I found this on the NCFMC site and thought that I would back track so that you know how you got here. We love you.
Ovulation Induction and Monitoring (we started this process on 2/16/05 Mommy's first shots started on 3/14/05)
ART success rates depend upon the number and quality of embryos available for transfer. The egg retrieval must be carefully timed so as to retrieve mature eggs. To accomplish these two goals, ovulation inducing medications and careful monitoring are employed. In most cases, the female begins subcutaneous injections of Lupron one week before the next expected menses. This hormone prevents premature ovulation, which would result in cancellation of the cycle. Nearly 20% of cycles are canceled when Lupron is not used.Once menses occurs, a vaginal ultrasound examination is performed to make sure there are no ovarian cysts. As specified by the planned schedule of treatment, the woman then begins injections of gonadotropins (Gonal-f, Follistim, Repronex). Arbitrarily, we call the first day of gonadotropin administration Cycle Day 2.In order to monitor a patient's response to these drugs, daily ultrasound examinations and serum estradiol levels are performed beginning on Cycle Day 9. These help us determine when the eggs are ready for retrieval. (Most patients will also need to have a serum estradiol on Cycle Day 7 prior to their first ultrasound.)Once the follicles (containing the eggs) are deemed ready, the patient stops taking the Lupron and gonadotropins. Thirty-six (36) hours prior to the egg retrieval, the patient takes an injection of human chorionic gonadotropin (hCG) or ovidrel. This hormone mimics the woman's normal LH surge and is necessary for a final maturation of the eggs so that they can be fertilized.
Egg Retrieval ( This happened on 4/5/05)
In almost all cases, egg retrieval is accomplished using a vaginal ultrasound probe to guide a needle into the ovaries. The egg and fluid from each follicle are aspirated into a plastic test tube that is then transferred into the IVF laboratory. The fluid is carefully inspected by the embryologists and the eggs are placed into special IVF media. The egg retrieval usually takes no more than ten minutes and is performed with intravenous sedation administered by an anesthesiologist. As a result, the experience is not painful and recovery is brief.
Sperm Processing
Freshly ejaculated sperm must undergo a biochemical and structural change called capacitation before they are able to fertilize an egg. In an IVF cycle, sperm are capacitated in the laboratory prior to inseminating the eggs. This is accomplished by a process of centrifugation with isolation of the population of motile sperm.
In Vitro Fertilization
In-vitro fertilization literally means "fertilization in glass". The fluid obtained from the follicles is carefully examined in the IVF laboratory and the eggs contained therein are isolated and placed in culture media inside an incubator. A few hours later, several thousand processed sperm are placed around each egg. In some cases where sperm counts are very low, the process of fertilization must be assisted via the injection of individual sperm into each egg (see ICSI below).
Eggs and sperm are left to incubate together in a carefully controlled environment provided by the IVF laboratory. Approximately 18 hours following insemination, the eggs are inspected under the microscope to determine how many have been successfully fertilized. These so-called "pronuclear" embryos or zygotes are still single cells at this stage.
Embryos
The embryos are examined daily and their developmental progress is recorded. Three days following the egg retrieval, the best embryos contain 8 cells called blastomeres. This is the stage at which many programs will perform the embryo transfer. In selected patients, embryos may be cultured for an additional two or three days to a developmental stage known as the
blastocyst stage. These embryos contain approximately 60 to 100 cells and represent the embryos with the highest potential for establishing a pregnancy. As such, fewer embryos may be transferred without lowering the chances for conception. Select programs, including our own, have instituted this option for certain patients in an attempt to diminish the rate of multiple pregnancies.
Blastocyst - Day 5
Embryo - Day 3
Embryo Transfer (Back into mommy on 4/11/05)
Using a coaxial catheter system, a small outer catheter is inserted into the cervical canal. The embryos are then loaded into a smaller, soft, inner catheter that is passed through the outer catheter and into the uterine cavity. After localization of the tip of the inner catheter by abdominal ultrasound, the embryos are then deposited in the central portion of the uterine cavity and the catheter is withdrawn. Very little discomfort is experienced with this procedure. Following the transfer of embryos, the patient is sent home to rest for the following two days. During this period of limited activity, hatching (see explanation below) and implantation will occur.
Micromanipulation (Intracytoplasmic Sperm Injection and Assisted Hatching) (we did this)
Even with in vitro fertilization, men with very low concentrations of sperm and/or low motilities may be at risk for impaired fertilization of their partner's eggs. Fortunately, a procedure known as intracytoplasmic sperm injection (ICSI) has all but eliminated this problem. This procedure involves the direct injection of a single sperm into each egg and requires a great deal of expertise as well as special instrumentation.
Before an embryo implants itself into the uterine lining, it must first hatch out of its shell (zona pellucida). In some cases, failure to conceive may be due to a problem with hatching and several procedures have been developed to assist this process. The most common procedure utilizes a weak acid to "drill" a hole in the zona just before the embryo is transferred. Many clinics, including our own, use a specially designed laser to perform this procedure. Other indications for assisted hatching may include thick zonas, prior unsuccessful IVF treatment cycles, and fragmented embryos. This procedure is usually performed on embryos to be transferred at the 72 hour stage.
Post-Transfer Management (were waiting)
During the follow-up phase, the female partner receives supplemental progesterone and estrogen to maintain the integrity of the uterine lining. Progesterone may be administered by an intramuscular injection, a vaginal gel preparation (Crinone), and/or by vaginal suppository. Supplemental estrogen may also be administered. At 8 and 10 days after a day 3 embryo transfer (or at 6 and 8 days after a blastocyst transfer), blood pregnancy tests are performed. Rising blood levels of the pregnancy hormone, hCG, indicate that implantation has occurred. Approximately 10 days after the second HCG level, a third hCG level is obtained to confirm normal progression of the gestation. Affirmation of a clinical pregnancy is made by ultrasound examination four weeks following the transfer.
APRIL 28,2005- Your staying!!! YIPPIE. we can't wait to meet you.
