IVF Patient Information
Overview
- Basic timeline for IVF
- Preliminary testing
- Medications
- Procedures and what to expect
- Sample Protocols
IVF Long Lupron Protocol with BCP's
(PDF file)
IVF Micro Lupron Protocol with BCP's
(PDF file)
Many patients have had a physical, emotional and financial journey by
the time they consider IVF as a treatment. OB/GYNs may have performed
surgeries or done ovulation induction with clomid for many months
that seem to drag on. The feeling of ‘loss of control’ is very real for
many patients. When patients get to IVF, things seem a bit more regimented
and hopefully some sense of control is restored. Generally we will get
eggs and know they fertilize and embryos grow, something we do not know
when clomid fails. When the menstrual cycle starts in month #1, we
fill in the dates on one of the protocols listed above. Most patients will
fall within a day or two of the predicted dates. We like to consider IVF
as a two-month process. During the 1st month ovarian reserve testing may
be done along with an assessment of the uterine cavity. A semen analysis
will be done and a semen sample cryopreserved as a back-up in case the
male can not provide a sample the day of the egg retrieval. The IVF lab
needs a more recent assessment of the sperm that will be used the
following month. Many patients will be placed on oral contraceptives in
order to reduce the chance of cyst formation secondary to lupron
injections and to better control the stimulation start date. The 2nd month
is the stimulation, egg retrieval and embryo transfer.
Ovarian reserve tests
Assessment of ovarian reserve may provide information about the
chance for pregnancy, likelihood of response to medications, number of
oocytes and their potential quality. It is the most important test for
the female patient. A cycle day #3 FSH and estradiol is generally
obtained. FSH is secreted by the anterior pituitary gland in the brain
and functions to stimulate the ovaries to produce follicles and eggs. If
there are fewer eggs and follicles in the ovaries, the brain senses this
and secretes increased amounts of FSH. High FSH can be seen in patients
that have had chemotherapy, ovarian surgery (i.e. endometriosis
resection or destruction), certain metabolic conditions and increased
age. We generally like to see the FSH level <12 mIU/ml. If the estradiol
level is elevated (i.e. >75 pg/ml) and the FSH is borderline, it is
possible that the patient will have a difficult stimulation. Based upon
the ovarian reserve test, we may choose the micro lupron protocol over
the long lupron protocol for ovarian stimulation. Anti-Mullerian
hormone (AMH) may be used to estimate the pool of small basal
follicles and potential chance for pregnancy. AMH is a hormone secreted
by the small ovarian follicles. This is a direct indicator of ovarian
function compared to FSH, which indirectly measures the ovarian
function. In general, AMH levels of <0.3 are associated with poor
outcomes. Ultrasound evaluation of the antral follicle count is
another method to assess ovarian function. Good responses are generally
seen in patients with a count >12. Other less used tests include the
Clomid Challenge Test and Inhibin B levels.
Infectious disease screening
All patients are tested for hepatitis B, hepatitis C, and HIV 1 and
2.
Uterine evaluation
It is important to have an evaluation of the uterus and fallopian
tubes prior to IVF. The hysterosalpingogram (HSG) is a study
performed in the hospital radiology department. It will show the uterine
cavity filled with dye and any defects like fibroids, polyps, septae, or
scar tissue will be visible. It will also show if the fallopian tubes
are open or closed. If a patient has dilated fallopian tubes (i.e.
hydrosalpinges) on a HSG, generally from a prior infection such as
chlamydia or gonorrhea, the chances to get pregnant with IVF go down. It
is thought that fluid inside the tube will go back into the uterine
cavity and inhibit implantation. The tubes may have to be excised. The
Saline Infusion Sonogram (SIS) is done in the physician’s office
to evaluate the uterine cavity and adjacent uterine wall. Typically,
after placing a speculum in the vagina, the cervix is washed with a
betadine solution and a small catheter is placed in the uterus. The
catheter is attached to a syringe with saline. Once the speculum is
removed, a trans-vaginal ultrasound is performed. Saline is injected
into the uterine cavity. As the fluid enters the cavity any defects are
visualized. Also, the ultrasound will show if the uterus is ‘tilted’
(i.e. retroverted, retroflexed) which provides important information for
the eventual embryo transfer. This is a trial embryo transfer.
Studies have shown that the embryo transfer technique is crucial IVF
success and the trail transfer aids the physician greatly.
Hormonal Evaluation
Patients should have their thyroid hormone level evaluated. Studies
have shown that untreated hypothyroidism (i.e. high TSH, low T4) may
have increased complications of pregnancy like spontaneous loss and the
children may suffer from certain neurological conditions. Pregnancy
affects the status of the thyroid, so the replacement dose may need to
be changed in the pregnant patient. Patients with Polycystic Ovarian
Syndrome (PCOS) have several hormonal issues to deal with. PCOS is
diagnosed in patients that have polycystic appearing ovaries on
ultrasound exam, anovulation or oligo-ovulation with or without elevated
androgens. If PCOS patients have elevated testosterone levels, it is
wise to lower them with birth control pills prior to IVF in order to
improve stimulation, egg quality, implantation and pregnancy rates. Some
patients with PCOS may have increased insulin levels, typically detected
with a 2-hour glucose tolerance test. If the insulin is high,
miscarriage rates are higher and treatment with metformin may be
beneficial.
Semen Analysis
Patients should have a recent semen analysis. It is important for the
ART lab to see the patient’s sample to get a feel for what they are
going to work with. Additionally, we often cryopreserve a sample of the
semen to be used in case the partner can not be at the egg retrieval or
has difficulty collecting the day of the procedure. This happens in
about 1% of the cases. If the sperm count is low, we will perform Intra-Cytoplasmic
Sperm Injection (ICSI) to increase fertilization. We may have the male
seen by a urologist to see if he has a varicocele or other cause of a
low sperm count. Tests that may be done on the male include FSH, LH, TSH,
testosterone, karyotype, or cystic fibrosis screening depending upon the
clinical scenario.
Lifestyle Factors
Patients that smoke tobacco have roughly ½ the pregnancy rate of
non-smokers. Women that smoke have lower ovarian reserve and may produce
poor quality eggs. The products in tobacco may bind to the DNA in sperm
and the seminal fluid of smokers has increased oxygen radicals that may
affect sperm function. Don’t smoke! Certain herbs may also affect sperm
function. Please be sure you have discussed with the doctor all
medication you are taking. Hot tubs may damage the sperm which depend
upon lower temperatures to develop appropriately. Alcohol should be
consumed only in moderation if at all. Exercise has many benefits
including decreasing stress and is encouraged.
Patients generally make one egg per month. IVF as it is practiced
currently depends upon stimulation of the ovaries with medicines to
increase the number of eggs produced in a given month. Each patient is
different and responses may vary significantly. There is generally no ‘one
protocol fits all.’ Dr. Donahue will review your previous records of
ovarian stimulation to see what can be improved upon. Most IVF practices
will have a flow sheet that summarizes the ultrasound findings during
stimulation and the estradiol, LH and progesterone levels at each
ultrasound. We can get a feel for the egg quality by looking at these
parameters during the stimulation. Also, the ovarian reserve test may help
provide information concerning the best protocol to use. We often see a
different response when we change the protocol. Some of the possible
medications are reviewed below.
A. Lupron (luprolide acetate)
Lupron acts upon the pituitary gland in the brain to alter the
secretion of FSH and LH. It is a gonadotropin releasing hormone (GnRH)
agonist. GnRH is the hormone that is secreted by the hypothalamus in the
brain and acts upon the pituitary to stimulate the secretion of FSH and
LH. An agonist is a medication that binds the same receptor as the
natural ligand, in this case GnRH, and has a similar effect. Luprolide
has modifications of the 10 amino acids found in GnRH that prolong its
half-life and function to make it more suitable as a drug therapy.
Luprolide will first stimulate the pituitary gland, so there will be an
initial increase in FSH and LH. This may cause patients to have ovarian
cysts, especially if begun in the 1st part of the menstrual cycle. After
prolonged treatment where luprolide is bound to the GnRH receptors in
the pituitary, the number of GnRH receptors will be decreased. This
basically shuts off the hormonal communication between the ovaries and
the pituitary. As the ovaries are stimulated with FSH containing drug
the body will naturally want to ovulate as estrogen and other ovarian
hormones increase. The luprolide suppresses ovulation and thus allows
more follicles to grow. We start lupron on or about day 21 of the cycle
(i.e. late luteal phase) or when on birth control pills. The birth
control pills will suppress ovarian cysts that may form due to the
stimulatory effect of luprolide and will also help with the egg quality
in some patients. When the menses come, we generally lower the dose of
lupron by ½ and continue it with the addition of gonadotropins (i.e. FSH).
When we do the baseline ultrasound exam, we look for the presence of
ovarian cysts and check the LH and estradiol levels to confirm
appropriate ovarian suppression. A cycle may be canceled if the
estradiol or LH levels are too high or too low or if the menses are
delayed more than a week. We generally like the cycle to start around
the 10th day of lupron. Microdose Lupron is a preparation of
diluted luprolide that is given in the 1st part of the menstrual cycle
(i.e. follicular phase) that takes advantage of the stimulatory effects
of the drug on FSH and LH. It is more of a ‘stimulatory’ than
‘suppressive’ protocol. It is often used in patients that had a
sub-optimal response to the more suppressive long lupron
protocol.
Administration: Lupron is taken subcutaneously as an
injection once or twice a day beginning on day 21 of the cycle or
towards the end of the birth control pills the month prior to the egg
retrieval.
Side effects: Headaches, fatigue, mood swings, hot flashes,
delayed onset of menses, bruising or irritation at injection site.
B. Gonadotropins
These are the drugs that directly stimulate the ovaries to produce
multiple follicles and eggs. They are produced from either recombinant
DNA technology (i.e. Gonal-F, Follistim, Luveris) or highly
purified menopausal urine (i.e., Menopur,
Repronex, Bravelle). The recombinant DNA based drugs are essentially
100 % pure FSH or LH activity. The purified menopausal urine
preparations may have small amounts of other biologically active
compounds like hCG. The purified menopausal urine preparations have FSH
and LH, 75 IU each, in each vial. The recombinant preparations have 75
IU of FSH per dose or vial. There are protocols which call for the
addition of LH to the FSH, so these drugs may be combined. Luveris
is recombinant LH, 75 IU per dose, which may be used when LH is desired.
Is one drug better than another? Studies have shown that these drugs are
equal in many respects. A patient may respond better to one or the
other. Ultimately it is the patient response to the drug that is most
important.
Administration: Gonadotropins are generally administered
subcutaneously with a pre-filled syringe or mixed by the patient prior
to use with the urinary derived products. The injections may be once or
twice a day depending upon the protocol. They generally begin on day 3
of the stimulatory cycle and continue until the follicle sizes reach
‘maturity’, about 18 mm to 22 mm, with a corresponding estradiol, LH,
and progesterone level. The dose may be modified during the stimulation
when ultrasound scans are done on days 7, 9, and 11 according to the
protocols above. Once mature follicles are documented, hCG will be given
to finally mature the eggs 36 hours prior to the egg retrieval.
Side effects: Mood swings, discomfort around ovaries, abdominal
fullness, soreness at injection sites.
C. Human chorionic gonadotropin (hCG)
hCG is given when the follicles reach the appropriate size to act on
the LH receptors to finally mature the eggs and induce ovulation. In IVF,
we retrieve the eggs 36 hours after the injection. The eggs could release
on their own several hours later, so timing is crucial. Naturally
occurring LH has a very short half-life (i.e. disappears quickly from the
serum) compared to hCG. Therefore, hCG can continue to stimulate the
ovaries after an egg retrieval and in some patients lead to ovarian
hyperstimulation syndrome. Ovulation may also be triggered with a GnRH
agonist like Lupron, which acts on the pituitary to release
naturally occurring LH to mature the eggs. hCG is given as an
intra-muscular injection as Profasi, Pregnyl, and Novarel. It is
given subcutaneously as Ovidrel.
Administration: hCG must be mixed with sterile water prior to
intra-muscular infection. It is important to use only 2 cc’s of the water
to dissolve the 10,000 IU of lyophilized drug. These instructions are
different than the instructions that are on the box the medicine comes
with.
Side effects: Discomfort around ovaries, soreness at injection
site, ovarian hyperstimulation syndrome.
D. Antibiotics
We commonly prescribe doxycycline to reduce the risk of infection
related to the egg retrieval. This begins on the day of hCG administration
and continues for 6 days. Infections are extremely rare with IVF. If a
patient has a hydrosalpix (i.e. dilated fallopian tube secondary to a
pelvic infection), the tubes are generally removed prior to IVF. In the
past, patients with a hydosalpinx in situ were at increased risk for a
pelvic infection related to the egg retrieval. In years past patients were
screened for the presence of Mycoplasma sp. and Ureaplasma sp. and treated
with doxycycline, however there is no association with these
microorganisms and infertility.
Administration: Doxycycline 100 mg twice a day with meals.
Side effects: Stomach upset, allergic reactions (i.e. hives,
itching, swelling), and vaginal yeast infection.
E. Progesterone
Progesterone is crucial for the development of a uterine lining that
will support the early pregnancy. With the egg retrieval, cells that have
the ability to produce progesterone are removed from the ovaries. Because
progesterone is important for the ‘implantation window’ all IVF patients
receive some extra support. Additionally, vaginally administered
progesterone has been shown to decrease uterine contractions that occur
between the time of egg retrieval and embryo transfer and increase
pregnancy rates. We use intra-muscular injections of progesterone because
some studies have shown better pregnancy rates compared to vaginal or oral
routes. We realize that some patients have discomfort with these
injections. We try and reduce the dose after 8 weeks of pregnancy. Prior
to this time, the ovaries are responsible for most progesterone secretion.
After 8 weeks, the placenta takes over progesterone production.
Administration: 100 mg vaginal progesterone from day of egg
retrieval until embryo transfer to relax uterus. 100 mg progesterone IM
from day after egg retrieval until about 10 weeks of pregnancy.
Side effects: soreness at injection site, delayed onset of menses
if not pregnant, breast tenderness.
F. Estrogen
Studies have shown the estrogen administered during the luteal phase
after egg retrieval improves pregnancy rates. It can be transdermal or
oral routes. Estradiol levels are checked one week after embryo transfer
and if levels are excessively high, the estrogen support is discontinued.
Administration: Estrace, 2mg twice a day until 1st pregnancy ultrasound.
Side effects: Nausea, headache, and breast pain.
G. Methylprednisolone
This low dose steroid is taken when assisted hatching is performed. It
is thought that the steroid will suppress immune system cells at the level
of the endometrium that may attack the embryo and inhibit implantation.
Steroids typically have many different effects so some other effect may be
operational.
Administration: 16 mg oral from day of egg retrieval until
day of embryo transfer.
Side effects: Fluid retention.
H. Low-dose aspirin
Very high levels of estrogen are thought to increase blood clotting
which may be detrimental to the embryo implantation. It has been shown the
low-dose aspirin improves blood flow to the uterus.
Administration: One 81 mg pill per day until about 12 weeks
of pregnancy.
Side effects: Upset stomach, prolonged bleeding time.
I. Pre-natal vitamins
Studies have shown that increased folic acid in pregnancy reduces the
risk for neural tube defects in babies. The nutritional requirements
change dramatically with pregnancy and increased vitamins are needed.
Administration: One pill daily.
Side effects: Upset stomach, nausea, and constipation.
A. Ovarian stimulation
A baseline transvaginal ultrasound exam will be performed by day 3 of
the menstrual cycle. Do not be alarmed if you are still on your menses at
this time, it is very common. The ultrasound will show if any cysts are
present. If large cysts are present, it is possible that the cycle will be
canceled and a different protocol attempted the following month. Blood
will be drawn to check estradiol levels and LH levels. This will give us
an estimation of the ovarian suppression from Lupron and baseline data to
compare the future scans. In general, you will be seen after 5 days of the
FSH stimulation. We expect to see ovarian follicles in the 10 mm to 12 mm
range and an estradiol level >200 pg/ml. If the estradiol level were < 100
pg/ml, there is a chance that the cycle would be cancelled due to a slow
start. It is better to cancel a cycle that is ‘too suppressed’ rather than
increasing the dose of the drugs because of the increased likelihood that
we will get poor quality eggs on such a cycle. It is unusual to be
canceled for an excessive response, but this may happen in patients with
PCOS that have very high estradiol levels (i.e. >1000 pg/ml) and very
small follicles (i.e. <10 mm) because of the high risk for ovarian
hyperstimulation syndrome. Ultrasound exams may be done on day 9 or day 11
of the cycle. When the follicles are 18 mm to 22 mm and the estradiol is
appropriately elevated and the LH and progesterone are low, hCG will be
administered to prepare for egg retrieval. Occasionally, a patient will
have increased progesterone levels detected (i.e. > 2 ng/ml), which may be
a sign of premature luteinization (i.e. progesterone production before the
release of the egg), which may be associated with decreased implantation.
In general, only about 15 % of cycles get canceled. We feel it is better
to cancel the cycle if there is a sign that the outcome will not be good
and a different protocol is indicated.
B. Egg retrieval
The egg retrieval is scheduled 36 hours after the hCG shot is given. We
ask patients to arrive 30 minutes before the procedure and to have had
nothing to eat or drink since midnight so that they have an empty stomach.
This is because of the anesthesia. Upon arrival, we will escort the
patient and her partner to the pre-OP/recovery room. The couple will have
a chance to ask further questions of Dr. Donahue and our embryologists.
The patient will change into a gown for the procedure and the
anesthesiologist will start the IV fluids and answer any questions. This
gives the patient a chance to meet our anesthesiologist and feel more
comfortable with the procedure. We will review a new set of instructions
for medications that will be needed between the time of egg retrieval and
embryo transfer. We like to review instructions on multiple occasions with
the patients to ease their potential stress and not have an information
overload.
The patient will next walk a few steps down the hall to the entrance of
the procedure room. Pictures of the procedure room are shown in the new
IVF lab section of our web site. Once in the procedure room the patient
will be helped onto the procedure table. The room is very comfortable.
Soft music is generally playing. We tend to avoid bright lighting in the
room because bright light may damage eggs and embryos. The patient will
have ECG leads placed, pulse oximeter placed on the finger tip (i.e.
measures oxygen in blood, so no fingernail polish on index finger) and a
blood pressure cuff. The anesthesiologist is at the side of the patient
throughout the entire procedure. The anesthesiologist may give the patient
some medicine to relax a bit more (i.e., versed or fentanyl), prior to an
IVF drip of propofol (i.e., diprovan).
Propofol induces deep sedation. The
patient is not intubated and is breathing on her own. About one 1 in 10
patients may actually start talking with no recollection of what they
said. Some patients even snore. In general, most patients find the
anesthesia very acceptable and sleep through the 15-20 minute egg
retrieval procedure.
Following the administration of the sedation Dr. Donahue will insert a
speculum in the vagina and cleanse the cervix and upper vagina. The egg
retrieval is performed with an ultrasound-guided needle attached to the
transvaginal ultrasound probe. This is very similar to the ultrasound
exams that were done to monitor the ovarian stimulation. The ovaries
generally are located next to the vaginal wall in the pelvis and the
needle, under direct visualization, passes through the vaginal wall and
into the ovaries. The needle has 2 barrels, one to aspirate the follicular
fluid and one to inject media to flush the follicle out. The needle set is
closed to the environment and attached to a suction device and test tubes
where the follicular fluid is collected. The test tubes are kept in a
warmer to keep the fluid at body temperature. Once the test tube is
filled, it will be handed off to the embryologist who will examine the
contents for the presence of the oocyte cumulus complex (i.e. egg and
surrounding cumulus cells). Once an egg is confirmed, we move onto the
next follicle and repeat the process. We aspirate each follicle. We may
not get eggs from every follicle. Quality counts more than quantity. At
the time of the egg retrieval we examine the uterus and ovaries. If there
is fluid in the uterine cavity it may be a cause for concern and we may
need to cryopreserve the embryos due to decreased implantation. Uterine
contractions may be seen as well. Patients with endometriosis may have
endometriomas containing ‘chocolate fluid’ that may be aspirated. We can
measure the ovarian volume and free fluid in the pelvis (i.e. assess risk
for ovarian hyperstimulation syndrome). The ultrasound allows the
physician to carefully stay away from vital structures like blood vessels
and bowel. When we are convinced that all eggs have been collected, the
procedure is completed. In general, most patients will wake up pretty
quickly once the propofol drip is discontinued. The ultrasound probe is
removed from the vagina and the vagina will be inspected for signs of
bleeding. Rarely a small blood vessel in the vaginal wall is found to be
bleeding and a stitch can be placed to stop the bleeding. The patient will
then be moved to the recovery room. Once in recovery the patient will wake
up pretty quickly. We will review the findings with the couple regarding
the number of eggs and their potential quality. The 1st question seems to
always be ‘how many eggs did we get?’ When the patient is alert and able
to drink water and ambulate she will be allowed to leave. This is usually
less than 1 hour after the procedure.
Generally the male will collect a semen sample while his partner has
her egg retrieval. We have a private collection room. Men can collect a
specimen at home as long as it is within 1 hours driving time.
After the egg retrieval we encourage for patients to take the day off
from work and relax. Progesterone vaginal suppositories, 100 mg, are used
for four days to help relax the uterus. The day after the egg retrieval,
patients begin IM progesterone, 100 mg/day and estrace, 4 mg/day. The
embryologist will call the patient the morning after the egg retrieval to
give the fertilization report. The decision to perform a day 3 embryo
transfer or day 5 embryo transfer is often made on this day. In general,
it is best to sleep with the upper body raised with pillows so that fluid
that leaks from the ovaries stays in the pelvis rather than under the
diaphragm and cause shortness of breath. We prescribe Demerol for pain
control to be taken as needed. Most patients do not need much pain
medicine.
C. Embryo Transfer
The embryo transfer is really the most important part of the whole IVF
procedure from a technical standpoint. Studies have shown that difficult
embryo transfers may have lower pregnancy rates. This is the reason we do
the trial embryo transfer the month before the entire process starts. At
that time, we can see if the cervix has any significant deviation (i.e.
retroflexed or anteflexed, sharply tipped backwards or forwards). If so,
we use a special transfer catheter, which will negotiate the sharp turn
from the entrance of the cervix to the uterine cavity. If the cervix is
stenotic (i.e. very tight) and we are unable to pass the trial transfer
catheter, we may need to perform a hysteroscopy and dilate the cervix
before we start the IVF procedure. The goal is to have the easiest
transfer as possible in the shortest amount of time between embryo
placement in the catheter and transfer to the uterus. The embryo transfer
is normally performed 3 days after the egg retrieval. We may do a day 5 or
‘blastocyst’ stage embryo transfer depending upon the circumstances. The
transfer is done in the procedure room. Your partner will wear an OR cap,
mask and gown so he can be there with you. We play relaxing music at the
time of the transfer and patients may bring their own CDs if they desire.
We will ask you to arrive 30 minutes prior to the scheduled procedure.
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
during the transfer procedure. The placement of the embryos into the
uterus is done with ultrasound guidance. This time, however, 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 and then do another
trail transfer. We use culture media moistened swabs to remove the
remnants of the progesterone suppositories and the flush out the cervical
mucus with culture media. We do not want the mucus to interfere with the
transfer by clogging up the catheter opening as it passes through the
cervix with embryos inside. Once the trial transfer is comfortably done,
he will instruct the biologist in the lab to place the embryos in the
catheter. There is a door between the procedure room and the embryo lab
that is open at this time. It is just a few steps in-between. When Dr.
Donahue confirms that the catheter should pass easily, he instructs the
partner to step inside the lab with the embryologist. The partner will see
the embryologist take the Petri dish that has your embryos in it out of
the incubator. The dish has your name and ID number etched in the bottom.
We have a special form where we have a witness confirm the identity of the
gametes or embryos whenever important procedures are being done. This
includes identification of the sperm and eggs at retrieval, insemination
or ICSI, and identification of the embryos for embryo transfer. We feel
this added level of security is important. We have the partner sign off as
the final witness after we do the embryo transfer. We have a special
witness form that shows date, time, and initials of person performing the
procedure and witnessing. At this time, the embryos 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 mid to upper 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 recovery 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. We suggest no heavy lifting,
exercise, or hot tubs for the next couple of weeks. Some studies have
suggested that you could have regular intercourse during this period.
Fewer miscarriages were reported and the pregnancy rates were the same as
patients that had no intercourse. It is possible that seminal fluid has
factors in it that may help with implantation.
Progesterone and Estrogen levels will be checked one week after the
embryo transfer. 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. 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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