Procedures - What to Expect
Several months will be needed to complete the process:
Month 1 - Meet with
Month 2 - Psychological
Month 3 - Evaluation
of uterus/trial embryo transfer. Begin Lupron.
Month 4 -
Stimulate and do procedure.
The procedure done to remove the eggs from the ovaries is referred to
as the “oocyte retrieval”. This is an out-patient minor procedure
performed in our office IVF clinic. Patients are given intravenous
sedation by the Anesthesiologist while monitoring oxygen levels in the
blood, EKG, and blood pressure continuously. The patient generally sleeps
through the procedure, which lasts about 15-20 minutes.
Following administration of the sedation, Dr. Donahue will insert a
speculum, and cleanse the cervix and vagina. The speculum is then removed,
and the ultrasound probe with needle guide attached is inserted. (A
similar ultrasound machine and probe are used for the retrieval as are
used in the office to monitor follicle development.) Dr. Donahue will
identify and examine the uterus, endometrium, and both ovaries. When the
ovaries are aligned properly on the ultrasound monitor, Dr. Donahue will
introduce the needle through the wall of the vagina and into the first
follicle. Suction is applied, and the follicle will be emptied of its
contents. The follicle walls collapse as the follicular fluid, and eggs
are collected into a plastic test tube. The follicle is then refilled,
rinsed and emptied again, to be sure that the egg has, indeed, been
removed. Normally each follicle is rinsed three to four times. This
process continues until all follicles from that ovaries have been emptied.
When the second ovary is finished, Dr. Donahue will remove the
ultrasound probe and check the cervix and vagina for any bleeding. The
retrieval procedure is then complete, and you will be taken to the
recovery room. You will be observed by the surgery/recovery nurses while
the effects of the sedation wear off. You should be ready to go home
within one hour after the end of the procedure. You will be given oral
pain medicines. In the 24-hour time period following the retrieval, it
will be important for you to rest in a semi-upright position. When the
ovaries are punctured to remove eggs, they ooze bloody fluid for a while
until the puncture sites heal over. If this bloody fluid reaches the area
of your diaphragm (as would happen if you laid flat), you may experience
some chest and shoulder pain. Plan to sleep in a recliner chair or propped
up in bed with pillows on that first night after retrieval. You will be
given a prescription for pain medication when you leave the recovery area.
Tylenol often works well to relieve post-procedure pain as well; we do
request that you not use ibuprofen medications (Motrin, Advil, etc.) for
pain relief, however.
The procedure to place the embryos into the uterus is referred to as
the “embryo transfer. The transfer is done in our IVF procedure room. We
will ask you to arrive 30 minutes prior to the scheduled procedure, and
you may take the Valium 10 mg pill to help you relax at this time.
Additionally, you will already on the progesterone vaginal suppositories.
This may help the uterus soften and not contract for during the transfer
procedure. The placement of the embryos into the uterus is done with
ultrasound guidance- but this time, the ultrasound will be done
abdominally. It will be necessary, therefore, for you to have a moderately
full bladder when Dr. Donahue performs the transfer. Plan to drink 2 to 3
glasses (8 ounces) of fluid about an hour before the scheduled transfer
Husbands are encouraged to be present for the transfer procedure. Dr.
Donahue will cleanse the cervix and vagina, similar to the retrieval
procedure, and then do a “test pass” of a catheter into the uterus. Once
this is comfortably done, he will instruct the biologist in the lab to
place the embryos in the embryo transfer catheter. At this time, they are
removed from the incubators, placed into the transfer catheter, and
brought into the transfer room. Dr. Donahue will pass the very slender
catheter through the cervix, and guide it to the proper location in the
fundal area of the uterus. You will be able to watch on the ultrasound
monitor as the embryos are expelled from the catheter into your uterus.
The laboratory biologist will then check the catheter, under the
microscope, to be sure it has been emptied of the embryos.
In order to give the uterus ample time to calm down, and the embryos a
chance to “settle in,” we will keep you in the recovery room for about 1
hour after the transfer. You will need to lie flat for this time. Once
discharged, and for the next two days, it will be important for you to
keep your activity to a minimum. You should plan to rest on the couch,
recliner, or in bed as much as possible. Activity restrictions for the
next two weeks will include:
- No intercourse
- No heavy lifting or strenuous exercise
- No hot-tubs or jacuzzis
Progesterone and estrogen levels will be checked one week after the
embryo transfer to be sure the levels are adequate for implantation. A
blood pregnancy test can be performed at 14 days after the transfer. If
you have not started a period by that “target date”, please call the
office to make arrangements for testing. Keep in mind that it is possible
to have not begun a period by the target date, and still not be pregnant.
This is due to the large amount of progesterone you will be taking for
those 2 weeks after the retrieval. Progesterone can cause a delay in the
onset of a menstrual period.
If the blood test is positive (>5.0), we will want you to have a second
pregnancy test in two more days. This second test lets us know if the
pregnancy is developing normally, and gives a clue about the possibility
of twins. Progesterone levels will also be checked on these positive
tests, and Dr. Donahue will adjust your continued need for progesterone
support accordingly. If your blood test is negative, or if you start a
full period, we will instruct you to stop the progesterone injections. A
period should start (if it hasn’t already) within 3 to 4 days of stopping
the shots. Those patients who experience an unsuccessful cycle are
strongly encouraged to come in for a follow-up consult with Dr. Donahue to
review and discuss the cycle, and discuss future options.