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IVF treatment with Dr. Charles MPL |
The
objective
of
this
approach
is
to
increase
the
chance
of
pregnancy
while
reducing
inconvenience,
discomfort
and
cost.
Although
the
ICSI
variation
of
IVF
is
generally
recommended
when
the
husband
has
very
few
sperms,
one
preference
is
to
employ
ICSI
for
all
cases
undergoing
IVF.
The
purpose
is
to
maximize
the
number
of
embryos
by
ICSI.
Two
fresh
embryos
are
placed
into
the
uterus
and
the
rest
are
frozen
for
future
attempts
at
transfer.
This
increases
the
cumulative
chance
for
pregnancy.
Moreover,
a
hole
is
made
in
the
shell of
the
egg
during
the
procedure
of
ICSI.
In
theory,
this
may
allow
the
embryo
to
hatch
out
more
easily
and
increase
the
chance
of
pregnancy.
One
scenario
is
to
produce
about
12
follicles,
giving
10
eggs
and
resulting
in
6
embryos.
This
allows
for
up
to
three
attempts
at
embryo
transfer,
thereby
increasing
the
cumulative
chance
for
pregnancy.
Preparation
cycle:
1.
On
day
2
of
your
preparation
cycle,
blood
is taken
for
FSH
and
AMH
level
in
order
to
determine
dosage
of
ovarian
stimulation
medicine.
2.
On day
3
of
your
preparation
cycle,
start
taking
Microgynon
oral
contraceptive
pills
for
a
total
of
14
to
28
days.
The
last
tablet
should
be
on
Monday.
3.
In
the
LH-Agonist
approach,
on
Monday,
the
last
day
of
Microgynon,
you
will
start
down-Regulation
by
injecting
Lucrin 0.1ml
into
the
fat
under
the
skin of
your
tummy,
once
daily
until
HCG
trigger
(about
15 days).
4.
In the LH-Antagonist
approach, on Tuesday, the day after the last tablet of oral
contraceptive, Cetrotide 0.25mg is injected under the skin of your tummy every
day for three days.
5.
In
the
Flare-Up
approach, sometimes used
for
women
above
the
age
of
39
years
or
who
have
a
basal
FSH
of
more
than
9 IU/lit
or
who are
poor
responders,
Lucrin
is
started
together
with
Gonal
F on
the
first
Friday
of
the
treatment
cycle.
6.
On
Monday, the
last
day
of
Microgynon,
an
attempt
is
made
to
pass
the
Wallace
embryo
transfer
catheter
through
the cervix
into
the
uterine cavity.
If
difficulty
is
encountered,
hysteroscopy
is
performed
the
next
day
to straighten
the
canal
of
the cervix.
If
endometrial
polyps
are
found,
these
will
be
removed. For
cases
with
previous
failed
implantation,
an
endometrial
scratch
is
performed
using
an
endometrial
sampler.
Treatment
cycle:
1.
On
the
first
Friday
of
your
menstrual
cycle,
you
will
commence
ovarian
stimulation
by
injecting
Gonal F daily
for
five
days
under
the
skin
of
your
tummy.
The
dose
varies
from
150
to 600 units,
depending
on
age,
cycle
length,
Antral
Follicle
Count,
basal
FSH
level
and
AMH
level.
2.
On
the
sixth day
of
injection,
blood
is
taken
for
measurement
of
the
female
hormone
Estradiol (E2)
level.
A
vaginal
probe
ultrasound
scan
is
performed
to
measure
the
size
of
the
leading
follicle.
This
is
repeated
every
two
days. The
dose
of
Gonal F
will
be
reduced
if
hyperstimulation
is
anticipated. Gonal F
will
continue
until
the
leading
follicle
reaches
20mm
in diameter.
3.
For
LH
Antagonist
cycles,
starting
from
follicles
reaching
14mm, Cetrotide 0.25mg is injected under the skin of your tummy every day
until
the
HCG
trigger
day.
4.
On
estimated
ripe
eggs
day,
blood
is
taken
for
measurement
of
the
Estradiol
and
Progesterone
level
and
an
ultrasound
scan
is
performed
to
measure
the
size
of
the
leading
follicles.
5. When
two
or
more
follicles
exceed
20mm
in
diameter
and
when the
Estradiol
level
approximates
1,000
pmol
per
Lit
per
follicle
exceeding
18mm,
the
eggs
are
considered
ripe.
HCG
(Pregnyl) 10,000
units
is
injected into
the
muscle
of
your
buttock at
about
eleven
o’clock
at
night,
in
the
emergency
department
of
the
hospital
thirty-six
hours
before
egg
collection. For cases where hyperstimulation is
anticipated, the triggering dose of HCG (Pregnyl) is reduced to 5,000 units.
6.
On the
day
of
egg
collection,
sperms
are
obtained
from
fresh
semen
or
from
frozen
stored
semen
or
from
biopsy
of
the
testes.
7.
Egg
collection
is
a
day-surgery
procedure.
This
is
performed
under
a
short
general
anesthesia
with
a
trans-vaginal
Cook
needle.
There
will
be
only
minimal
discomfort
after
the
procedure.
8. The
eggs
are
stripped
of
their
cumulus
and
intra-cytoplasmic
sperm
injection
is
performed.
9.
One day after egg collection, luteal
phase
support
is
started.
You
will
be given
an
implantation
promoting
hormone,
progesterone
(Crinone) 90mg
to
insert
into
the
vagina
two
times
a
day
for
twenty days.
This
increases
the
receptivity
of
the
internal
lining
of
your
uterus
(endometrium)
to
your
embryos. If you have discomfort from vaginal Crinone, it would be
replaced by Cyclogest 400mg inserted two times a day into the rectum.
10.
For cases where hyper-stimulation is anticipated, instead of HCG, luteal
phase support is augmented with Estradiol valerate (Progynova) 2mg, three
tablets two times a day from the day after egg collection for the next 20 days.
Luteal phase support is also augmented by oral Utrogestan 100mg, two capsules
two times a day and Duphaston 10mg two times a day for the next 20 days.
11. The
day
after
egg
collection,
the
incubated
injected
eggs
are
inspected
for
fertilization. The
Embryologist
will
inform
you
of
the
progress
of
your
embryos
daily.
12. Five
days
after
egg
collection ,
the
embryos
will
be
in
the
blastocyst
stage
of
development.
Depending
on
your
choice,
one or two
embryos
will
be
transferred
into
your
uterus
with
a
Wallace
or
Cook
catheter.
The
embryo
transfer
procedure
is
painless.
13.
On
the
day
of
embryo
transfer,
the
implantation (luteal)
phase
support
is
augmented with
HCG (Pregnyl)
2,500 units
under
the
skin
only
if
there
are
no
features
of
hyperstimulation.
14. Fourteen
days
after
embryo
transfer,
your
urine
will
be
tested for
pregnancy.
If
you
are
pregnant,
Crinone, Utrogestan, Duphaston
and Progynova will be continued for the next 10 weeks. You
will also be
given
folic
acid
5 mg
a day,
salbutamol (Ventolin) 1mg
two times a day.
15.
If
your
menses
occurs,
you
will
be
given
Progynova
2mg,
three tablets
two
times
a
day,
starting
from
the
third
day
of
your
menses.
On
day
15
of
your
menstrual
cycle,
your
endometrial thickness
will
be
measured.
If
it
is
8mm
or
more,
Crinone, Utrogestan and Duphaston will be added and the frozen embryo
will be transferred four days later.
Alternatively
you
will
be
seen
on
day
12
of
the
menstrual
cycle
for
timing
of
thawed
embryo
transfer.
Urine
will
be
tested
twice
daily
for
the
LH
surge
and
blastocyst
embryo
transfer
will
take
place
seven
days
after
the
surge.
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