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| IVF/ICSI Procedure |
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Treatment Information Appointment
When you are ready to commence treatment, you can contact the Centre to arrange an appropriate time to meet a Nurse Coordinator who will go through the procedure step by step, and demonstrate how to self-inject the drugs to be used. Most of the fertility drugs used are given by subcutaneous injection. A provisional programme of dates will be given, so that time off from work can be arranged if necessary.
You will have ample opportunity to ask as many questions as required until you feel confident. You will be given a set of treatment consent forms which will be explained in detail to you. These will normally be completed during that appointment or you can take them home for further consideration and completion at your leisure.
Completion of these forms is a legal requirement of The Human Fertilisation and Embryology Authority, and without them your treatment cannot proceed.
Please note that whether you have conventional IVF or ICSI the treatment programme is identical up to the time of egg collection.
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Drug Regime 1
The first drug, Suprecur, (Buserelin) is commenced on day 21 of a 28-day cycle and is given by subcutaneous injection. This drug will suppress the natural activity of the ovaries and in effect causes a brief and reversible menopause-like state. This allows the development of the follicles to be controlled by the fertility drugs and also prevents spontaneous ovulation.
If a patient has a long or irregular cycle, a preliminary ultrasound scan may be necessary to check that conditions are right to begin treatment. Special tablets may be necessary to induce a period artificially.
You should expect a period within 7-10 days of commencing the Suprecur, but occasionally it may be delayed up to a week.
Please telephone the Centre at the start of your period to book your first ultrasound scan. Usually, this will be on a Tuesday or Wednesday following the onset of the period. This scan should confirm adequate downregulation, ie that the endometrium has been shed and that there is no ovarian activity. The number of baseline follicles will be assessed and the dosage of ovarian stimulation required will be prescribed by the consultant.
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Ovarian Stimulation
Follicle Stimulating Hormone (FSH) or human Menopausal Gonadotrophin (hMG) is the second drug to be used. It is started after your period has commenced, on the day of your first ultrasound scan.
It stimulates the growth and development of the baseline follicles in your ovaries. It is administered on a daily basis until the eggs are ready to be ripened, which will be approximately 12 days from your first ultrasound scan.
Some patients, including women over 40 years of age, will require Drug Regime 2.
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Drug Regime 2
Between Day 1 and Day 3 of your period, you will need to attend the clinic by 9.00am to have blood tests for FSH and Oestradiol. An ultrasound scan is usually needed on the same or following day. Together, these will give an indication as to the likely ovarian response to drugs in that particular cycle.
If the results are unfavourable, and as they can vary significantly from one month to another you will be advised to wait and repeat the tests in a subsequent cycle. In the event of abnormal blood levels in three consecutive cycles, you may be advised not to proceed with any treatment. If the test results are favourable, treatment will proceed as follows.
On Day 3 ovarian stimulation will commence using daily subcutaneous injections of FSH or hMG. After approximately five days of injections a second scan will assess ovarian response, and a drug known as GnRH antagonist is started to prevent natural ovulation occurring. Further scan appointments will be made, if appropriate. The treatment then proceeds as for the standard protocol described below.
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Monitoring
Serial ultrasound scans are used to monitor the number and growth of ovarian follicles and the development of the lining of the uterus (endometrium).
Three or four scans are normally required during the stimulation phase which usually lasts 10-14 days after the first FSH/hMG injection. Almost all scans are performed vaginally.
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hCG (human Chorionic Gonadotrophin): the late night injection
When the follicles have reached the required size and the endometrium is sufficiently developed, a crucial injection of hCG is given to ripen the eggs prior to their collection approximately 36 hours later.
This injection is given at a specific time at night (usually between 9.00pm and 1.00am) and is directly related to the time of your egg collection. The timing of this injection is critical. Detailed written and verbal instructions will be given regarding the dose, date and time for this injection and for your egg collection.
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