Welcome to the IVF board and hints.../Injection Tips!

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Welcome to the IVF board.
I hope you will find this board as wonderful as I do. Its a great place for support and friendship.
I have also added the helpful hints section from the old board which Milli put together....if you can think of anymore please let me know and I will add them to the list... Please feel free to snag any of the blinkies at http://www.freewebs.com/blinkiesbyalexis/ttcloss.htm

PLEASE SAVE TO YOUR COMPUTER do not piggyback!

Information on doctors in your area, state health insurance mandates, ivf success rates -

www.asrm.org


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Information on medicines used in ivf - compiled from the posts on this board


Follistim/Gonal-f/Pergonal genetically derived stimulation drugs, taken usually in the form of subcutaneous injections. Helps to ice area before injecting


Antagon vs Lupron some women seem to respond better to antagon - improve egg quality. Using insulin needles is easier than the needles that comes with the box, the former is finer.


Synaral - equivalent to lupron; used by our Aussie and European friends


Baby Aspirin - pro - helps implantation, con- thins blood


Medrol & Tetracycline taken if there is assisted hatching


Doxycycline antibiotic taken by both to help stave off any infection and to decrease bacteria in sperm that are inevitably present

Medrol used for anti-inflammatory effects during assisted-hatching

Tetracycline to control bacteria that may affect implantation; used during assisted-hatching

Metformin to take if PCOS

Provera

Progesterone in Oil/Progesterone suppositories/PrometriumProgesterone supplements to sustain implantation/pregnancy. Usually taken until the placenta of the fetus develops and takes over. PIO injection consists of a thick solution, so warming it by keeping it next to your body for a few minutes, and applying heat afterwards to the area helps it get absorbed better. Also hurts less. Also Ice area before shot !

Cronine contains progesterone in a bioadhesive gel that sticks to the vaginal sidewalls. This is an advantage over the suppositories, which are very messy and tend to leak out of the vagina. Also, the absorption of Crinone is more directly into the uterus (because of the blood supply of the vagina and uterus)



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Tamoxifen Contributed by our own Lovely Phoebe!
it was originally developed as a birth contril pill but it was quickly noted that it actually stimulates the ovaries-egg production. the chemical structure is quite similar to clomid. it is now used widedly for women who have had breast cancer (most often with estrogen receptor positive breast cancer) as it acts as a weak estrogen. it blocks estrogen receptors in breast tissue so as to keep estrogen from stimulating cancer recurrences in the breast. for breast cancer prevention the drug is taken for 5 years. it has many bad side effects and there are significan risks of taking it. while RE's could use tamoxifen for follicle stimulation, (and at one time some did) they find that clomid and the other more widely used injectibles to be better. there are better alternatives to using tamoxifen for fertility. one should not take tamoxifen during a pg as it is associated with birth defects.
i found alot of my info with its use in regards to breast cancer on the nolvodex (name brand) website (i think...i did a google search.) that website, if i remember correctly does not mention its fertility use. i have read that some RE's are considering its use for stimulating follicles in women with breast cancer if they want to freeze embies for future use (or gestational carrier use.)
Injection Tips!

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I know we have all had some injection questions~ So here are Tips!

Sub-Q Injection Tips
To reduce stinging:

Try putting ice OR a product called EMLA (available at pharmacies) on the injection site to numb the skin before injecting
Before injecting, make sure you let the injection site dry after you clean your skin with the alcohol wipe
Some women find that injections sting less given in the abdomen and others find they sting less in the thigh. You might want to try switching locations to see which one works best for you
Some medications sting less than others. If your clinic gives you a choice, Gonal-F seems to sting less than Puregon or Follistim.
For better absorption:

Try giving yourself injections in the abdomen instead of the thigh. The abdomen is actually the best site for injections for most people because the blood flow to the tissue remains the same and generally speaking there is more fatty tissue there. However, you must stay away from your bellybutton by at least 1 inch in diameter. The more blood flow to the injection site the quicker the medication is absorbed.
To reduce leakage of medication: (a small amount of leakage is normal)

Release the fold of skin you are holding before removing the needle
Apply gentle pressure to the injection site with a cotton ball after withdrawing the needle
Try leaving the needle in for a few seconds before withdrawing
Try pulling some extra air in after you've pulled all the medication into the syringe. Turn it needle end down and tap all the air to the plunger end, which leaves the air bubble there. When you inject, you end up pushing all of the medication out and some of this air. A little air in a sub-cutaneous injection won't hurt you.
Ask your clinic if you can use less dilutent for mixing your injections. Some medications can be given with less dilutent than stated in the drug company's mixing guidelines. Only do this with your clinic's approval.


Injection Tips!
Progesterone in Oil Injection Tips

Try warming the progesterone in oil vial next to your skin (slipping the vial in your bra is ideal) for half an hour before the injection.
Change the needle after drawing up the Progesterone to avoid injecting yourself with a dull, oil-covered needle
To lessen the pain of the progesterone IM injections, place warm compresses on the injection site after the injection is given and rub the area really well so the oil gets disbursed more quickly. *The rubbing really does make a differance*




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Cogy

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tars415

Welcome to the IVF board and hints...Also what is PGD

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. PRE-IMPLANTATION GENETIC DIAGNOSIS (PGD)

The major reason in IVF for failure of an embryo to implant and result in a delivered pregnancy is that it is chromosomally abnormal. In fact, the vast majority of human embryos, whether from fertile or infertile couples, are chromosomally abnormal. That is why even fertile couples have only a 15% to 20% chance per month of conceiving. Humans are unlike all other animals in this regard. Most of our embryos have an abnormal number of chromosomes, and are not compatible with life. They will either never implant and produce a pregnancy, or they will implant, produce a pregnancy, but then “miscarry” in the first three months, or just become a “chemical pregnancy.”

When IVF is performed, classically we try to decide which embryos are normal by looking at their appearance under the microscope. But we can’t be sure. That is why we replace 3 embryos (or more sometimes). We just don’t know which ones, if any, can develop into a baby. “PGD” is a means to genetically analyze a single cell from an 8-cell embryo in order to determine more accurately if it is normal.


The benefits of PGD in most infertile couples are:


To reduce the number of embryos that have to be replaced so as to reduce the risk of triplets or quadruplets.
To possibly increase the pregnancy rate by determining more accurately which embryos to implant in the woman, which to freeze, and which to discard as non-viable.
To dramatically reduce the risk of miscarriage.
To better counsel patients who do not produce any normal embryos (who might need thereby to consider donor eggs so that they don’t waste time, emotion, and energy on multiple cycles that fail to produce a viable pregnancy.)
To encourage couples who have failed to get pregnant, but whose embryos are “chromosomally normal.“
PGD can be used to reduce the risk that an embryo with Down’s syndrome would be transferred. Also, it means parents who are specifically carriers of severe genetic diseases like cystic fibrosis, muscular dystrophy, sickle cell anemia, Tay-Sachs, Marfan’s, etc. may be able to avoid having children with these heartbreaking genetic diseases. But the most common reason for PGD is for infertile couples to improve the selection of embryos most likely to lead to a viable pregnancy.






II. WHAT IS EMBRYO BIOPSY?

When an embryo reaches the third day of development, it normally has eight cells (see Figure 1). One or two of these cells, called “blastomeres,” can be removed from the embryo with the same sort of micromanipulation technique that is used for ICSI, and the embryo will be unharmed, and can go on to develop just as though this one cell were never removed. Every cell of the embryo at the eight-cell stage is genetically identical to every other cell, and any group of those cells will develop normally on their own because they have the complete genetic potential to develop into a normal embryo. You are not removing any genetic material that is necessary for the complete and normal expression of that embryo’s genes if you take out a single cell at this stage. You can then subject those one or two cells to genetic analysis, and know thereby the genetic composition of the embryos. These genetic tests can be performed within a day, giving plenty of time to decide which embryos to transfer back to the patient and which embryos not to transfer.

The embryo is held in a holding pipette much the same as for an ICSI procedure. A very narrow micropipette is then used to drill a hole through the zona pellucida, using an acid-type solution. This has been demonstrated not to damage the embryo. Then a larger micropipette is inserted through the hole in the zona pellucida, and a blastomere (cell) from each of the embryos is gently sucked and teased away. These blastomeres that have now been removed from the embryo can be tested genetically. Their genetic complement is indicative of the genetic composition of the remaining six to seven cells.






Chromosomes

These 6 billion DNA “letters” are located on forty-six chromosomes, which are coiled up inside the nucleus of every single cell in your body and are divided into twenty-three pairs, twenty-two “autosomal” pairs and one “sex” chromosome pair. The sex chromosomes are the “X” and the “Y” chromosome. Every female has two X chromosomes, and every male has an X and a Y chromosome. The reason these are called the “sex chromosomes” is that these chromosomes determine whether a child will be a boy or a girl. The child who has two X chromosomes will be a girl, and one with one Y chromosome and one X chromosome will be a boy. There are other genetic traits located on the sex chromosomes, most specifically on the X, for example those for blood clotting and for muscle development.


IV. GENETICS OF GETTING PREGNANT

For conception to occur, twenty-three chromosomes from the husband’s set of forty-six, and twenty-three chromosomes from the wife’s set of forty-six, must meet at the moment of fertilization and become an embryo with a new normal set of forty-six chromosomes. The process whereby primitive sperm cells and primitive eggs lose half of their chromosome number as they become sperm and mature eggs ready for fertilization is called “reduction division,” or to be more technical, “meiosis.”


The testicle is continually making sperm at a fantastic rate, up to 100 million to 200 million per day. However, no new eggs are made during a woman’s lifetime. She simply ovulates the eggs she was born with. Because she is not making new eggs, the eggs she does have go through a process of aging, with every year she is alive. This aging process of eggs makes it harder for them to undergo the meiotic reduction division process that results in a separation of the chromosomes from the normal adult component of forty-six to twenty-three that are necessary to make the egg fertilizable.

This process gets to be more and more difficult for the eggs the older they get, and that is why the eggs from older women are less likely to result in a viable embyro. That is also why older women are more infertile than younger women, and why older women have higher rates of miscarriage and of babies with abnormalities such as Down’s syndrome. In men, however, because fresh sperm are made daily, there is no aging process and, therefore, a man does not lose his fertility as he gets older, the sperm do not lose their fertilizing potential as he gets older, and having babies at his older age does not significantly increase his wife’s risk of miscarriage or Down’s syndrome.

If there is an error in division of the egg’s chromosomes and one of the pairs of chromosomes fails to separate, then the egg will have twenty-four chromosomes instead of twenty-three. In Down’s syndrome, the baby has a total of forty-seven chromosomes instead of forty-six because it has three sets of chromosome 21 instead of the normal two sets. This is because during the reduction division process in the egg, the chromosome 21 failed to separate even though all of the other chromosomes did separate. This kind of a chromosome error, in which one of the chromosomes has three copies instead of the proper two copies, is called “trisomy.” All of these chromosomal errors, including trisomies, monosomies, and various combinations can occur in virtually any of the chromosomes, and these errors are called “aneuploidy.”


Meiosis of the eggs is such a fragile process that actually the majority of human embryos are chromosomally abnormal. Most of these chromosomal defects that occur in the majority of human embryos are lethal and result in either failure of the embryo to implant, or result in a miscarriage. Miscarriage in the first three months of pregnancy usually occurs because of one of these chromosomal defects. Only occasional chromosomal defects (such as trisomy 21, or Down’s syndrome) result in the actual birth of an abnormal baby. Most chromosomal defects are lethal, and there is either no pregnancy or an early miscarriage.


Nothing about in vitro fertilization (IVF) or ICSI, increases the risk of these chromosomal abnormalities. It is simply the result of the aging of the woman’s eggs (which becomes more dramatic in her thirties) or severe sperm defects, which causes this problem, resulting in increased miscarriage rate, increased infertility, and a very slightly increased risk of abnormal children.


V. WHO SHOULD HAVE PGD?

Ideally, if we could test for every single chromosome, cheaply and easily, then every IVF cycle should include PGD. However since this technology is not cheap, and we can only test for the major nine (out of 24) chromosomes that affect embryo viability, we limit our recommendation for PGD to the following couples in which it is most indicated.

Older women with previous miscarriage or previous failure to become
pregnant with IVF
Women with recurrent miscarriages
Any couples with repeated failure to get pregnant with properly performed
IVF cycles
Couples in whom the man’s sperm production is so low that we have to
operate on the testis to retrieve sperm for IVF
These are all cases in which a better selection of the chromosomally “normal” (5 to 9 chromosomes) embryos should lead to better embryo selection for transfer, a lower miscarriage rate, and more intelligent counseling for those who fail to get pregnant. Logically, it just avoids the problem (which good IVF centers perform daily) of inadvertently transferring abnormal embryos back into the woman, while freezing the normal ones, because they all “appear” similar. PGD is not mandatory in any IVF cycle, but it should be considered in these special cases.
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Taryn

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lgrimaldi


Re: Welcome to the IVF board and hints...

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This info was supplied by poster T Rose- thanks girl

Info on beta's- charts!

www.advancedfertility.com/earlypre.htm

www.betabase.info/showBasicChart.php?type=single

Lisa (lgrimaldi) HOST of the IVF Board

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lgrimaldi


Re: Welcome to the IVF board and hints...

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This info is from our poster Marian

I stole this from another board. I thought some of you may be interested in reading about this! I was! Your clinic may do things a little differently (i.e. my clinic had a 1-5 grading system) but it has the basics.


Science Pulse How Embryos Make the Grade


Patients are often awestruck when they see a photo of their embryos for the first time on the morning of their transfer. That morning each embryo is carefully observed under a powerful microscope and the information about the quality of the individual embryos is given to patients prior to their transfer. There are three pieces of evaluative information patients receive about each of their embryos: the number of pro-nuclei, the number of cells present and the grade of the embryo. Using this information, decisions are then made about how many embryos to transfer and how many to freeze, and importantly, what to do with embryos that are not developing very well.
For the most part, the process of gauging the quality of an embryo involves a lot more than what meets the eye. Embryo evaluation, a standard practice in fertility clinics worldwide, allows PFC embryologists to provide you and your physician with valuable information about your embryos, and about your fertility.

When eggs are retrieved from a patient's ovaries, they are surrounded by thousands of helper cells that prevent us from seeing eggs directly or making any comments about quality. For patients having ICSI (Intra-Cytoplasmic Sperm Injection), we strip away the helper cells, but even then, very little information on quality can be ascertained. Only when eggs are of particularly poor quality are we able to observe obvious differences from healthy eggs. The vast majority of eggs do not show any characteristics to indicate quality. Therefore, the embryologist will not typically convey any information about egg quality.

For most patients, about 70% of their eggs will fertilize, regardless of egg quality (see Fertility Flash Vol 3 Issue 3 for more details). And fertilization is not necessarily an indication of things to come. A high rate of fertilization does not suggest better embryo quality.

The first step in embryo evaluation is examining fertilized eggs for the presence of two pro-nuclei (PN) in their centers. Each of these pro-nuclei contain the DNA from one parent, and in 95% of fertilized eggs they are unremarkable. In a small number of fertilized eggs however, we do see nuclear abnormalities such as asymmetry of size, any number other than 2, or failure to align in the egg center. These unusual abnormalities do suggest abnormal embryos, and we make patients aware of these. Each embryo will be noted for its number of pro-nuclei, e.g. 2PN or 3PN.

All of the fertilized eggs or embryos are kept in the laboratory for a minimum of 48 hours prior to the embryo transfer procedure. Only eggs that are grossly abnormal, such as those fertilized by more than one sperm, are discarded. Even eggs in which we see no evidence of fertilization are kept in case they fertilize late. No further observations are made until close to the time of transfer as the embryos must be left undisturbed in the laboratory incubator.

While incubating, the fertilized egg begins to divide. This first round of cell division happens within 12 hours of fertilization and thereafter, the cells in the embryo divide in two about every 16 hours. This continuous process of cell division is a very important indicator of embryo health as the embryos have only 4 to 5 days to make enough cells for implantation in the uterus. When we look at the embryos on their third day of life, we expect to see about 8 cells. Many embryos will have close to this number, and some will even have more, but embryos that are significantly delayed with 4 cells or fewer will have very little chance of establishing a pregnancy. Counting the number of cells in an embryo is the most important part of assessing their quality. (Article continued on back) We will give patients this cell count for each of their embryos.

A much less important aspect of determining quality involves observing the integrity of the cells. Some embryos will have uneven or asymmetrical cells and some will have one or more cells that are disintegrating. Cellular fragments that result from this disintegration are only an indicator of quality when they are severe, or when most or all of the embryo has broken up. Fragmentation is a normal feature in embryos and only about 20% of embryos have no fragments at all. However, the absence of fragments does not guarantee pregnancy as there are many other factors involved in embryo quality.

This degree of fragmentation and cell asymmetry is given as a grade, usually 1, 2 or 3. Grade 1 embryos look beautiful and normal in every way. Grade 2 embryos will have a small degree of fragmentation and or unevenness, but are still considered high quality. Only if an embryo is in real trouble and has more fragments than cells, will we assign the dreaded Grade 3. These embryos very rarely implant after transfer and are not considered viable enough to freeze regardless of how many cells they contain.

While cell number is a very important predictor of embryo quality, grade is mostly most useful in deciding which embryos to transfer or freeze. Grade allows us to rank embryos when there are several embryos with the same cell number, and grade is only loosely associated with quality. Embryos that are given a poor grade are unlikely to implant after transfer, but other factors are much more important in establishing a pregnancy. A patient's age for example is the best predictor of pregnancy, regardless of embryo grade. Also there is no correlation between embryo grade and genetic status. Genetically abnormal embryos are just as likely to be Grade 1 as genetically normal embryos. Moreover, a pregnancy from a Grade 3 embryo has no more increased risk of birth defects than a pregnancy from a Grade 1 embryo.


Lisa (lgrimaldi)
HOST of IVF Board

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From our ivf poster Nicole:

Hi all,

Found this great detailed link on the different phases of the IVF process and wanted to share:

http://www.ivfconnections.com/questions.htm

I know when I first started I was a bit confused about the different stages so this might help some others.

Nicole

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From our IVF Poster Mollyjp (Molly)

Embryo Glue Information/Links

http://www.zanderivf.com/zivf/gill/embryoglue.asp

http://www.infertilitydoctor.com/fe...e2.htm#content1

http://www.vitrolife.com/fertility/...1BD1FE2E02A2C73

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I found this link and thought it had some great tips and info

http://www.fertilityplus.org/faq/ivfhints.html

IVF DUE DATE Calculator found by our regular poster: meriandbob

http://www.ivf.ca/calcu.htm

From our poster (deeceetoo) A Must read for ANY ivfer!!!

http://abclocal.go.com/kgo/story?sec...t_7&id=4149246

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Here are some abberviations from the IUI Board and most are used here:

2WW: Two-week wait (until you can take a pregnancy test)
AF: Aunt Flo(w), your period (menses)
AO: Annovulatory
BA: Baby Aspirin
Babydust: Fairy dust, good luck getting pregnant
BB's: Breasts
BC: Birth Control
BCP: Birth Control Pills
BBT: Basal Body Temperature
BD: Baby dance, sex
BFN: Big Fat Negative (test result)
BFP: Big Fat Positive (test result)
BIL: Brother-in-Law
BMS: Baby-making sex
BTDT: Been There Done That
BTW: By The Way
BW or B/W: Blood Work
CB: Cycle Buddy (someone who shares the same menstrual cycle/ovulation dates)
CD: Cycle day
CF: Cervical fluid
CL: Corpus luteum
CM: Cervical mucus
CP: Cervical position
CY: Cycle
D&C: Dilation & Curretage
DD: Dear/Darling Daughter
D&E: Dilation & Evacuation
DH: Dear/Darling Husband
DI: Donor Insemination
DPO: Days past ovulation
DS: Dear/Darling Son
DTD: Doing the dance, sex
DW: Dear/Darling Wife
E2: Estradiol
EDD: Estimated Due Date
EPT: Early Pregnancy Test
ET: Embryo Transfer
EWCM: Eggwhite cervical mucus
FET: Frozen Embryo Transfer
FF: Fertililty Friend
FIL: Father-in-Law
FM: Fertility Monitor
FMU: First morning urine
FP: Follicular Phase
FRE: First Response Early
FSH: Follicel Stimulating Hormone
GF: Girlfriend
hCG: Human Chorionic Gonadotropin (pregnancy hormone)
H&H: Happy and Healthy
HPT: Home Pregnancy Test
HSC: Hysteroscopy
HSG: Hysterosalpingogram
ICSI: Intra-Cytoplasmic Sperm Injection
IF: Infertility
IM: Intramuscular
IMO: In My Opinion
IUI: Intra-uterine Insemination
IVF: In Vitro Fertilization
IYKWIM: If You Know What I Mean
KWIM: Know What I Mean
LAP: Laparoscopy
LH: luteinizing hormone
LMP: Last Menstrual Period
LP: Luteal phase
LOL: Laugh Out Loud
LP: Luteal Phase
LPD: Luteal Phase Defect
MC: Miscarriage
MF: Male Factor
MS: Morning Sickness
NP: Nurse Practitioner
O: Ovulation
OB: Obstetrician
OB/GYN: Obstetrician/Gynecologist
OC: Oral Contraceptives
OHSS: Ovarian Hyperstimulation Syndrome
OMG: Oh My Gosh
OPK: Ovulation Predictor Kit
OT: Off Topic
OTC: Over-the-counter
P4: Progesterone
PC: Post-Coital
PCOS (POS): Polycystic Ovarian Syndrome
PCP: Primary Care Physician
PCT: Post-Coital Test
PG: Pregnancy, pregnant
PID: Pelvic Inflammatory Disease
PIO: Progesterone In Oil
PMS: Premenstrual Syndrome
POAS: Pee On A Stick
RE: Reproductive Endocrinologist (Infertility Specialist)
S/A: Sperm/semen analysis
SAHD: Stay At Home Dad
SAHM: Stay At Home Mom
SHG: Sonohysterogram
SIL: Sister-in-Law
SO: Significant Other
SonoHSG: Sonohysterogram
STD: Sexually Transmitted Disease
TCOYF: Taking Charge of Your Fertility (book)
TIA: Thanks in advance
TL: Tubal Ligation
TMI: To Much Information
TR: Tubal Reversal
TRH: Thyroid Releasing Hormone
TSH: Thyroid Stimulating Hormone
TTC: Trying to conceive
TTYL: Talk To Ya Later
US or u/s: Ultrasound
UTI: Urinary Tract Infection
V: Vasectomy
VR: Vasectomy Reversal
WNL: Within Normal Limits
WTG: Way To Go

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In the Sept. 2006 issue of Prevention Magazine:

Here are 2 articles I found in my Prevention Magazine (Sept.) I'll type the main parts, but sounds like good info:

IVF: A Litlle needling Helps

This study compares women who had acupunture to those who had none here are the results:

German researchers found that the pregnancy rate among women who got acupunture immediately after embryo transfer and again 3 days after had a 18% greater rate in those who did not. Danish scientist reported that women who had acupuncture immediately before and after ET had a 13% higher pregnancy rate then those who had none. Finally, Australian doctors discovered that women who had acupuncture several days before ET, as well as immediately before and after it had an 8% higher pregnancy rate then those w/ no treatment.

But the Danish study raised a red flag. It included a group of women who got needled on the day of ET and again 2 days later-and these women were slightly more likely to miscarry than those w/ no treatment. One possible explanation: Acupuncture may have leped so much that boderline embryos implanted but eventually stopped developing or the increase could have been a fluke. Doctors are still investigating the proper number and timing of acupuncture treatments for IVF. BOTTOM line: Acupuncture at the time of ET seems safe and appears to help.

Next story:

Pregnant or trying? Bre-e-eathe

Women have longed worried that stress could increase thier risk of miscarriage. Now, the first study to look at stress and early pregnancy loss shows a connection. Researchers found women with high levels of the stress hormone cortisol were nearly 3x as likely to miscarry as women w/ normal levels.

Pablo A Nepomnaschy, PhD, a postdoctoral fellow at the National institutes of Health, measured cortisol in 61 Guatemalan women 3x a week for a year. Of the 22 pregnancies that occured, 13 ended in miscarriage. In pregnancies where the mother's cortisol was higher than normal, 90% ended in miscarriage. But only 33% of pregnancies were lost when levels were normal.

The likely reason, he says, is that too much cortisol suppresses production of progesterone, a hormone that helps sustain pregnancy.

Although you can't control all challenges and some stress is unavoidable, do whatever you can to eliminate pressure points from your life when you are ttc.

This last article is great. I can see that. I stopped stressing about ttc then got a month later after years of ttc. (I had meds to help btw, but meds I had taken before w/ no luck) could have been a fluke but maybe me stressing hurt me??

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Great info from our regular poster 2moms2be:

http://www.givf.com/library/whatisyoursuccessrate1.cfm

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