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  » Infertility  »  In vitro fertilization: IVF- Sample calendar for an IVF cycle using Lupron - No birth control pills Assisted Hatching

Sample calendar for an IVF cycle using Lupron - No birth control pills
A sample in vitro fertilization cycle showing the days various medications are taken and timing of the ovarian stimulation monitoring and IVF procedures.

This woman has a typical 28 day menstrual cycle. Birth control pills are not being used to control her cycle in this example.

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

Start Lupron

Menstrual cycle day 21 

2

Lupron

Menstrual cycle day 22 

3

Lupron

Menstrual cycle day 23 

4

Lupron

Menstrual cycle day 24 

5

Lupron

Menstrual cycle day 25 

6

Lupron

Menstrual cycle day 26 

7

Lupron

Menstrual cycle day 27

8
Menstrual period starts

Lupron

 



 

Menstrual cycle day 1

9



Lupron

Start FSH injections

Baseline blood and ultrasound

Day 1 of stimulation

10



Lupron

FSH

 


Day 2 of stimulation

11



Lupron

FSH

 


Day 3 of stimulation

12



Lupron

FSH

Blood test

 

Day 4 of stimulation

13



Lupron

FSH

 


Day 5 of stimulation

14



Lupron

FSH

Blood and ultrasound

Day 6 of stimulation

15



Lupron

FSH

Blood and ultrasound

Day 7 of stimulation

16
Lupron

FSH

Blood and ultrasound

Day 8 of stimulation

17



Lupron

FSH

HCG injection
Blood and ultrasound

Day 9 of stimulation

18

19

 

Egg Retrieval Procedure

20

 

Start daily progesterone shots or vaginal cream

21

22

Embryo Transfer Procedure

(day 3 transfer)

23

 

24

Embryo Transfer Procedure

(day 5 transfer, blastocyst transfer )

25

 

26

 

27

 

28

29

30

31

 

1

 

2

Pregnancy test

 

 


Key to table:

Blood and ultrasound = blood test for hormone levels and transvaginal ultrasound to measure follicle development in ovaries

Lupron = subcutaneous injection of a medication called Lupron (GnRH agonist). This medication is taken once daily.

FSH = subcutaneous injection of a medication containing follicle stimulating hormone (FSH), which causes follicles containing eggs to develop in the ovaries.

HCG injection = intramuscular injection of a medication called HCG, which causes the eggs to complete the maturation process. This is taken only once in the cycle.

Progesterone = vaginal cream or suppositories or intramuscular injection of a medication called progesterone, which helps to prepare a receptive uterine lining for embryo implantation

Note:

The calendar shown above is an example of how the cycle stimulation may evolve. However, some women will need to be monitored more often if they have a high response to the stimulation meds - or less often if the response is slower.

It is also possible that the stimulation process would take longer than that shown above. The example above shows 9 days of stimulation (FSH shots). The average number of days of taking the FSH injections is 9-10, with the general range being about 7-14.

Egg retrieval procedure = the procedure that obtains eggs from the woman's ovaries

Embryo transfer procedure = the procedure that places embryos back in to the uterine cavity of the woman

In vitro fertilization

Assisted Hatching


An 8-cell embryo in the process of assisted hatching

Holding pipette on left, hatching needle on right
As the shell (or zona pellucida) around the embryo is dissolved,
the needle is advanced to the left until a small opening is made

Who should be treated with assisted hatching?

The most commonly used indications for assisted hatching with an in vitro fertilization case are:

Age factor - Couples having IVF with the female partner's age over 37
Egg quantity and quality factor - Couples in which the female's day 3 follicle stimulating hormone (FSH)  level is elevated
Embryo quality factor - Couples having IVF with poor quality embryos (excessive fragmentation or slow rates of cell division)
Zona factor - Couples having IVF with embryos that have a thick outer shell (zona pellucida)
Previous failures - Couples having IVF that have had one or more previous IVF cycles that failed

In our IVF clinic, we use assisted hatching on just about all cases - because we think it increases the pregnancy and delivery rates.

How is assisted hatching performed?

1. The embryo is held with a specialized holding pipette.

2. A very delicate, hollow needle is used to expel an acidic solution against the outer "shell" (zona pellucida) of the embryo.

3. A small hole is made in the shell by digesting it with the acidic solution.

4. The embryo is then washed and put back in culture in the incubator.

5. The embryo transfer procedure is done shortly after the hatching procedure. Embryo transfer places the embryos in the woman's uterus where they will hopefully implant and develop to result in a live birth.

Pregnancy rates

Pregnancy rates for in vitro fertilization procedures with assisted hatching have been shown in some published studies to be higher than for IVF without hatching. There is an improvement in implantation and pregnancy rates in our IVF clinic with the use of assisted hatching. This is not seen in all IVF programs.

It is possible to damage embryos with hatching and lower the pregnancy rate in a program. Therefore, it is essential that if assisted hatching is done, it must be expertly performed by properly trained embryologists.

The actual pregnancy and live birth rates seen in an individual IVF center will vary according to the hatching technique used, the overall quality of the laboratory, the skill of the individual performing the hatching, the embryo transfer skills of the physician, and other factors.