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IVF Patient InformationOverview
1. Basic Timeline for IVFGenerally some preparation and testing is required in order to optimize IVF treatment. It is realistic to assume that you will need about 2 months to cover the topics below.
2. Preliminary TestingMonth 1 is the first day of bleeding and is considered cycle day (CD) #1. A. CD #3
FSH (Follicle Stimulating Hormone), Estradiol B. Routine Blood Testing C. Hysterosalpingogram (HSG) or
Saline Infusion Sonogram (SIS) Additionally, at the time of the SIS we will do a trial embryo transfer using a catheter similar to the actual transfer catheter. Studies have shown that the embryo transfer technique is very important. We want to have as easy of transfer as possible. D. Hormonal Evaluation E. Semen Analysis Do not smoke or take herbals or other supplements. Always check with us before any significant changes in diet, lifestyle or activity. 3. Medications to Produce Multiple EggsThe medications you will take in preparation for the egg retrieval are referred to as the drug “protocol”. Each patient’s protocol is unique, and determined by Dr. Donahue based on previous medical history. Possible medications include: A. LUPRON
(Luprolide acetate- 2-week kit) Administration: Lupron is taken as
a subcutaneous injection, once per day, beginning on or about cycle day 21 in
the month prior to egg retrieval. B. GONADOTROPINS (Pergonal, Humegon,
Repronex, Gonal-F, Follistim, Bravelle)
Administration: Gonadotropins
must be administered by intramuscular injection or subcutaneously once or
twice per day, according to your particular protocol. They are started
when baseline tests (ultrasound and blood tests) indicate that the ovaries
are in a resting, non-productive state. C. HCG (Profasi, Pregnyl, Novarel) Administration: HCG must be taken
as an intramuscular injection. You will be given a specific time to take this
injection- approximately 36 hours before your scheduled time for egg retrieval.
The powder is mixed with 2cc’s ONLY of saline prior to injection. D. ANTIBIOTIC (Doxycycline, Tetracycline,
Keflex) Administration: Doxycycline/Tetracycline:
1 tablet twice per day, by mouth, with meals, from the day of HCG
administration until embryo transfer OR Keflex: 1 tablet three times
a day for 7 days. E. PROGESTERONE Administration: Intramuscular
injections of 2cc’s daily are begun one day after retrieval and continue
(daily) through 10 weeks of pregnancy. F. PRE-NATAL VITAMINS Administration: 1
tablet per day, usually at bedtime G. METHYLPREDNISOLONE (Medrol) Administration: 1 (16mg) tablet, by
mouth, once per day as directed, OR 4 (4mg) tablets, by mouth, once per
day. H. LOW-DOSE ASPIRIN Administration: 1 (80mg) tablet, by
mouth, per day. I. DEXAMETHASONE (Decadron) Administration: 1 (0.5mg) tablet daily, at
bedtime. J. ESTROGEN PILLS 4. Procedures - What to Expect
The procedure done to remove the eggs from the ovaries is referred to as the “oocyte retrieval”. This is an out-patient minor surgical procedure, performed in the procedure room next to the embryology lab. . Patients are given intravenous sedation by our Anesthesiologists who are present through out the entire procedure. The medicine (Diprovan) works quickly and most women sleep right through the 15-20 minute egg retrieval. Following administration of the sedation, Dr. Donahue will insert a speculum, and cleanse the cervix and vagina. The speculum is then removed, and the ultrasound probe with needle guide attached is inserted. (A similar ultrasound machine and probe are used for the retrieval as are used in the office to monitor follicle development.) Dr. Donahue will identify and examine the uterus, endometrium, and both ovaries. When the ovaries are aligned properly on the ultrasound monitor, Dr. Donahue will introduce the needle through the wall of the vagina and into the first follicle. Suction is applied, and the follicle will be emptied of its contents. The eggs are collected into a plastic test tube and the embryologist will confirm the egg has been collected. We generally get eggs from most follicles, though some of the small ones will not have eggs that are mature enough to remove. Oocyte retrieval procedures normally take about 15-20 minutes to complete. We spend about 30 minutes in the procedure room. When the second ovary is finished, Dr. Donahue will remove the ultrasound probe and check the cervix and vagina for any bleeding. The retrieval procedure is then complete, and you will be taken to the recovery room. You will be observed by the surgery/recovery nurses while the effects of the sedation wear off. You should be ready to go home within one hour after the end of the procedure. Generally the husband collects the semen sample when the wife is having here procedure. Occasionally, if a specific laboratory procedure is being done with the sperm, collection will need to be done at a specific time. If this is the case, one of the biologists from the lab will make you aware of the instructions. You will begin progesterone vaginal suppositories, 100 mg until the day of the embryo transfer (put the last suppository in the vaginal about 1 hour before the transfer). Take the suppositories at night before you go to sleep. Wear a pad in case some leaks out of the vagina. The progesterone will relax the uterus by decreasing the contractions that appear to be frequent during the IVF procedure and may have a negative effect on implantation. Progesterone in oil shots, 2 cc’s, will begin the day after the egg retrieval for a day 3 transfer and two days after the egg retrieval for a day 5 embryo transfer. Progesterone support will go until 10 weeks of pregnancy. In the 24-hour time period following the retrieval, it will be important for you to rest in a semi-upright position. When the ovaries are punctured to remove eggs, they ooze bloody fluid for a while until the puncture sites heal over. If this bloody fluid reaches the area of your diaphragm (as would happen if you laid flat) you may experience some chest and shoulder pain. Plan to sleep in a recliner chair or propped up in bed with pillows on that first night after retrieval. You will be given a prescription for pain medication when you leave the recovery area. Tylenol often works well to relieve post-procedure pain as well; we do request that you not use ibuprofen medications (Motrin, Advil, etc.) for pain relief, however. In the late morning or early afternoon of the day following retrieval, you will receive a call from the lab regarding your embryo report. We will let you know how many of the eggs have fertilized, and when the embryo transfer is scheduled. Embryo Transfer The procedure to place the embryos into the uterus is referred to as the “embryo transfer”. It is normally performed 3 days after the egg retrieval. The transfer is done in the procedure room. Your husband will wear an OR cap, mask and gown so he can be there with you. We will ask you to arrive 30 minutes prior to the scheduled procedure and change clothes in preparation for the procedure. We will have you take the Valium 10 mg pill to help you relax at this time. Additionally, you will place the progesterone suppository in the vagina an hour before. This may help the uterus soften and not contract for during the transfer procedure. The placement of the embryos into the uterus is done with ultrasound guidance. But this time, the ultrasound will be done abdominally. It will be necessary, therefore, for you to have a moderately full bladder when Dr. Donahue performs the transfer. Plan to drink 2 to 3 glasses (8 ounces) of fluid about an hour before the scheduled transfer time. Dr. Donahue will cleanse the cervix and vagina, similar to the retrieval procedure, and then do another trail transfer. Once this is comfortably done, he will instruct the biologist in the lab to place the embryos in the catheter. At this time, they are removed from the incubators, placed into the transfer catheter, and brought into the transfer room. Dr. Donahue will pass the very slender catheter through the cervix, and guide it to the proper location in the fundal area of the uterus. You will be able to watch on the ultrasound monitor as the embryos are expelled from the catheter into your uterus. The laboratory biologist will then check the catheter, under the microscope, to be sure it has been emptied of the embryos. We will keep you in the recover room for 30-60 minutes after the transfer. You will need to lie flat for this time. There are studies that found patients could resume normal activities with in 1 hour and transfer without any negative effects on pregnancy rates. We still think it is prudent to take it easy for a day or so. Activity restrictions for the next two weeks will include:
Some studies have suggested that you should have regular intercourse during this period. It is possible that seminal fluid has factors in it that may help with implantation. You will begin estrace, 4 mg orally per day, until about 6 weeks of pregnancy. We feel this may help with implantation. Progesterone and Estrogen levels will be checked one week later. A blood pregnancy test can be performed at 14 days after the transfer. If you have not started a period by that “target date”, please call the office to make arrangements for testing. Keep in mind that it is possible to have not begun a period by the target date, and still not be pregnant. This is due to the large amount of progesterone you will be taking for those 2 weeks after the retrieval. Progesterone can cause a delay in the onset of a menstrual period. If the blood test is positive (>5.0), we will want you to have a second pregnancy test in two more days. This second test lets us know if the pregnancy is developing normally, and gives a clue about the possibility of twins. Progesterone levels will also be checked on these positive tests- and Dr. Donahue will adjust your continued need for progesterone and estrogen support accordingly. If your blood test is negative, or if you start a full period, we will instruct you to stop the progesterone injections. A period should start (if it hasn’t already) within 3 to 4 days of stopping the shots. Those patients who experience an unsuccessful cycle are strongly encouraged to come in for a follow-up consult with Dr. Donahue to review and discuss the cycle, and discuss future options.
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