Overview of IVF
IVF – Long Protocol
This is the main protocol most of your clients will be following.
- Starts on day 21 of your cycle
- Daily injections or sniffing to switch off ovarian reserve to send the patient into a menopause – DOWN REGULATION
- Downregulation drugs can include: Buserelin, Lupron – classed as GNRH agonists. Shuts down the pituitary.
- Bleed occurs
- Baseline scan takes place to insure downregulation has been effective. They will look to see the lining is thin and that the follicles are small.
- Downregulation takes around 14-21 days.
- The next phase of the long protocol is STIMULATION
- Stimulation drugs can include Gonal F ( FSH only) and Menopur (FSH and LH) . These are injections which are placed into the abdomen.
- Throughout this stage, you will be scanned at regular intervals to check the lining thickness of the uterus, size and amount of follicles on both ovaries. They will also make sure that the patient isn’t getting too over stimulated. Be aware of ovarian hyperstimulation syndrome. OHSS.
- The client will also be assessed to make sure the dosage of the drug is correct.
- Stimulation takes around 14 days.
- Once the clinic is happy that the thickness of the lining is sufficient and have a good number of follicles they will use a HCG trigger shot to help mature the eggs so they are ready to be collected.
- The drugs that can be used as this HCG shot are ovitrelle and pregnyl.
- Around 36 hours later EGG COLLECTION is performed ( takes around 20-60 minutes) . This carried out by sedation. A very fine needle is inserted through the vagina and up into the uterus, fallopian tubes and then the ovaries. The eggs are then collected through a sunction device which is at the end of the needle.
- The eggs are collected and counted ready to place with the sperm.
- The female will then start taking progesterone either as a pessary or injection. This nourishes the lining and to enhance the chances of implantation. This will continue for the 12th week until the placenta takes over.
- The male produces his sperm sample around the same time as the eggs are being removed.
- The sperm is washed and then placed in a petri dish with the eggs to allow natural fertilisation to take place.
- If there is a known male factor issue then ICSI is used which involves injecting the sperm straight into the egg.
- The eggs are placed into an incubator at 37 degrees for 24 hours and are monitored to see how many are fertilised . They will be graded for quality. The best quality egg with be transferred.
- The client will get a phone the next day to confirm how many have been fertilized and transfer will occur on either day 2 or day 5. This will dependent on how well they are developing. Any emryos left over and are of good quality they are frozen and a frozen cycle of IVF can be carried out at a later date.
- EMBRYO TRANSFER is carried out by a fine catheter this is placed into the uterus so that the embryo is allowed to implant naturally. There are some techniques used which can help some clinics will use such as embryo glue and endometrial scratch ( performed a month before the IVF cycle).
- TWO WEEK WAIT
IVF – Short protocol
Is used when there is a chance of excessive response to stimulation or a poor response to stimulation.
- Starts much earlier on a woman’s cycle. Around cycle day 2.
- Down regulation sniffing or injections is only carried for a few days.
- A scan will be carried out to make sure drugs have been effective.
- Stimulation, egg collection and embryo transfer occur exactly as described in the long protocol.
- Differences between long and short is you have less follicles on the short protocol around 4-7 follicles on each ovary and takes around 4 weeks instead of 6 weeks.
- At least 3 follicles – HCG trigger is administered.
Intrauterine Insemination (IUI) is the process by which sperm is injected into the uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. This technique is used in couples that have issues with ejaculation, single-sex couples where sperm donor is being used and even couples that have no fertility issues as a cheaper version.
- This is timed correctly using ovulation test strips.
- Sperm is washed and inserted.
- Progesterone support is given after insertion.