IVF stimulation protocols
For IVF we use basically two protocols:
the long one lasting about a month and
the short one lasting about 15 days.
In the long protocol the start of the analog (Suprefact / Daronda / Arvekap) takes place at the 21st or the 1st day of the cycle. The first two weeks concern only the prescription of the analog while during the last two weeks the stimulating drug is being added (Gonal-F, Puregon, Altermon, Menogon, Menopur, Merional) without stopping the analog.
In the short protocol, the beginning takes place necessarily on the 1st day of the cycle and either an analog may be used (Suprefact / Daronda / Arvekap) or an antagonist (Cetrotide, Ofgalutran). Before starting the short protocol a vaginal ultrasound is taking place so as to rule out the presence of ovarian cysts.
The doctor of the Unit will recommend the most appropriate protocol for you, taking into account the history, the age, the ovarian response to previous attempts etc.
In recent years, both we at Embryogenesis and internationally have adopted the short protocol with the antagonist which is very friendly and equally effective as the long one. Its duration is only 10 to 12 days with much fewer injections.
In an effort to increase the chances of success we use the Suprefact / Daronda / Arvecap drugs that stop (suppress) completely the secretion of the LH (hormone produced by the pituitary gland in the brain and is responsible for the ovulation).
We start using these medicines on the 21st or the 1st day of a normal cycle. During suppression, an informal period can occur, which is expected, however, and therefore it should not worry you at all. As a first day, we consider the appearance of little red blood (not the initial browny blood). After starting taking them, you must inform the Secretariat by telephone and book your appointment (suppression day appointment) which will be after two weeks approximatelly to certify that you are ready to start the injections of the ovarian stimulation.
When you stop the medicine, the pituitary gland and thus your cycle they are coming back to their normal functioning. The side effects of these drugs are relatively small and totally harmless. They include nose irritation, headache, flushings, sweatings, etc.
You never stop the "suppression" drugs (Suprefact / Daronda / Arvecap) as long as you started taking them, until the moment of the "midnight injection".
For a small proportion of women, an additional week (third) of administering the sedation drugs may be needed in order to achieve the desired result. This is usually due to functional ovarian cyst, which secretes estrogens and can adversely affect the outcome of the effort. These cysts are easily treated by simple aspiration before the treatment begins whereby the onset of the ovarian stimulation injections is postponed for a week.
After the suppression phase, which has been already described, the most intensive phase of the Program begins, that is the stimulation of the ovaries.
These injections contain the same hormones which are naturally produced by the pituitary gland in the brain so as to stimulate the ovaries and initiate the follicular development, the oocyte's maturation and eventually the ovulation. In IVF we administer these hormones in larger doses. These medicines are almost equally efficient (bioactivity) and it seems that no medicine is superior to other ones.
Also, it is absolutely safe medicines since their use dates back to 1960, without the various epidemiological studies to correlate with cancer risk or other possible side effects.
The day the injections begin is also called as “first day”. You should contact the Unit in the afternoon (2-3 pm) of the sedation day, so as to be informed about the dosage of the injections (Puregon, Gonal-F, Altermon, Menogon, Merional, Luveris) with which to begin, and the day of their onset. Preferably, these injections are done during the afternoon and approximately during the same hours (e.g., 4-8 pm).
From the day you start these injections and until the midnight injection, you decrease:
SUPREFACT to a half dose of 0.5 ml or 50 lines of insulin to 0.25 ml or 25 lines of insulin and from 3 inhalations per 8 hours to two inhalations per 8 hours.
ARVECAP: half the injection is done and the other half is being kept in the refrigerato for the next day.
DARONDA: from 20 lines of insulin to 10 lines.
During the ovarian stimulation you may feel mild discomfort in the lower part of the abdomen due to the volume expansion of the ovaries as a result of their response to the treatment. Both during the suppression phase and during the phase of the ovarian stimulation you do not need to modify the rhythm and the way of your life (e.g, work, food, sex, etc.).
This injection (Profasi / Pregnyl / Ovitrelle) is done for the final maturation of the oocytes and it is almost identical to the LH hormone, which is secreted in the middle of a normal cycle, 36 hours before ovulation. We call it this way, because it is done around midnight, so as the oocyte retrieval can follow 36 hours later, that is the morning after next. After the midnight injection's prescription, you stop doing the injections (Suprefact / Daronda / Arvecap) as well as the injections (Puregon, Gonal-F, Altermon, Menogon, Merional, Luveris).
The prescription of this injection presupposes the existence of mature folliculars, which have a size of at least 18 x 18 mm. and the corresponding levels of estradiol in the blood. If there are no such conditions, the chances of success are small and we may decide to cancel the effort. In addition, the program can be stopped if the ovaries are stimulated excessively. Despite the close monitoring, the above adverse situations can occur in the best centers worldwide and at a rate of approximately 10%.
Finally, an abstention of 2-5 days before oocyte retrieval is recommended. The semen can be conveyed from home without any problem into suitable plastic containers and up to 120 minutes.
The oocyte retrieval is carried out daily as well as in the weekends. You should be at the Unit at 8 am and absolutely fasting. The process of the oocyte retrieval is done transvaginally using an ultrasound machine, with local anesthesia and "drunkenness", in order to be able to watch the oocyte retrieval through a screen. At noon of the same day you can go home, but you should avoid driving that day.
Before your departure from Embryogenesis, the Head of the Nursing should see you.
Embryo transfer is a simple procedure with an average duration of 15 minutes and without the need for anesthesia. It is carried out by using a special flexible catheter, which is connected to a specific syringe. The catheter enters the uterus slowly and without causing any injury.
Once removed, it is being transferred and examined into the laboratory in order to determine if it retained any fetus.
The patient remains in bed for 15 to 30 minutes, while for the next 2 to 3 days a reduction of activity is recommended, as it has not been yet proven that the absolute immobilization after the embryo transfer presents any advantages.
After 12 to 14 days, the woman does a pregnancy test in order to determine if she is pregnant.
The pregnancy test has to be done at the Unit 14 days after the oocyte retrieval by taking blood sample at 7-9 a.m. We make sure that you are informed about it as soon as possible!
If the result is positive, we will plan a vaginal ultrasound two weeks later so as to see the embryo(s). The pregnancy after IVF does not differ from any other pregnancy and thus taking some precautions is not required. It should be emphasized that any pregnancy either after IVF or after normal fertilization is unfortunately subjected to an abortion rate, which is 15-20%.
Most of the times the causes are unknown although chromosomal abnormalities in embryos are implicated, which are incompatible with life. This situation can not be predicted or treated with medicines and it is often seen in older pregnant women.
If the test is negative, we firmly believe that the responsible scientific team should review with you in detail all the effort that was made as well as examine in detail the prospects for the future.
As a general principle, a couple maximizes the chances of success after completing 3-4 very serious efforts maximum, reaching as a consequnce a success rate of 65-70%. Therefore, we are against the excessive ineffective efforts, so in this case, after a thorough analysis of the situation and the prospects, the most appropriate solution should be presented to the couple.
In addition, we always recommend an interval of 2-3 months between the two attempts. This time is necessary for you in order to regain your physical and psychological power.
In any case, do not hesitate to share with us all your concerns and thoughts and if you consider it is necessary, you can even consult our psychologist.