The document discusses the process of in vitro fertilization (IVF) in 3 steps: controlled ovarian stimulation using drugs like Lupron and injectables to grow multiple eggs, egg retrieval from the ovaries, and fertilization of the eggs with sperm in the lab. It then describes the steps of the IVF cycle in more detail, including medication administration, monitoring appointments, egg retrieval 35 hours after a trigger shot, fertilization techniques, embryo culture, and transfer back to the uterus. Finally, it discusses post-transfer care including progesterone support and pregnancy testing.

1. IN VITRO
FERTILIZATION
(IVF)

2. IN VITRO FERTILIZATION
STEPS:
•Controlled Ovarian Stimulation
(Lupron, Injectable Drugs)
•Egg Retrieval from ovaries
•Fertilization In Vitro
•Embryo Transfer to uterus

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

4. 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.

5. 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.

6. 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.

7. 10. Push plunger to inject
medication. Withdraw needle.
Wipe skin with alcohol swab.
11. Dispose of syringe.
Remember!
Use disposable syringe only once

8. Baseline Visit
• Arrive with a full bladder
• Estrogen
• Follicular Ultrasound
• Trial Transfer
• Payment
• Sign Consent

9. Monitor your Cycle using the
PATIENT PORTAL
• Username and password
• View lab results and medication instructions
• Results are ready by 1PM each day
• Schedule next appointment with front desk

10. GONAL F, FOLLISTIM, OR
BRAVELLE:
Used for 7-12 days to grow eggs. Given just
under skin with small needles. Potent drugs, so
monitoring with ultrasound and blood draws
and potential changes in dosing will occur.

11. FOLLICLES NEAR TRIGGER
DAY:

12. OVIDREL:
Given when eggs mature (several measure
about 20 mm in size). This marks last day of
Lupron and Follistim, Gonal F or Bravelle.
Given just under skin with small needle.
IMPORTANT TO TAKE THIS ONE
AT EXACTLY CORRECT TIME!

13. OVA ASPIRATION
35 HOURS LATER:

14. OOCYTE

15. OOCYTE & SPERM

16. ICSI

17. FERTILIZED OOCYTE

18. Medicines to start Day of
RETRIEVAL:
Doxycycline: 1 tablet orally, twice daily, 5 days.
Estrace: 1 tablet orally, twice daily*
Progesterone: 1mL shot same time daily*
* Continued until 11 weeks gestation

19. LUTEAL PHASE SUPPORT
INTERMUSCULAR PROGESTERONE:

20. LUTEAL PHASE SUPPORT
INTERMUSCULAR PROGESTERONE:

21. LUTEAL PHASE SUPPORT
INTERMUSCULAR PROGESTERONE:

22. LUTEAL PHASE SUPPORT
INTERMUSCULAR PROGESTERONE:

23. LUTEAL PHASE SUPPORT
INTERMUSCULAR PROGESTERONE:

24. LUTEAL PHASE SUPPORT
INTERMUSCULAR PROGESTERONE:

25. LUTEAL PHASE SUPPORT
INTERMUSCULAR PROGESTERONE:

26. LUTEAL PHASE SUPPORT
INTERMUSCULAR PROGESTERONE:

28. ASSISTED HATCHING:
•A Laboratory Technique That ‘hatches’ an Area
In Outer Coating of Embryo (Chemical vs. Laser)
•May Improve Implantation
•Indications:
Age 38 or greater
Prior Failed IVF Cycles
ICSI Embryos (Intracytoplasmic Sperm Injection)

29. Assisted Hatching

31. Pre-Implantation
Genetic Diagnosis

33. 2, 3 or 5 Days after Retrieval:
Embryo Transfer
Arrive with full or partially full bladder.
Bring Valium/Diazepam tablet.
Transfer performed, 30 minutes of rest.
Low activity for next few days.
Bedrest not recommended.
Normal activity within 3 days.

36. Pregnancy Testing
• Approx 2 ½ weeks after Ovidrel shot
• Blood test for hCG in our office
• With a positive  ultrasound 3 weeks later
• With bleeding or other problems  repeat
hCG
• With a negative  follow up with physician