. Main 8. Financial and Insurance 2. Diagnosis 9. Legal Rights 3. Male Factor 10. Psychological and Social 4. Treatment 11. Infertility Photos 5. Egg Donation and Egg Donors 12. Miscellaneous 6. Drugs and Medications MORE ON IVF: Glossary adhesions Bands of scar tissue attached to organ surfaces and capable of connecting, covering, or distorting organs, such as tubes, ovaries or uterus. AID (artificial insemination, donor) A procedure introducing sperm from an anonymous donor into a woman&rsquo;s uterus in order to achieve a pregnancy. AIH (artificial insemination, husband or homologous) A special insemination procedure used to introduce sperm collected from a woman&rsquo;s partner into the woman&rsquo;s uterus. Also referred to as intrauterine insemination (IUI). antisperm antibodies Antibodies that may be produced by either a female or male which may damage sperm or cause them to adhere to each other, thus limiting their fertility potential. azoospermia The absence of sperm in the ejaculate. cervical mucus Mucus produced by the cervix which changes in thickness and quantity at the time of ovulation. cervix The lower section of the uterus which protrudes into the vagina and serves as a passageway for sperm into the uterus. Corpus Luteum A structure in the ovary that develops after the egg is released, which secretes progesterone. cryopreservation The preservation of sperm or embryos by freezing, usually by immersion in liquid nitrogen. endometriosis The presence of endometrial tissue in abnormal locations, such as the fallopian tubes, ovaries and abdominal cavity. The condition frequently causes pain and discomfort during menstruation, or even chronic pelvic pain, and may also cause infertility. endometrium The inner lining of the uterus. estrogen The primary female hormone produced mainly by the ovaries from puberty to menopause. fallopian tube The tube that connects the uterus and ovary. It allows the egg to pass from the ovary to the uterus and the spermatozoa from the uterus toward the ovary. fibroids Smooth muscle tumors of the muscular wall of the uterus which are almost always benign but may cause infertility or recurrent miscarriages. follicle A cystic structure in the ovary which contains and nurtures the ovum (egg). It enlarges to a diameter of 18 - 28 mm (3/4 - 1 inch) before ovulation, at which point it releases the egg. FSH (follicle stimulating hormone) A hormone that recruits and then stimulates growth of the follicle in the ovary, as well as the formation of spermatozoa in the testes. GIFT (gamete intrafallopian transfer) A procedure in which eggs are removed from a ripened follicle and via laparoscopy are placed with sperm into the fallopian tube, where fertilization takes place. gonadotropin A hormone (FSH, LH, hMG, hCG) which stimulates the gonads (ovaries or testes). GnRH (gonadotropin releasing hormone) A small hormone produced by the brain which causes the pituitary gland to manufacture and release FSH and LH. GnRH agonist (Lupron) Differs from GnRH at 2 amino-acid positions. Used to stop production of FSH and LH from the pituitary gland. Gonal-F The brand name of a new recombinant FSH used to stimulate the ovaries to produce follicles. Follistim is the brand name of another recombinant FSH on the market. hCG (human chorionic gonadotropin) A hormone produced by the placenta. Detection of its presence in urine or blood is the basis of the pregnancy test. Also used to trigger final maturation and ovulation of the egg. hMG (human menopausal gonadotropin) A hormone (Pergonal or Humegon) used to stimulate follicle production. Equal parts of FSH and LH are present. hysteroscopy An endoscopic (fiber-optic tube) procedure used primarily to visualize the interior of the uterus. implantation The embedding of the embryo in the uterine wall. in-vitro fertilization/embryo transfer A procedure in which an egg is removed from a ripe follicle and fertilized with sperm outside the body. The resulting embryo is inserted into the woman&rsquo;s uterus. laparoscopy An abdominal surgical procedure using an endoscopic instrument (fiber-optic tube) to view the fallopian tubes, ovaries, uterus, and other abdominal structures. The laparoscope may also be used to perform surgical procedures, employing the use of lasers and other specialized equipment. LH (luteinizing hormone) A hormone produced and released by the pituitary gland. In the female, it is responsible for maturation and then the release of the ovum. In the male, it stimulates testosterone production. Lutrepulse The trade name for a gonadotropin releasing hormone (GnRH) used to induce ovulation in some patients. It is administered through an infusion pump in a pulsatile fashion. oligospermia The presence of a low number of sperm in the ejaculate. ovum The egg cell (gamete) produced in a woman&rsquo;s ovaries during each menstrual cycle. ovulation The release of a mature egg from the surface of the ovary. pituitary gland A gland at the base of the brain which produces many hormones, including FSH and LH. polyps Small, benign growths protruding from the lining of the endometrium or endocervix. progesterone A hormone produced and released during the second half of a woman&rsquo;s ovulatory cycle. It is necessary in the preparation of the uterine lining for implantation of the fertilized egg. semen The sperm and seminal secretions ejaculated by the male during orgasm. sperm Male reproductive cells contained in the seminal fluid. testosterone The most potent male sex hormone, produced in the testes. uterus The reproductive organ which protects and nourishes the developing embryo/fetus. It is a hollow, muscular structure that is part of the female reproductive tract, and it is the source of a woman&rsquo;s menses. vagina A tubular passageway in the female which connects the external sex organs with the cervix and uterus. IVF: In Vitro Fertilization(IVF) In vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy. In order to reach this potential, your participation and that of your physician (reproductive endocrinologist), nurses and embryologists require close coordination. Precise timing of medications is critical, and close monitoring with ultrasound is required. This reproductive journey is detailed and involved, but we are here to guide you and help ease as many of the complexities that may occur along the way. Please feel free to ask our nurses and physicians any questions you may have. IVF (In Vitro Fertilization) Overview With IVF, oocytes (eggs) are retrieved from the ovary and placed in a Petri dish with active, motile sperm. Because fertilization occurs in the Petri dish rather than in the woman’s body, this process has been called “in vitro.” The eggs and sperm are maintained in a special culture media (nutrient fluid) within a controlled environment (incubator). If a fertilized egg is developing properly, it will consist of 6-8 cells at 3 days after egg retrieval. If an embryo is continuing develop appropriately, it will form a blastocyst by 5-6 days after egg retrieval. After embryos have developed in the laboratory for several days, one or more are selected for transfer into your uterus and if additional embryos are developing, they may be frozen to be transferred at a future time. Step by step guide to IVF Although the details of individual cycles will vary, all of the assisted reproductive technologies have similar steps. 1. Pretreatment preparation 2. Ovulation induction 3. Oocyte retrieval 4. Fertilization of eggs in the laboratory 5. Embryo transfer 6. Luteal phase 7. Pregnancy test and pregnancy follow-up 1. Pretreatment preparation After the decision is made to proceed with IVF, you will meet with a Registered Nurse and will receive a medication log and a calendar outlining the treatment. In many cases, oral contraceptive pills (OCPs) will be prescribed in the cycle, prior to active treatment. The purpose of the OCP is to reduce the chance that an ovarian cyst will be present at the time when we plan to start treatment and to allow flexibility in the timing of the cycle (the number of days on OCP can be varied). Ultrasound. While you are on the OCP, you will have a Transvaginal ultrasound to assess whether there are any cysts present in the ovaries. In one commonly used protocol, you will begin a medication called Lupron (a GnRH agonist) while you are still taking the OCP. Your individual protocol may vary, and you may be prescribed a medicine other than Lupron (such as a GnRH antagonist called Ganirelix or Cetrotide) to prevent premature release of the eggs. Uterine screening. If you have not had an evaluation of your uterus within the last year, your MD may recommend a screening test as a hysteroscopy or a saline infusion sonography to be done while you are taking the OCP. You will be given more information about any procedure that will be recommended. Backup semen sample. In some cases a semen sample is obtained, frozen, and stored as a “back-up” specimen available on the day of egg retrieval. Please inform your MD or RN if you anticipate any difficulty in collecting a sample on the day of the retrieval so that you can arrange to have a back-sample frozen ahead of time. 2. Ovulation induction Success rates with reproductive technologies (ART) are improved if multiple mature oocytes are available for retrieval. In order to mature a group of eggs, medications are administered by subcutaneous injection on a daily basis. The medications are in a class called gonadotropins. Some of the commercial names are Follistim, Gonal-F, Menopur and Repronex. Baseline Ultrasound. Your baseline ultrasound will be performed before starting the gonadotropin. Occasionally you may have an ovarian cyst at this time. If you have a cyst, it often disappears with continued Lupron treatment, or less commonly your MD might recommend aspiration of the cyst. If the baseline ultrasound is normal, you will begin gonadrotropin injections. This medication will promote a group of several follicles (the sacs of fluid which contain the microscopic eggs) to develop together. Ideally about 10-12 follicles develop, but the response is quite variable and you may produce only 2-3 follicles, or as many as 20-30. The dose of medication you will receive is based on a prediction of how your ovaries will respond based on your age, your baseline FSH and estradiol levels, and any previous ovulation induction experience. When you begin the gonadotropin medication, it is important to not pursue intense physical exercise (kick boxing, jumping, etc.) because such activity could cause discomfort and twisting of the ovaries. The gonadotropin injections have some risks and side effects which are discussed in detail in the medication information and in consent forms that you will be given. Most women taking gonadotropin injections for IVF will feel a sense of fullness in their ovaries. Risks include ovarian hyperstimulation syndrome (OHSS) and multiple birth (particularly if multiple embryos are transferred). There has been some concern regarding the possibility of increased risk of ovarian cancer with the use of fertility medications. However, more recent studies have overall been reassuring. Timing of hCG. When ultrasound examination suggest that the eggs are mature (usually when the lead follicle size is about 18 mm in diameter), you will be asked to take an injection of human chorionic gonadotropin (hCG). The timing of the hCG is critical, so you need to take it precisely at the time given to you on the schedule. Once you take hCG, your gonadotropin and GnRH agonist or GnRH antagonist will stop. 3. Oocyte retrieval Approximately 35 hours after the hCG injection, the egg retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval. If you are taking medications for any other reason, talk to your MD or RN about taking medication prior to retrieval. Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the IVF laboratory. The egg retrieval takes approximately 20-30 minutes. After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small. On the day of egg retrieval, you will need to have someone available to drive you home (you cannot drive on the day of egg retrieval due to the intravenous medications that you will be receiving). You should not plan to do any work on the day of egg retrieval. Many women do return to work the next day, while others also rest the day following the retrieval. You may feel some pelvic heaviness or soreness and cramping. It is okay to take Tylenol, but you should avoid ibuprofen (i.e. Advil, Motrin). Often there is a small amount of spotting. Your bleeding should be less than a normal period. We recommend that you avoid immersing yourself in water (avoid swimming, take showers rather than baths, avoid vaginal intercourse) from the day of the retrieval for several days to allow the vagina to heal. After the procedure, you will be given complete written instructions and phone numbers. It is important to know that your ovaries are still enlarged immediately after the egg retrieval and that they remain enlarged for the next several weeks. For this reason, avoid heavy lifting or vigorous exertion such as running or aerobics until they return to normal size (which occurs either at 6-10 weeks into the pregnancy or with menses if pregnancy does not occur). It is okay to take stairs slowly, and walk short distances, less than a mile. Avoid any vaginal creams, lubricants, or spermicides other than the progesterone that is prescribed. Avoid hot tubs and Jacuzzis. Avoid intercourse until advised by your physician. If you travel, give yourself twice as much time as usual and minimize stress. Semen sample. Your partner will give a sperm sample the day of the egg retrieval. It is recommended that he abstain from ejaculation for 2 days (48 hours) to 5 days before giving the sample. 4. Fertilization of eggs Once the eggs are retrieved and placed in the incubator, they rest for several hours before the sperm is added, usually in the afternoon of the egg retrieval. Addition of sperm to the culture media is called insemination, and is followed by fertilization, when the sperm enters the egg. Fertilization can also be accomplished by ICSI (intracytoplasmatic sperm injection). ICSI will be recommended if your physician suspects that there will be a significant chance of no fertilization or a low rate of fertilization with conventional insemination of the oocytes in the laboratory. We will call you the day after retrieval to let you know how many eggs have fertilized. It is important to understand that all the embryos may not be able to be observed on that day and that of those that are seen, they may not continue to grow. The embryo can begin cleaving, or dividing, first into two cells, then into four. Cleavage to four cells generally takes 36-48 hours or more after the egg retrieval. After 3 days, an embryo which is growing properly will have 6-8 cells. An embryo should reach a blastocyst stage at 5-6 days after retrieval. 5. Embryo transfer Three to five days after the oocyte retrieval you will be scheduled for your embryo transfer. Your physician will recommend which day is most appropriate for you. In general, blastocyst transfer is recommended when there are a large number of embryos of good quality, or for couples desiring only a single embryo to be transferred. Your physician will give you a recommendation regarding the number of embryos to be transferred based on your age, your history if you have had IVF performed in the past, and the quality of the embryos. Abdominal ultrasound is used to guide the transfer. To perform the transfer, your physician will place a speculum in the vagina and the cervix will be rinsed with a sterile solution. The embryologist in the laboratory will load the embryos into a small catheter and your physician will ease the tip of the catheter through the cervix into the uterus. You may have a sensation or twinge as the catheter passes through your cervix or you may not feel anything. For this reason, anesthesia is not used for the transfer. On the day of your transfer wear comfortable clothing and socks to keep your feet warm. Your bladder should feel full, but not very uncomfortable. A partially full bladder often will allow the transfer to be completed more easily and will allow a better picture on the abdominal ultrasound. We suggest that you rest the day after the transfer, to allow yourself time to relax as much as possible. Also, your ovaries will still be enlarged and activity should be minimized as described above to prevent ovarian discomfort. However, it is important to know that nothing you will do, such as walking or going to the bathroom will cause the embryos to dislodge from the uterine wall. The main factors that determine whether an embryo will implant are the viability (“health”) of the embryo and the quality of the uterine lining. Healthy embryos will be much more likely to implant and develop than embryos which are not viable. 6. Luteal phase You will take progesterone by injection and/or vaginal suppository gel because it has been shown that progesterone supplementation increases the chance of success with IVF. Progesterone is the natural hormone that your body produces to support the uterine lining and maintain an early pregnancy. Although the FDA requires the drug manufacturer to include warnings about using progesterone in early pregnancy, this is due to the fact that progestins (a synthetic progesterone-like substance) or high doses of progesterone in animal experienced have raised concerns. However, you will only receive progesterone, the same natural hormone your ovaries produce, in a dose that is not excessive. After the egg retrieval, you will receive your first dose of progesterone. You will continue this daily for the next two weeks according to a schedule you will receive. This schedule will include the dose you should take. As noted above, it is common to have a sensation of heaviness or cramping in your pelvis 4-10 days after egg retrieval. Your ovaries frequently enlarge at this time. If you are gaining weight rapidly (more than a pound a day) which can occur due to fluid retention, or if you are not urinating the normal amount for you, or if you have any other concerns, please call. Light bleeding sometimes occurs in the weeks following egg retrieval, even if there is a normally developing pregnancy. A pregnancy test will be performed approximately two weeks after your egg retrieval. Waiting for your pregnancy test is a difficult time. It is not unusual to have symptoms of pregnancy that come and go due to the hormonal changes with IVF. The only way to know whether or not you are pregnant is by the pregnancy test done two weeks after egg retrieval. Bleeding may occur even if a pregnancy is developing normally. Please continue to take the progesterone that is prescribed until your pregnancy test, even if you think you may not be pregnant. Because the hormones that you are taking may confuse the symptoms that you have come to recognize as signs that you may or may not be pregnant, try not to guess or do home pregnancy tests before the blood test. They may not be accurate. If the first test is positive, you will be asked to return for a follow-up test 2-3 days later to see that the level of the hormone hCG is rising appropriately. Hopefully you will receive good news and find out that the pregnancy test is positive and have follow-up as described below. If unfortunately you are not pregnant, you will be instructed to stop the progesterone and expect a period within 2-5 days (you should call us if a menses does not occur within about 5 days of stopping progesterone). If you do not conceive, you may find it helpful to schedule a follow-up visit with the MD to occur about 2 weeks after your pregnancy test results. This visit is important so we can counsel you regarding your next steps. Another cycle of treatment can begin as soon as one month after a failed cycle. Pregnancy Hopefully, you will be pregnant, and an ultrasound will be scheduled 4-5 weeks after your egg retrieval. The ultrasound will be done again 2 weeks later (6-7 weeks from retrieval). We will then refer you to your obstetrician for the remainder of the pregnancy. You will remain on progesterone until 8-10 weeks from your retrieval. We truly look forward to hearing from you when you deliver your child. <img src="http://cdn.slidesharecdn.com/shivani-scientific-final-brochurenew-1212466826453167-8-thumbnail-2?1212459994" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> info@shivaniscientific.com http://www.shivaniscientific.com Infertility Treatment - Overview, IVF, GIFT, TET, Microsurgical Tubal Reanastomosis, Frequently Asked Questions, Women Over 40, PCOS, Assisted Hatching, Microsurgery, Immunological Testing and Treatment, Donor Egg, ICSI, Hysterectomy, Laparoscopic Procedures, Sex Selection You need information about IVF, ICSI, infertility clinics, donor egg and surrogacy services (e.g., surrogate mothers), tubal reversal doctors, vasectomy reversal doctors, natural infertility treatment, male infertility services, sperm banks, pharmacies, infertility books and videotapes, sperm testing, infertility support, and drugs and medications, such as Metrodin, Pergonal, Clomid. Infertility News and Announcements Infertility Service Providers 1. Infertility IVF clinics 9. Lawyers 2. Egg donor programs 10. Pharmacies 3. Tubal reversal doctors 11. Surrogacy programs 4. Vasectomy reversal doctors 12. Counselors &amp; consultants 5. Financial assistance 13. Egg Freezing 6. Natural treatment 13. PGD programs 7. Sperm banks 14. Embryo adoption 8. Male infertility doctors 15. Adoption Agencies Infertility Products 1. Women - fertility monitors, etc. 5. Conception products 2. Women - fertility supplements 6. Fertility product stores 3. Men - sperm testing 7. Infertility books 4. Men - fertility supplements 8. Infertility videos and CDs Education 1. Main 8. Financial and Insurance 2. Diagnosis 9. Legal Rights 3. Male Factor 10. Psychological and Social 4. Treatment 11. Infertility Photos 5. Egg Donation and Egg Donors 12. Miscellaneous 6. Drugs and Medications MORE ON IVF: Glossary adhesions Bands of scar tissue attached to organ surfaces and capable of connecting, covering, or distorting organs, such as tubes, ovaries or uterus. AID (artificial insemination, donor) A procedure introducing sperm from an anonymous donor into a woman&rsquo;s uterus in order to achieve a pregnancy. AIH (artificial insemination, husband or homologous) A special insemination procedure used to introduce sperm collected from a woman&rsquo;s partner into the woman&rsquo;s uterus. Also referred to as intrauterine insemination (IUI). antisperm antibodies Antibodies that may be produced by either a female or male which may damage sperm or cause them to adhere to each other, thus limiting their fertility potential. azoospermia The absence of sperm in the ejaculate. cervical mucus Mucus produced by the cervix which changes in thickness and quantity at the time of ovulation. cervix The lower section of the uterus which protrudes into the vagina and serves as a passageway for sperm into the uterus. Corpus Luteum A structure in the ovary that develops after the egg is released, which secretes progesterone. cryopreservation The preservation of sperm or embryos by freezing, usually by immersion in liquid nitrogen. endometriosis The presence of endometrial tissue in abnormal locations, such as the fallopian tubes, ovaries and abdominal cavity. The condition frequently causes pain and discomfort during menstruation, or even chronic pelvic pain, and may also cause infertility. endometrium The inner lining of the uterus. estrogen The primary female hormone produced mainly by the ovaries from puberty to menopause. fallopian tube The tube that connects the uterus and ovary. It allows the egg to pass from the ovary to the uterus and the spermatozoa from the uterus toward the ovary. fibroids Smooth muscle tumors of the muscular wall of the uterus which are almost always benign but may cause infertility or recurrent miscarriages. follicle A cystic structure in the ovary which contains and nurtures the ovum (egg). It enlarges to a diameter of 18 - 28 mm (3/4 - 1 inch) before ovulation, at which point it releases the egg. FSH (follicle stimulating hormone) A hormone that recruits and then stimulates growth of the follicle in the ovary, as well as the formation of spermatozoa in the testes. GIFT (gamete intrafallopian transfer) A procedure in which eggs are removed from a ripened follicle and via laparoscopy are placed with sperm into the fallopian tube, where fertilization takes place. gonadotropin A hormone (FSH, LH, hMG, hCG) which stimulates the gonads (ovaries or testes). GnRH (gonadotropin releasing hormone) A small hormone produced by the brain which causes the pituitary gland to manufacture and release FSH and LH. GnRH agonist (Lupron) Differs from GnRH at 2 amino-acid positions. Used to stop production of FSH and LH from the pituitary gland. Gonal-F The brand name of a new recombinant FSH used to stimulate the ovaries to produce follicles. Follistim is the brand name of another recombinant FSH on the market. hCG (human chorionic gonadotropin) A hormone produced by the placenta. Detection of its presence in urine or blood is the basis of the pregnancy test. Also used to trigger final maturation and ovulation of the egg. hMG (human menopausal gonadotropin) A hormone (Pergonal or Humegon) used to stimulate follicle production. Equal parts of FSH and LH are present. hysteroscopy An endoscopic (fiber-optic tube) procedure used primarily to visualize the interior of the uterus. implantation The embedding of the embryo in the uterine wall. in-vitro fertilization/embryo transfer A procedure in which an egg is removed from a ripe follicle and fertilized with sperm outside the body. The resulting embryo is inserted into the woman&rsquo;s uterus. laparoscopy An abdominal surgical procedure using an endoscopic instrument (fiber-optic tube) to view the fallopian tubes, ovaries, uterus, and other abdominal structures. The laparoscope may also be used to perform surgical procedures, employing the use of lasers and other specialized equipment. LH (luteinizing hormone) A hormone produced and released by the pituitary gland. In the female, it is responsible for maturation and then the release of the ovum. In the male, it stimulates testosterone production. Lutrepulse The trade name for a gonadotropin releasing hormone (GnRH) used to induce ovulation in some patients. It is administered through an infusion pump in a pulsatile fashion. oligospermia The presence of a low number of sperm in the ejaculate. ovum The egg cell (gamete) produced in a woman&rsquo;s ovaries during each menstrual cycle. ovulation The release of a mature egg from the surface of the ovary. pituitary gland A gland at the base of the brain which produces many hormones, including FSH and LH. polyps Small, benign growths protruding from the lining of the endometrium or endocervix. progesterone A hormone produced and released during the second half of a woman&rsquo;s ovulatory cycle. It is necessary in the preparation of the uterine lining for implantation of the fertilized egg. semen The sperm and seminal secretions ejaculated by the male during orgasm. sperm Male reproductive cells contained in the seminal fluid. testosterone The most potent male sex hormone, produced in the testes. uterus The reproductive organ which protects and nourishes the developing embryo/fetus. It is a hollow, muscular structure that is part of the female reproductive tract, and it is the source of a woman&rsquo;s menses. vagina A tubular passageway in the female which connects the external sex organs with the cervix and uterus. IVF: In Vitro Fertilization(IVF) In vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy. In order to reach this potential, your participation and that of your physician (reproductive endocrinologist), nurses and embryologists require close coordination. Precise timing of medications is critical, and close monitoring with ultrasound is required. This reproductive journey is detailed and involved, but we are here to guide you and help ease as many of the complexities that may occur along the way. Please feel free to ask our nurses and physicians any questions you may have. IVF (In Vitro Fertilization) Overview With IVF, oocytes (eggs) are retrieved from the ovary and placed in a Petri dish with active, motile sperm. Because fertilization occurs in the Petri dish rather than in the woman’s body, this process has been called “in vitro.” The eggs and sperm are maintained in a special culture media (nutrient fluid) within a controlled environment (incubator). If a fertilized egg is developing properly, it will consist of 6-8 cells at 3 days after egg retrieval. If an embryo is continuing develop appropriately, it will form a blastocyst by 5-6 days after egg retrieval. After embryos have developed in the laboratory for several days, one or more are selected for transfer into your uterus and if additional embryos are developing, they may be frozen to be transferred at a future time. Step by step guide to IVF Although the details of individual cycles will vary, all of the assisted reproductive technologies have similar steps. 1. Pretreatment preparation 2. Ovulation induction 3. Oocyte retrieval 4. Fertilization of eggs in the laboratory 5. Embryo transfer 6. Luteal phase 7. Pregnancy test and pregnancy follow-up 1. Pretreatment preparation After the decision is made to proceed with IVF, you will meet with a Registered Nurse and will receive a medication log and a calendar outlining the treatment. In many cases, oral contraceptive pills (OCPs) will be prescribed in the cycle, prior to active treatment. The purpose of the OCP is to reduce the chance that an ovarian cyst will be present at the time when we plan to start treatment and to allow flexibility in the timing of the cycle (the number of days on OCP can be varied). Ultrasound. While you are on the OCP, you will have a Transvaginal ultrasound to assess whether there are any cysts present in the ovaries. In one commonly used protocol, you will begin a medication called Lupron (a GnRH agonist) while you are still taking the OCP. Your individual protocol may vary, and you may be prescribed a medicine other than Lupron (such as a GnRH antagonist called Ganirelix or Cetrotide) to prevent premature release of the eggs. Uterine screening. If you have not had an evaluation of your uterus within the last year, your MD may recommend a screening test as a hysteroscopy or a saline infusion sonography to be done while you are taking the OCP. You will be given more information about any procedure that will be recommended. Backup semen sample. In some cases a semen sample is obtained, frozen, and stored as a “back-up” specimen available on the day of egg retrieval. Please inform your MD or RN if you anticipate any difficulty in collecting a sample on the day of the retrieval so that you can arrange to have a back-sample frozen ahead of time. 2. Ovulation induction Success rates with reproductive technologies (ART) are improved if multiple mature oocytes are available for retrieval. In order to mature a group of eggs, medications are administered by subcutaneous injection on a daily basis. The medications are in a class called gonadotropins. Some of the commercial names are Follistim, Gonal-F, Menopur and Repronex. Baseline Ultrasound. Your baseline ultrasound will be performed before starting the gonadotropin. Occasionally you may have an ovarian cyst at this time. If you have a cyst, it often disappears with continued Lupron treatment, or less commonly your MD might recommend aspiration of the cyst. If the baseline ultrasound is normal, you will begin gonadrotropin injections. This medication will promote a group of several follicles (the sacs of fluid which contain the microscopic eggs) to develop together. Ideally about 10-12 follicles develop, but the response is quite variable and you may produce only 2-3 follicles, or as many as 20-30. The dose of medication you will receive is based on a prediction of how your ovaries will respond based on your age, your baseline FSH and estradiol levels, and any previous ovulation induction experience. When you begin the gonadotropin medication, it is important to not pursue intense physical exercise (kick boxing, jumping, etc.) because such activity could cause discomfort and twisting of the ovaries. The gonadotropin injections have some risks and side effects which are discussed in detail in the medication information and in consent forms that you will be given. Most women taking gonadotropin injections for IVF will feel a sense of fullness in their ovaries. Risks include ovarian hyperstimulation syndrome (OHSS) and multiple birth (particularly if multiple embryos are transferred). There has been some concern regarding the possibility of increased risk of ovarian cancer with the use of fertility medications. However, more recent studies have overall been reassuring. Timing of hCG. When ultrasound examination suggest that the eggs are mature (usually when the lead follicle size is about 18 mm in diameter), you will be asked to take an injection of human chorionic gonadotropin (hCG). The timing of the hCG is critical, so you need to take it precisely at the time given to you on the schedule. Once you take hCG, your gonadotropin and GnRH agonist or GnRH antagonist will stop. 3. Oocyte retrieval Approximately 35 hours after the hCG injection, the egg retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval. If you are taking medications for any other reason, talk to your MD or RN about taking medication prior to retrieval. Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the IVF laboratory. The egg retrieval takes approximately 20-30 minutes. After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small. On the day of egg retrieval, you will need to have someone available to drive you home (you cannot drive on the day of egg retrieval due to the intravenous medications that you will be receiving). You should not plan to do any work on the day of egg retrieval. Many women do return to work the next day, while others also rest the day following the retrieval. You may feel some pelvic heaviness or soreness and cramping. It is okay to take Tylenol, but you should avoid ibuprofen (i.e. Advil, Motrin). Often there is a small amount of spotting. Your bleeding should be less than a normal period. We recommend that you avoid immersing yourself in water (avoid swimming, take showers rather than baths, avoid vaginal intercourse) from the day of the retrieval for several days to allow the vagina to heal. After the procedure, you will be given complete written instructions and phone numbers. It is important to know that your ovaries are still enlarged immediately after the egg retrieval and that they remain enlarged for the next several weeks. For this reason, avoid heavy lifting or vigorous exertion such as running or aerobics until they return to normal size (which occurs either at 6-10 weeks into the pregnancy or with menses if pregnancy does not occur). It is okay to take stairs slowly, and walk short distances, less than a mile. Avoid any vaginal creams, lubricants, or spermicides other than the progesterone that is prescribed. Avoid hot tubs and Jacuzzis. Avoid intercourse until advised by your physician. If you travel, give yourself twice as much time as usual and minimize stress. Semen sample. Your partner will give a sperm sample the day of the egg retrieval. It is recommended that he abstain from ejaculation for 2 days (48 hours) to 5 days before giving the sample. 4. Fertilization of eggs Once the eggs are retrieved and placed in the incubator, they rest for several hours before the sperm is added, usually in the afternoon of the egg retrieval. Addition of sperm to the culture media is called insemination, and is followed by fertilization, when the sperm enters the egg. Fertilization can also be accomplished by ICSI (intracytoplasmatic sperm injection). ICSI will be recommended if your physician suspects that there will be a significant chance of no fertilization or a low rate of fertilization with conventional insemination of the oocytes in the laboratory. We will call you the day after retrieval to let you know how many eggs have fertilized. It is important to understand that all the embryos may not be able to be observed on that day and that of those that are seen, they may not continue to grow. The embryo can begin cleaving, or dividing, first into two cells, then into four. Cleavage to four cells generally takes 36-48 hours or more after the egg retrieval. After 3 days, an embryo which is growing properly will have 6-8 cells. An embryo should reach a blastocyst stage at 5-6 days after retrieval. 5. Embryo transfer Three to five days after the oocyte retrieval you will be scheduled for your embryo transfer. Your physician will recommend which day is most appropriate for you. In general, blastocyst transfer is recommended when there are a large number of embryos of good quality, or for couples desiring only a single embryo to be transferred. Your physician will give you a recommendation regarding the number of embryos to be transferred based on your age, your history if you have had IVF performed in the past, and the quality of the embryos. Abdominal ultrasound is used to guide the transfer. To perform the transfer, your physician will place a speculum in the vagina and the cervix will be rinsed with a sterile solution. The embryologist in the laboratory will load the embryos into a small catheter and your physician will ease the tip of the catheter through the cervix into the uterus. You may have a sensation or twinge as the catheter passes through your cervix or you may not feel anything. For this reason, anesthesia is not used for the transfer. On the day of your transfer wear comfortable clothing and socks to keep your feet warm. Your bladder should feel full, but not very uncomfortable. A partially full bladder often will allow the transfer to be completed more easily and will allow a better picture on the abdominal ultrasound. We suggest that you rest the day after the transfer, to allow yourself time to relax as much as possible. Also, your ovaries will still be enlarged and activity should be minimized as described above to prevent ovarian discomfort. However, it is important to know that nothing you will do, such as walking or going to the bathroom will cause the embryos to dislodge from the uterine wall. The main factors that determine whether an embryo will implant are the viability (“health”) of the embryo and the quality of the uterine lining. Healthy embryos will be much more likely to implant and develop than embryos which are not viable. 6. Luteal phase You will take progesterone by injection and/or vaginal suppository gel because it has been shown that progesterone supplementation increases the chance of success with IVF. Progesterone is the natural hormone that your body produces to support the uterine lining and maintain an early pregnancy. Although the FDA requires the drug manufacturer to include warnings about using progesterone in early pregnancy, this is due to the fact that progestins (a synthetic progesterone-like substance) or high doses of progesterone in animal experienced have raised concerns. However, you will only receive progesterone, the same natural hormone your ovaries produce, in a dose that is not excessive. After the egg retrieval, you will receive your first dose of progesterone. You will continue this daily for the next two weeks according to a schedule you will receive. This schedule will include the dose you should take. As noted above, it is common to have a sensation of heaviness or cramping in your pelvis 4-10 days after egg retrieval. Your ovaries frequently enlarge at this time. If you are gaining weight rapidly (more than a pound a day) which can occur due to fluid retention, or if you are not urinating the normal amount for you, or if you have any other concerns, please call. Light bleeding sometimes occurs in the weeks following egg retrieval, even if there is a normally developing pregnancy. A pregnancy test will be performed approximately two weeks after your egg retrieval. Waiting for your pregnancy test is a difficult time. It is not unusual to have symptoms of pregnancy that come and go due to the hormonal changes with IVF. The only way to know whether or not you are pregnant is by the pregnancy test done two weeks after egg retrieval. Bleeding may occur even if a pregnancy is developing normally. Please continue to take the progesterone that is prescribed until your pregnancy test, even if you think you may not be pregnant. Because the hormones that you are taking may confuse the symptoms that you have come to recognize as signs that you may or may not be pregnant, try not to guess or do home pregnancy tests before the blood test. They may not be accurate. If the first test is positive, you will be asked to return for a follow-up test 2-3 days later to see that the level of the hormone hCG is rising appropriately. Hopefully you will receive good news and find out that the pregnancy test is positive and have follow-up as described below. If unfortunately you are not pregnant, you will be instructed to stop the progesterone and expect a period within 2-5 days (you should call us if a menses does not occur within about 5 days of stopping progesterone). If you do not conceive, you may find it helpful to schedule a follow-up visit with the MD to occur about 2 weeks after your pregnancy test results. This visit is important so we can counsel you regarding your next steps. Another cycle of treatment can begin as soon as one month after a failed cycle. Pregnancy Hopefully, you will be pregnant, and an ultrasound will be scheduled 4-5 weeks after your egg retrieval. The ultrasound will be done again 2 weeks later (6-7 weeks from retrieval). We will then refer you to your obstetrician for the remainder of the pregnancy. You will remain on progesterone until 8-10 weeks from your retrieval. We truly look forward to hearing from you when you deliver your child. Infertility clinics, fertility clinics, fertility doctors,fertility and IVF treatment
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]]> 2461 2 http://cdn.slidesharecdn.com/shivani-scientific-final-brochurenew-1212466826453167-8-thumbnail-2?1212459994 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Female Libido Enhancing Herbs http://www.slideshare.net/Female_Libido/female-libido-enhancing-herbs
Female libido enhancing herbs have been around for ages but not every woman was privi with the knowledge]]>
Female libido enhancing herbs have been around for ages but not every woman was privi with the knowledge]]> Tue, 13 May 2008 23:49:22 GMT http://www.slideshare.net/Female_Libido/female-libido-enhancing-herbs Female_Libido@slideshare.net(Female_Libido) Female Libido Enhancing Herbs Female_Libido Female libido enhancing herbs have been around for ages but not every woman was privi with the knowledge <img src="http://cdn.slidesharecdn.com/libido-enhancing-herbs-1210729760633373-9-thumbnail-2?1210722562" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Female libido enhancing herbs have been around for ages but not every woman was privi with the knowledge Female Libido Enhancing Herbs
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]]> 937 0 http://cdn.slidesharecdn.com/libido-enhancing-herbs-1210729760633373-9-thumbnail-2?1210722562 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Enhancing Performance Planning And Review for Business and Talent Management http://www.slideshare.net/kennyong/enhancing-performance-planning-and-review-for-business-and-talent-management
*Why we hate Performance Appraisals and why most Performance Management Systems do not work *From performance appraisal to performance management, and from a bureaucratic requirement to a tool for managing and improving performance *Planning, managing and developing the performance of subordinates *Rewarding performance and Managing Talent]]>
*Why we hate Performance Appraisals and why most Performance Management Systems do not work *From performance appraisal to performance management, and from a bureaucratic requirement to a tool for managing and improving performance *Planning, managing and developing the performance of subordinates *Rewarding performance and Managing Talent]]> Tue, 22 Apr 2008 01:58:17 GMT http://www.slideshare.net/kennyong/enhancing-performance-planning-and-review-for-business-and-talent-management kennyong@slideshare.net(kennyong) Enhancing Performance Planning And Review for Business and Talent Management kennyong *Why we hate Performance Appraisals and why most Performance Management Systems do not work *From performance appraisal to performance management, and from a bureaucratic requirement to a tool for managing and improving performance *Planning, managing and developing the performance of subordinates *Rewarding performance and Managing Talent <img src="http://cdn.slidesharecdn.com/abf-workshop-by-kenny-ong-part-1-enhancing-performance-planning-and-review-1208836398407278-8-thumbnail-2?1208829497" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> *Why we hate Performance Appraisals and why most Performance Management Systems do not work *From performance appraisal to performance management, and from a bureaucratic requirement to a tool for managing and improving performance *Planning, managing and developing the performance of subordinates *Rewarding performance and Managing Talent Enhancing Performance Planning And Review for Business and Talent Management
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]]> 3307 1 http://cdn.slidesharecdn.com/abf-workshop-by-kenny-ong-part-1-enhancing-performance-planning-and-review-1208836398407278-8-thumbnail-2?1208829497 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Enhancing Computer Security via End-to-End Communication Visualization http://www.slideshare.net/amiable_indian/enhancing-computer-security-via-endtoend-communication-visualization
Enhancing Computer Security via End-to-End Communication Visualization ]]>
Enhancing Computer Security via End-to-End Communication Visualization ]]> Tue, 01 Apr 2008 01:20:52 GMT http://www.slideshare.net/amiable_indian/enhancing-computer-security-via-endtoend-communication-visualization amiable_indian@slideshare.net(amiable_indian) Enhancing Computer Security via End-to-End Communication Visualization amiable_indian Enhancing Computer Security via End-to-End Communication Visualization <img src="http://cdn.slidesharecdn.com/enhancing-computer-security-via-endtoend-communication-visualization-9238-thumbnail-2?1207012852" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Enhancing Computer Security via End-to-End Communication Visualization Enhancing Computer Security via End-to-End Communication Visualization
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presented at the Medical and Health Librarians Association of the Philippines (MAHLAP) Conference on Knowledge, Skills, and Personality Enhancement: Platform for Change, held at Pearl Manila Hotel, UN Avenue, Manila, Philippines on 2004 Feb19]]>
presented at the Medical and Health Librarians Association of the Philippines (MAHLAP) Conference on Knowledge, Skills, and Personality Enhancement: Platform for Change, held at Pearl Manila Hotel, UN Avenue, Manila, Philippines on 2004 Feb19]]> Mon, 18 Feb 2008 16:15:37 GMT http://www.slideshare.net/verzosaf/evaluating-enhancing-and-supplementing-the-library-resources verzosaf@slideshare.net(verzosaf) Evaluating, Enhancing, and Supplementing the Library Resources verzosaf presented at the Medical and Health Librarians Association of the Philippines (MAHLAP) Conference on Knowledge, Skills, and Personality Enhancement: Platform for Change, held at Pearl Manila Hotel, UN Avenue, Manila, Philippines on 2004 Feb19 <img src="http://cdn.slidesharecdn.com/evaluating-enhancing-and-supplementing-the-library-resources-1203358535992109-3-thumbnail-2?1203351337" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> presented at the Medical and Health Librarians Association of the Philippines (MAHLAP) Conference on Knowledge, Skills, and Personality Enhancement: Platform for Change, held at Pearl Manila Hotel, UN Avenue, Manila, Philippines on 2004 Feb19 Evaluating, Enhancing, and Supplementing the Library Resources
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]]> 690 0 http://cdn.slidesharecdn.com/evaluating-enhancing-and-supplementing-the-library-resources-1203358535992109-3-thumbnail-2?1203351337 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted Presentation Skills For Managers http://www.slideshare.net/nusantara99/presentation-skills-for-managers
Excellent presentation slides about presentation skills : concepts and applicative skills]]>
Excellent presentation slides about presentation skills : concepts and applicative skills]]> Sat, 19 May 2007 23:48:15 GMT http://www.slideshare.net/nusantara99/presentation-skills-for-managers nusantara99@slideshare.net(nusantara99) Presentation Skills For Managers nusantara99 Excellent presentation slides about presentation skills : concepts and applicative skills <img src="http://cdn.slidesharecdn.com/presentation-skills-for-managers-19669-thumbnail-2?1224902960" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Excellent presentation slides about presentation skills : concepts and applicative skills Presentation Skills For Managers
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]]> 47018 52 http://cdn.slidesharecdn.com/presentation-skills-for-managers-19669-thumbnail-2?1224902960 presentation http://activitystrea.ms/schema/1.0/post http://activitystrea.ms/schema/1.0/posted &quot;How to&quot; : Visual Effects in PowerPoint 2003 http://www.slideshare.net/mjamesno/how-to-visual-effects-in-powerpoint-2003
Brief Guide to some viusal effects for Presentations using PowerPoint 2003. This is just another example of some visuals and do’s and don’ts for PowerPOint - you can see a full animated version at Slideboom.com http://www.slideboom.com/presentations/19840/PowerPoint-Design. You can also visit my powerpoint blog at http://presentationslides.blogspot.com where there is now a $5 e-Book available that has step-by-step instructions for many of the effetcs you see in the slides.]]>
Brief Guide to some viusal effects for Presentations using PowerPoint 2003. This is just another example of some visuals and do’s and don’ts for PowerPOint - you can see a full animated version at Slideboom.com http://www.slideboom.com/presentations/19840/PowerPoint-Design. You can also visit my powerpoint blog at http://presentationslides.blogspot.com where there is now a $5 e-Book available that has step-by-step instructions for many of the effetcs you see in the slides.]]> Tue, 27 Mar 2007 03:35:39 GMT http://www.slideshare.net/mjamesno/how-to-visual-effects-in-powerpoint-2003 mjamesno@slideshare.net(mjamesno) &quot;How to&quot; : Visual Effects in PowerPoint 2003 mjamesno Brief Guide to some viusal effects for Presentations using PowerPoint 2003. This is just another example of some visuals and do&rsquo;s and don&rsquo;ts for PowerPOint - you can see a full animated version at Slideboom.com http://www.slideboom.com/presentations/19840/PowerPoint-Design. You can also visit my powerpoint blog at http://presentationslides.blogspot.com where there is now a $5 e-Book available that has step-by-step instructions for many of the effetcs you see in the slides. <img src="http://cdn.slidesharecdn.com/how-to-visual-effects-in-powerpoint-2003-2893-thumbnail-2?1226399418" alt ="" style="border:1px solid #C3E6D8;float:right;" /><br> Brief Guide to some viusal effects for Presentations using PowerPoint 2003. This is just another example of some visuals and do&rsquo;s and don&rsquo;ts for PowerPOint - you can see a full animated version at Slideboom.com http://www.slideboom.com/presentations/19840/PowerPoint-Design. You can also visit my powerpoint blog at http://presentationslides.blogspot.com where there is now a $5 e-Book available that has step-by-step instructions for many of the effetcs you see in the slides. "How to" : Visual Effects in PowerPoint 2003
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