What is a Sonohystogram? This is one of the tests done early in the fertility treatment process.
Clomiphene Citrate Challenge Test:
It is a test designed to assess ovarian reserve, or a general evaluation of remaining egg supply. This test in combination with a woman’s age and her antra follicle count (number of small follicles containing oocytes (eggs) seen on ultrasound) can be used to guide treatment choices and likelihood for success.
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IVF medications
Lupron:
These medications are used to stimulate follicle development in the ovaries. Stimulation medications include: Bravelle, Menopur, Gonal-F, Gonal-F Pen and Follistim Pen.
Bravelle, Menopur, and Gonal F require mixing a powder with water using a Q-cap. This injection is taken subcutaneously using a 27GA ½” needle, and 3cc syringe.
Gonal-F Pen and Follistim Pen are in a pen-like delivery system that you dial the pen to the appropriate dose, attach a needle, and then take the injection subcutaneously. The pens are typically used for several doses.
This injection is taken to stimulate oocyte maturity. It is a timed injection and is typically taken 36 hours prior to oocyte retrieval.
To mix the HCG injection: use a 3cc syringe with 1 ½ inch needle to draw 1cc/ml of water into the syringe. Then inject the water into the vial of powder. Remove the syringe and roll the vial between your hands. Once dissolved, withdraw the full 1cc/ml of fluid out of the vial. Your injection is now ready. This is injection is taken in the upper outer quadrant of the buttock, right behind the hip.
There is no mixing required for Ovidrel, it is provided in a prefilled syringe and is taken subcutaneously.
This injection is taken to stimulate oocyte maturity. It is a subcutaneous timed injection and is typically taken 36 hours prior to oocyte retrieval. It comes in a pre-filled syringe with the needle already attached. The entire amount is taken as instructed. This injection is also used to boost hormone levels when necessary following oocyte retrieval.
This medication is used to supplement the body with Progesterone to maintain a pregnancy if one is to occur. Using a 3cc syringe with 18GA 1 ½ inch needle you will draw up 1cc/ml of oil. You will then switch the needle to a 22GA 1 ½ inch needle to inject in the muscle. This injection is given in the same place as the HCG injection. See diagram above.
Helpful hints:
- Warm baths or showers prior to injection will help the oil to flow into the muscle easier.
2. Warm the vial in your hands for approximately 10 minutes.
Use ice packs to help relieve irritation at the injection site. (Not immediately before or after the injection). (Do not apply to bare skin, wrap packs in a towel).
Massage the area after injecting to promote the flow of medication.
Apply a warm compress for 10 minutes to the injection site to help the medication disperse.
This medication is used to supplement the body with Progesterone to maintain a pregnancy if one is to occur. It comes in the form of a vaginal suppository and is placed up near the cervix using an applicator.
This comes in the form of a pill and is taken daily as a supplement to maintain a pregnancy if one is to occur. This can be taken orally or vaginally as instructed.
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Ovulation Induction
Day one is considered the first day of “full flow”. If you start after 6 p.m., the next day is considered day one. Schedule baseline blood work and ultrasound.
The doctor will be assessing your response to the medication through ultrasound and estradiol levels. You can plan on returning every other day or so from that point. The closer you get to ovulation, the more often we need to assess you. The average number of days on the stimulation medication is 10-12.
Once your follicles are in the mature range (18-20mm), you will stop the gonadotropins. You will be instructed on when to take your HCG (Ovidrel). This is a one time per cycle medication used to “trigger” ovulation. It needs to be given subcutaneously or into the “fatty layer”, just beneath the skin. Whether it is given in the abdomin or thigh, its mechanism of action is the same. If you are using Ovidrel for the first time, you may bring it with you on the day of your mid cycle ultrasound. Providing you have follicles in the mature range, we can give (demonstrate) how to administer the medication. You will then be scheduled for insemination or instructed to have intercourse every other day for a week.
One week from the HCG injection you will be asked to return for a progesterone level. This tells us that you have ovulated and confirms that the level is sufficient to maintain the endometrial lining.
Two weeks from HCG you will be asked to come in for a blood pregnancy test.
If you are not pregnant, you can expect a period to start approximately 12-14 days after the HCG injection. If you have not started a period within 17 days after HCG, please call the office.
Please avoid any product that contains ibuprofen or aspirin such as: Motrin or Nuprin. Ibuprofen has the potential to interfere with ovulation. Tylenol is acceptable.
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Hysterosalpingogram (HSG)
This procedure takes 30 minutes. You will need to arrive 15 minutes before your scheduled appointment. The Doctor will place a speculum into the vagina, then clean your cervix with an antiseptic solution. A small catheter will be placed to inject the dye through the uterus, into the fallopian tubes. You may be asked to roll from side to side to help the doctor see the dye flow through your tubes. You may experience some cramping when the dye is injected, the Motrin will help the cramping. The Doctor will take delayed x-rays, which make sure that all the dye has passed through the ends of the tubes.
Please bring a sanitary napkin/pad, the dye will stain your panties.
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SEMEN ANALYSIS
An integral part of the infertility evaluation of a couple is the examination of the male’s semen. The semen analysis is an accurate measurement of the number of sperm, their motility, an estimate of their normal structure and other important parameters. The information gained from the semen analysis is essential for the proper evaluation of the male partner.
The quality of the specimen you produce for analysis and/or insemination will be better maintained by carefully following these instructions. Please use the sterile specimen container that we provide.
2. Wash your hands and penis with warm water. Rinse and dry with a fresh towel.
3. Collect the specimen by masturbation. DO NOT use soaps, gel or lotions as these are highly toxic to sperm. Ejaculate directly into the sterile container.
4. Safely secure the top of the container. Label the container with your name, date, and time of collection. Unlabeled container cannot be accepted.
5. Insert the specimen container into the biohazard bag provided. Seal the bag.
6. Please hold the container upright while transporting it to the lab. Keep the specimen between room and body temperature.
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Letrozole/Gonadotropin Combination Therapy
strenuous
Instructions for administration of Ovidrel are also available at: www.seronofertility.com