Wisconsin Fertility Institute: Injection Class 2011

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Wisconsin Fertility Institute: Injection Class 2011

  1. 1. IN VITRO FERTILIZATION (IVF)
  2. 2. <ul><li>Suppress the endocrine(hormonal) system </li></ul><ul><li>Baseline visit </li></ul><ul><li>Stimulate Ovaries + monitoring </li></ul><ul><li>Egg Retrieval </li></ul><ul><li>Fertilize eggs in laboratory </li></ul><ul><li>Embryo Transfer to uterus </li></ul>IN VITRO FERTILIZATION STEPS:
  3. 3. IVF Protocols <ul><li>Agonist </li></ul><ul><li>Antagonist </li></ul><ul><li>Microdose Flare </li></ul><ul><li>Minimal Stimulation IVF </li></ul><ul><li>With or without birth control pills </li></ul>
  4. 4. Step One: Suppression <ul><li>Birth Control Pills for 2-3 weeks, then stop </li></ul><ul><li>Day one of menstrual cycle </li></ul><ul><li>Birth control pills + lupron </li></ul><ul><li>Lupron only </li></ul>
  5. 5. Suppression (cont.) <ul><li>Birth Control pills </li></ul><ul><ul><li>Begin day one of period </li></ul></ul><ul><ul><li>Take daily, same time </li></ul></ul><ul><ul><li>Skip placebo pills </li></ul></ul><ul><li>Menstrual cycle </li></ul><ul><ul><li>Call day 1 </li></ul></ul><ul><ul><li>Monitoring will be day 2 or 3 </li></ul></ul><ul><ul><li>Weekend instructions </li></ul></ul>
  6. 6. Suppression (cont.) Birth control pills + lupron <ul><li>Pills for 2-3 weeks- </li></ul><ul><li>Overlap pills + lupron for 2 days </li></ul><ul><li>May have vaginal bleeding after starting lupron </li></ul><ul><li>Lupron stops early ovulation, may recruit more follicles. Given with small subcutaneous shot. </li></ul><ul><li>Continue lupron during stimulation. </li></ul>
  7. 7. 1. Wash hands thoroughly. 2. With new bottle, flip off plastic cover. Use alcohol swab; cleanse metal ring and rubber stopper every day, just before use. 3. Remove outer wrapping from one syringe.
  8. 8. 4. Pull syringe plunger back until tip is at proper mark. 5. Uncover needle. Do not touch needle. 6. Place bottle on flat surface, push needle through rubber stopper. Push plunger to inject air into bottle. 7. Keep needle in bottle. Lift bottle, turn straight upside down. Check to see that needle tip is in liquid.
  9. 9. 8. Pull back plunger until syringe fills to proper mark. Remove bubbles by pushing plunger up slowly. With needle tip still in liquid, pull the plunger until at proper mark. 9. Cleanse injection site with alcohol swab. Stretch skin.Slide needle through skin, into subcutaneous tissue, at 90° angle.
  10. 10. 10. Push plunger to inject medication. Withdraw needle. Wipe skin with alcohol swab. 11. Dispose of syringe. Remember! Use disposable syringe only once
  11. 11. Baseline Visit <ul><li>Arrive with a full bladder </li></ul><ul><li>Estrogen blood test </li></ul><ul><li>Follicular Ultrasound (vaginal) </li></ul><ul><li>Trial Transfer (abdominal ultrasound) </li></ul><ul><li>Payment </li></ul><ul><li>Sign Consent </li></ul>
  12. 12. Monitor your Cycle using the PATIENT PORTAL <ul><li>Username and password </li></ul><ul><li>View lab results and medication instructions </li></ul><ul><li>Results are ready by 1PM each day </li></ul><ul><li>Schedule next appointment with front desk </li></ul>
  13. 13. Used for 9-13 days to stimulate ovaries (grow eggs). Given just under skin with small needles. Potent drugs; so monitoring with ultrasound and blood draws and potential changes in dosing will occur. GONAL F and FOLLISTIM:
  14. 14. FOLLICLES NEAR TRIGGER DAY:
  15. 15. Given when eggs mature (several measure about 20 mm in size). Given just under skin with small needle. IMPORTANT TO TAKE THIS ONE AT EXACTLY CORRECT TIME! Trigger Shot: Ovidrel or Lupron
  16. 16. Egg Retrieval
  17. 17. OOCYTE
  18. 18. CONVENTIONAL FERTILIZATION
  19. 19. ICSI FERTILIZATION
  20. 20. Doxycycline: 1 tablet orally, twice daily, 5 days. Estrace: 1 tablet orally, three times daily* Progesterone: 1mL shot (Intramuscular) same time daily or 1 suppository vaginally 2x daily * Continued until 11 weeks gestation Medicines to start Day of RETRIEVAL (Day Zero):
  21. 21. LUTEAL PHASE SUPPORT INTERMUSCULAR PROGESTERONE:
  22. 22. LUTEAL PHASE SUPPORT INTERMUSCULAR PROGESTERONE:
  23. 23. LUTEAL PHASE SUPPORT INTERMUSCULAR PROGESTERONE:
  24. 24. LUTEAL PHASE SUPPORT INTERMUSCULAR PROGESTERONE:
  25. 25. LUTEAL PHASE SUPPORT INTERMUSCULAR PROGESTERONE:
  26. 26. LUTEAL PHASE SUPPORT INTERMUSCULAR PROGESTERONE:
  27. 27. LUTEAL PHASE SUPPORT INTERMUSCULAR PROGESTERONE:
  28. 28. LUTEAL PHASE SUPPORT INTERMUSCULAR PROGESTERONE:
  29. 29. After the Retrieval <ul><li>The day after the retrieval, you will start 1 low dose, 81 mg aspirin daily </li></ul><ul><li>Daily phone calls between 1-3 PM with embryo updates </li></ul>
  30. 30. FERTILIZED OOCYTE
  31. 32. ASSISTED HATCHING: <ul><li>A Laboratory Technique That ‘hatches’ an Area </li></ul><ul><li>In Outer Coating of Embryo (Chemical vs. Laser) </li></ul><ul><li>May Improve Implantation </li></ul><ul><li>Indications: </li></ul><ul><ul><li>Age 38 or greater </li></ul></ul>Prior Failed IVF Cycles ICSI Embryos (Intracytoplasmic Sperm Injection)
  32. 33. Assisted Hatching
  33. 35. Pre-Implantation Genetic Diagnosis
  34. 36. Day 5: Blastocyst
  35. 37. 2, 3 or 5 Days after Retrieval: Embryo Transfer <ul><li>Arrive with full or partially full bladder. </li></ul><ul><li>Bring Valium/Diazepam tablet. </li></ul><ul><li>Transfer performed, 30 minutes of rest. </li></ul><ul><li>Low activity for next few days. </li></ul><ul><li>Bedrest not recommended. </li></ul><ul><li>Normal activity within 3 days. </li></ul>
  36. 40. Pregnancy Testing <ul><li>Approx 2 ½ weeks after trigger (ovidrel or lupron) shot </li></ul><ul><li>Blood test for hCG in our office </li></ul><ul><ul><li>With a positive  ultrasound 3 weeks later </li></ul></ul><ul><ul><ul><li>Then, off to OB provider </li></ul></ul></ul><ul><ul><li>With a negative  follow up with physician </li></ul></ul><ul><li>Frozen Embryos </li></ul>

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