In Vitro Fertilization (IVF)
Please click here for the PowerPoint version of this page, with voice-over.
In-Vitro Fertilization
- Use oral and/or injectable drugs to grow extra eggs
- Retrieve eggs with ultrasound guidance
- Fertilize in the Petri Dish
- Transfer embryo into uterus
Egg Retrieval
- On day 1 of your menstrual cycle, call WFI to schedule your day 3 baseline visit
- Day 1 consists of the first day of bright red, full flow
- Your day 3 baseline visit will consist of the following:
- Blood work
- Transvaginal ultrasound
Letrozole or Gonal F or Follistim
![slide4.png-2](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide4.png-2-300x48.png)
![slide4.png-3](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide4.png-3-300x40.png)
- Injected days 3-14 of cycle in the lower abdomen
- Allows the ovaries to grow extra eggs
- Gonal-F and Follistim are refrigerated
Menopur
![slide5.png-1 slide5.png-1](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide5.png-1-200x200.png)
- 75-150 IU injected days 3-14 of cycle in the lower abdomen
- Allows the ovaries to grow extra eggs
- Refrigerate after mixing
Omnitrope
![slide6.png-1 slide6.png-1](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide6.png-1-250x250.png)
- Injected days 3-14 of cycle in the lower abdomen
- Allows the ovaries to grow extra eggs
- Gonal-F and Follistim are refrigerated
Omnitrope Mixing Instructions
- Supplies
- 5ml syringe
- 18g 1½ inch needle
- Insulin syringe with needle attached
- Vial of powder
- Vial of fluid
- To Mix:
- Use 5ml syringe and 18g needle to draw up all fluid.
- Inject fluid into vial of powder. Gently swirl to mix.
- With insulin syringe draw up 38 units of mixture for a subcutaneous injection.
- Refrigerate after mixing.
Ganirelix or Cetrotide
![slide7.png-1](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide7.png-1-300x97.png)
![slide7.png-2](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide7.png-2-300x105.png)
- Injected in the lower abdomen
- SAME EXACT time in the morning
- Stops early ovulation
- Cetrotide is refrigerated
Novarel
![slide8.png-1](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide8.png-1-300x244.png)
- Usually need to mix with 5 ml of diluent
- Injected in the lower abdomen
- Improves egg quality
- Can also be used for as a “trigger” medication
- Refrigerate after mixing
Novarel Mixing Instructions (low dose Hcg):
- Supplies
- 5ml syringe
- 18g 1½ inch needle
- Insulin syringe with needle attached
- Vial of powder
- Vial of fluid
- To Mix:
- Use 5ml syringe and 18g needle to draw up 5ml of fluid.
- Inject fluid into vial of powder. Gently swirl to mix.
- With insulin syringe draw up dose indicated on medication calendar for a subcutaneous injection.
- Refrigerate after mixing.
Follicles Near Trigger Day
![slide9 slide9](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide9.jpg)
Triggers:
Lupron, Novarel, Ovidrel or a combo!
![leupron leupron packaging](https://wisconsinfertility.com/wp-content/uploads/2023/10/leuprolide.jpg)
![Novarel Novarel packaging](https://wisconsinfertility.com/wp-content/uploads/2023/10/Novarel.jpg)
![ovidrel ovidrel packaging](https://wisconsinfertility.com/wp-content/uploads/2023/10/ovidrel.jpg)
- Injected to prepare the follicles for egg retrieval (day 12 of the cycle)
- We will tell you how much to inject and EXACT timing
Novarel Mixing Instructions (trigger):
- Supplies
- 5ml syringe
- 18g 1½ inch needle
- Syringe with subcutaneous needle attached
- Vial of powder
- Vial of fluid
- To Mix:
- Use 5ml syringe and 18g needle to draw up 1ml of fluid.
- Inject fluid into vial of powder. Gently swirl to mix.
- With separate syringe with subcutaneous needle attached draw up dose indicated on medication calendar for a subcutaneous injection
Cabergoline
- Vaginally: once or twice per day, starting the night of trigger
- 8 days total
![slide11 slide11](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide11.png)
Egg Aspiration
![slide12 slide12](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide12.jpg)
Don’t worry, you are asleep and comfortable during this part!
Antibiotics
- Taken orally, twice per day for 5 days
- Starting with your first meal after egg retrieval
- Take with meals!
Egg
![slide14 slide14](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide14-600x600.png)
Egg & Sperm
![slide15](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide15-300x190.png)
ICSI (Inject Sperm Into Egg)
![slide16 slide16](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide16-600x600.png)
The Embryo Grows
![slide17](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide17-300x300.jpg)
Fertilized Egg = Embryo
![slide18 slide18](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide18-600x600.png)
Day 3 Embryos
![slide19](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide19-300x223.jpg)
Day 5/6 Embryos: Blastocysts
![slide20 slide20](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide20-600x600.jpg)
Assisted Hatching
- Taken orally, twice per day for 5 days
- Starting with your first meal after egg retrieval
- Take with meals!
![Screenshot 2023-04-24 at 10.54.55 AM Screenshot 2023-04-24 at 10.54.55 AM](https://wisconsinfertility.com/wp-content/uploads/2023/04/Screenshot-2023-04-24-at-10.54.55-AM.png)
Pre-Implantation Genetic Screening/ Diagnosis
- Look at chromosome number and XX or XY
- (Example: Down’s syndrome and gender)
- Look at a single gene disorder
- (Example: Cystic Fibrosis)
Pre-Implantation Genetic Screening
![slide23.png-1](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide23.png-1.png)
- Looks for normal chromosome number, ensures no extra pieces, & gender
![slide23.png-2](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide23.png-2.png)
Pre-Implantation Genetic Diagnosis
![slide24](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide24.png)
- Look for specific single gene defect
- Example: Cystic Fibrosis
Embyro Freezing
- Happens on embryo day of life 3 or 5/6 after retrieval
- If doing genetic testing? Tissue removed then embryos frozen at WFI
- The next month, transfer happens
Embyro Transfer
- On day 1 of your menstrual cycle, call WFI to schedule your day 3 baseline visit
- Day 1 consists of the first day of bright red, full flow
- This will likely occur 5-10 days following your retrieval
- Day 1 consists of the first day of bright red, full flow
- Your day 3 baseline visit will consist of the following:
- Blood work
- Transvaginal ultrasound
- Mock embryo transfer
- Please arrive with a full bladder for this appointment
Embryo Transfer
- Estrogen for 10 of days
- Once lining is ready, add IM Progesterone
- Also need antibiotic & prednisone
![slide27](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide27-300x170.png)
Embryo Transfer
![slide28.png-1](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide28.png-1-300x244.png)
Empty Bladder
![slide28.png-2](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide28.png-2-300x247.png)
Full Bladder
![slide29 slide29](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide29-300x300.jpg)
Full Bladder
Pregnancy Test
- Blood test to confirm
- (Might repeat test each few days)
- Vaginal ultrasound for head count
Nine Months Later:
![slide31](https://wisconsinfertility.com/wp-content/uploads/2023/04/slide31-300x199.jpg)
Additional medication instructional videos can be found here:
- MDR: https://mdrmedcoach.com/
- Freedom Fertility: https://www.freedomfertility.com/resources-support/freedom-medteach/