IVF and ICSI

LONG AGONIST CYCLE

Requesting treatment

Please ring 01625 569 448 or 07500 806 319 on the first day of your period (the morning you wake up bleeding) to request treatment. The Fertility Nurse will review your files and discuss with the Consultant as necessary.

Pre-treatment assessment

Having checked through your medical notes and ensuring all relevant information is up to date and conferring with our designated Licensed Unit the Fertility Nurse will ring you back later that day. Please note that it may not be possible to commence your treatment in the month you ring and you may be told to ring again the following month (this is very rare).

Treatment cycle procedures

You need to avoid unprotected intercourse and engage in only protected intercourse (usually with condoms) once your treatment commences. You will be asked to begin injections of a drug called ‘Buserelin’ on a particular day of your cycle (usually around Day 21). The Fertility Nurse will teach you how to give the injections.

Approximately 2 weeks later, you will attend RFS for a blood test. If this is satisfactory, you will start an additional lot of daily injections of either ‘Menopur’ or ‘Gonal-F’ to stimulate the follicles in your ovaries aiming for an egg to develop within each follicle. Please continue these injections until you are told to stop.

You will be monitored by regular blood tests and scans usually with blood tests on days 3 and 6 and blood tests and scans on days 8 and 10 of the cycle of stimulation. Blood tests and scans are done between 7.30am and 8.30am so they cause minimal disruption to work routines. You will receive telephone calls from the Fertility Nurse in the afternoon of the days you attend RFS informing you of any changes to your drug dose and to let you know your next appointment.

An average of 10-12 days stimulation with either Menopur or Gonal-F is usual but you may be ready for egg collection sooner, or even later, than this. The Fertility Nurse will advise you and your partner when it is best for him to avoid ejaculation near the end of the treatment cycle.

When you are ready for egg recovery, you will be requested to give yourself a final injection of ‘Pregnyl’. This helps to mature the eggs and needs to be taken about 36 hours before your egg collection. The nurses will explain what to do with this and how and when to take it.

On egg collection day you will be required to report to our designated Licensed Unit with your partner at 7.30am. This is the day your partner will be required to provide a semen sample, unless frozen sperm is being used. You will be told how many eggs were obtained from you on discharge that day. Further information about egg recovery will be given nearer the time.

SHORT ANTAGONIST CYCLE

Requesting treatment

Please ring 01625 569 448 or 07500 806 319 on the first day of your period (the morning you wake up bleeding) to request treatment. The Fertility Nurse will review your files and discuss with the Consultant as necessary.

Pre-treatment assessment

Having checked through your medical notes and ensuring all relevant information is up to date and conferring with our designated Licensed Unit the Fertility Nurse will ring you back later that day. Please note that it may not be possible to commence your treatment in the month you ring and you may be told to ring again the following month (this is very rare).

Treatment cycle procedures

You need to avoid unprotected intercourse and engage in only protected intercourse (usually with condoms) once your treatment commences. You will be asked to attend RFS for a blood test and a teach appointment (if not already done) the next day.

If the blood test result is fine, you will be asked to begin injections of either ‘Menopur with/without Gonal-F’ later that day (Day 1 of stimulation) to stimulate the follicles in your ovaries aiming for an egg to develop within each follicle. You will be asked to start another injection called Cetrotide on Day 4 of stimulation. Please continue these injections until you are told to stop. The Fertility Nurse will teach you how to give the injections.

You will be monitored by regular blood tests and scans usually with blood tests on days 3 and 6 and blood tests and scans on days 8 and 10 of the cycle of stimulation. Blood tests and scans are done between 7.30am and 8.30am so they cause minimal disruption to work routines. You will receive telephone calls from the Fertility Nurse in the afternoon of the days you attend RFS informing you of any changes to your drug dose and to let you know your next appointment.

An average of 10-12 days stimulation with either Menopur and/or Gonal-F is usual but you may be ready for egg collection sooner, or even later, than this. The Fertility Nurse will advise you and your partner when it is best for him to avoid ejaculation near the end of the treatment cycle.

When you are ready for egg recovery, you will be requested to give yourself a final injection of ‘Pregnyl’. This helps to mature the eggs and needs to be taken about 36 hours before your egg collection. The nurses will explain what to do with this and how and when to take it.

On egg collection day you will be required to report to our designated Licensed Unit with your partner at 7.30am. This is the day your partner will be required to provide a semen sample, unless frozen sperm is being used. You will be told how many eggs were obtained from you on discharge that day. Further information about egg recovery will be given nearer the time.

ANAESTHESIA FOR EGG COLLECTION

During the process of egg recovery the surgeon will place a scanning probe into the vagina in a very similar way to your previous scans. A fine needle is then inserted alongside the probe. When the needle is used to suck out the ripened eggs a momentary discomfort often occurs: usually only once for each ovary. To help manage this it is routine practice to use intravenous sedation and a short acting and very powerful pain killer together rather than general anaesthetic. You will therefore be sedated and not fully unconscious. This is very safe.

You may have had a general anaesthetic in the past and feel you will not cope with sedation. The facts are that the vast majority of patients in the UK and throughout the world have sedation to enable egg recovery and are very satisfied with it. Sedation is recommended and preferred as the method for this procedure by NICE1 and is our technique of choice in this unit. In a recent survey well over 95% of patients were very happy with their experience and would have sedation again if it was needed. They also benefitted from low rates of nausea and vomiting and a shorter recovery and stay in hospital – often leaving by lunchtime. The majority of our sedated patients do not remember any detail of the procedure itself or discomfort.

During the procedure you will have full monitoring which is routine. The surgeon will reassure you if necessary during the egg recovery however it is best to relax with the sedation and allow the surgeon to proceed.

There are occasionally some surgical reasons for general anaesthetic (GA), however these are rare and your surgeon will advise you if it is necessary for you to have GA. It is important that you understand that with sedation there is a possibility that you will remember some events during surgery and that you will feel the probe and possibly a little discomfort. Only with general anaesthetic would you be completely unaware.

We would strongly advise that sedation is our preferred method for egg recovery. After a short period of recovery and a bite to eat and a drink the ward nurses will ensure that you are safe to leave us. Typically the whole process takes about 30 minutes, however our experience with general anaesthesia means that you would take longer to recover and may have to stay in hospital longer – this is because the dose of anaesthetic is larger, and is often different.

Please remember that you should not operate any machine, drive or sign important documents until the day after your procedure as your judgement may be impaired. This applies to both sedation and anaesthetic.

Please ask the Fertility Nurse if you have any questions about what will happen to you.

LEADING UP TO YOUR EGG RECOVERY

You are now ready for egg recovery. The Fertility Nurse will ring to inform you of your final drug doses as normal.

You should administer the final egg maturation trigger injection (usually 5,000iu Pregnyl subcutaneously) to achieve egg maturation. The date and time of this injection will be confirmed by the Fertility Nurse. This will be your final injection. We do not need to see you the following day and you will not require any further injections. You need to report to the Reception at the Licensed Unit that you have been advised to attend (either Manchester Fertility Services in Cheadle or Hewitt Centre in Liverpool) for the egg recovery procedure two days after your final injection: we will make all the arrangements for you and give you the directions to the licensed Unit.

You should have nothing to eat or drink from midnight before the egg recovery. You should not chew gum as this is classed as food and can lead to cancellation of your procedure. Please discuss with the IVF Team whether you can take any regular medication that morning.

Please report to the Reception at the Licensed Unit at 7.30am on the morning of your egg recovery. The nurses will direct you to the Ward where you will be admitted for the procedure.

Take a dressing gown, slippers, your toilet bag and some reading material with you. You will be fit for discharge after you have eaten and passed urine (usually by lunchtime).

We wish you the very best of luck with the procedure.

FOLLOWING YOUR EGG RECOVERY

We hope your egg recovery was successful and that you are feeling well.

Following your egg recovery you may feel tired, bloated, have mild abdominal pain and light vaginal bleeding for few days. These are normal and we recommend that you rest and use mild painkillers if necessary (Paracetamol is suitable). Sanitary towels should be used, not tampons. You should plan to have at least a day (preferably two) off work to recover.

An Embryologist will see you before you are discharged from the Licensed Unit to discuss your egg number and further plans. You will need somebody to take you home and stay with you overnight.

Please contact the Fertility Nurse at Regency if you experience persistent sickness, vomiting, severe pain, thirst, swelling of your abdomen or reduction in the amount of urine you pass, as these symptoms may indicate ovarian hyperstimulation.

You should start using Cyclogest pessaries the day after your egg recovery. The Fertility Nurse would have explained how and when to use these. One pessary should be inserted high up vaginally first thing in the morning and another one last thing at night.

ON THE DAY OF EMBRYO TRANSFER DO NOT USE THE MORNING PESSARY UNTIL AFTER THE TRANSFER. PLEASE WAIT FOR THE EMBRYOLOGISTS TO CONFIRM YOUR TRANSFER DATE BEFORE USING A PESSARY THAT DAY.

Please do not hesitate to ask us if you have any questions.

In the event of an emergency outside normal working hours, please contact your nearest Emergency Gynaecology or nearest A&E Department.

***YOU MUST INFORM US IF YOU ARE ADMITTED TO ANOTHER HOSPITAL FOLLOWING YOUR EGG RECOVERY***