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IVF treatment with Dr. Charles MPL |
Preamble:
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
in pairs
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 8 embryos. This
allows for
up to four
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 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 Friday.
3.
On the
Wednesday before
stopping Nordette,
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 20
days).
4. On the Wednesday before
stopping 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.
Treatment
cycle:
1.
On the
first Thursday
of your
menstrual cycle,
you will
commence ovarian
stimulation by
injecting Gonal F daily for
seven days
under the
skin of
your tummy.
The dose
varies from
150 to 600 units,
depending on
basal FSH
level, age
and cycle
length.
2.
On the
eight 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
and to
estimate when
it will
reach 20mm
in diameter. Gonal F will be
continued until the leading follicle reaches 20mm.
The dose depends on the E2 level.
3. On the day that is likely for the eggs to be ripe, blood is taken for measurement of the Estradiol level and an ultrasound scan is performed to measure the size of the leading follicles.
4. 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, some thirty-six hours before egg collection.
5. On the day of egg collection, sperms are obtained from fresh semen or from frozen stored semen or from biopsy of the testes.
6. Egg collection is a day-surgery procedure. . It is performed under a short general anesthesia with a trans-vaginal Wallace needle. There will be only minimal discomfort after the procedure.
7. The eggs are stripped of their cumulus and intra-cytoplasmic sperm injection is performed.
8.
One
day
after
egg collection,
luteal phase
support is
started. Vaginal
progesterone 90mg (Crinone) is inserted two
times daily
for 20
days.
9.
One day after egg collection, the luteal
phase is augmented with Estradiol valerate (Progynova) 2mg, two tablets
three times a day for the next 20 days.
10. The day after egg collection, the incubated injected eggs are inspected for fertilization.
11. Three days after egg collection , the embryos will be in the six to eight-celled stage of development. Depending on your choice, two or three embryos will be transferred into your uterus with a Wallace or Cook cannula. The embryo transfer procedure is painless.
12.
13. Sixteen days
after embryo
transfer, the
urine will
be tested for
pregnancy. If
you are
pregnant, Crinone
and Progynova will be continued for the next 10 weeks. You will also be given
folic acid 5 mg daily, salbutamol (Ventolin) 1
mg twice daily
and
Duphaston 10 mg three times daily.
14. If your menses occurs, you will be seen on day 12 of the menstrual cycle for timing of frozen- thaw embryo transfer. Urine will be tested twice daily for the LH surge and embryo transfer will take place five days after the surge.
For cases where hyper-stimulation is anticipated, the triggering dose of HCG (Pregnyl) is reduced to 5,000 units. No further HCG is given.
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