Monitoring (IVF) Note Page1

Transcription

1 Monitoring (IVF) Note Page1 IVF Monitoring Note; Baseline Cycle Day Ovum donor Recipient MOCK EMBRYO TRANSFER: anteverted neutral retroverted Depth (cm): Note: Luteal Lupron Microdose Lupron Antagonist Clear to start COH/IVF (await E2, if indicated) Postpone Start Recipient: clear to start when donor is ready TVUS: Total # Follicles: Endometrium (mm): Assessment: Plan: progressing as expected poor response Comment: check E2 continue medications, follow-up E2/US tomorrow continue medications, follow-up E2/US two days continue medications, follow-up E2/US three days coast, continue lupron, follow-up tomorrow for E2 reduce medication dose to: follow-up E2/US tomorrow follow-up E2/US two days Increase dose: check LH Ovidrel/hCG this PM for ER 36 hours thereafter Recipient is ready, await donor times convert to IUI cancel cycle Comment: EMBRYOLOGY PLANS ICSI 100 percent ICSI 50 percent ICSI (other percent): standard insemination Plan AH with Day 3 ET Plan Day 3 ET

2 Monitoring (IVF) Note Page2 Plan Day 5 ET Goal is to transfer # embryos. Transfer no more than # of embryos: Transfer exactly # of embryos: Patient WILL NOT reduce Patient will reduce, if necessary Topics Discussed: OHSS - reviewed symptoms/side effects including bloating, abdominal pain, N/V/D, ascites, wt gain, SOB, oliguria, th advised of options to: cancel the cycle coast to a lower estradiol level with possible loss of some of the oocytes and/or a decrea proceed to the ER with possible cryopreservation of all embryos (i.e. no transfer) transfer of a single embryo (if symptoms not significant by that tim transfer of more than one embryo pending assessment of sympto Patient elects to: cancel the cycle coast continue with the cycle and proceed to ER Day 5 vs. Day 3 Embryo Transfer - discussed general recommendation for a day 5 transfer when there are more than three high quality embry advised that embryos are not better off transferred on day 3 or on day 5 but that the adva discussed general recommendations for # of embryos to transfer relative to the woman < 35: two or three day 3 embryos or one or two blastocysts 35-37: two or three day 3 embryos or two blastocysts 38-40: three or four day 3 embryos or two or three blastocysts >40: four to six day 3 embryos (rarely are these patients eligible fo Endometrium - discussed our limited ability to evaluate the endometrium and its adequacy for implantati advised we prefer to see the lining at or great than 8 mm in thickness and in a trilaminar c advised that we have seen pregnancies with linings of 6-7 mm advised that implantation is likely to be impaired with linings less than 6 mm Multifetal Gestation - discussed multiple gestation rate of 30 to 35% in IVF patients (large majority are twins) advised that most multiples are due to implantation of multiple fraternal embryos; < 5% due to embryo split advised that transferring more embryos may increase the odds for pregnancy but may also increase the ris discussed potential complications with multiple gestation including premature labor/birth and increased inc briefly discussed selective reduction of pregnancy and risks including bleeding, infection, and loss of entir Assisted Hatching - advised that oocyte has a shell around it called the zona pellucida the sperm penetrates the shell in the process of fertilizing the egg the early embryo develops inside the shell and must hatch prior to implantation into the uterine wall AH is a procedure (performed by a laser) that produces a weak spot in the zona pellucida and may facilitate AH may increase the odds of implantation/pregnancy in some women including those with: thickened zona

3 Monitoring (IVF) Note Page3 Poor Response - discussed next stimulation cycle with MDL and an increase dose of medication; advised we cannot guarant given the current stimulation is already an aggressive one, a future stimulation may not yield any larger num

4 Monitoring (IVF) Note Page4

5 Monitoring (IVF) Note Page5 ain, SOB, oliguria, thrombosis, and worsening with pregnancy ytes and/or a decrease in their quality er) ignificant by that time) sessment of symptoms at that time high quality embryos on day 3 y 5 but that the advantage lies in the choice of embryos to transfer if there are many good embryos available for transfer ative to the woman's age: o blastocysts ocysts hree blastocysts e patients eligible for blastocyst transfer) quacy for implantation and in a trilaminar configuration n 6 mm due to embryo splitting also increase the risk for a multpile h and increased incidence of HTN, DM, preeclampsia and C/S delivery on, and loss of entire pregnancy uterine wall a and may facilitate the process of hatching th: thickened zona pellucidas, age equal to or greater than 38, high FSH levels

6 Monitoring (IVF) Note Page6 d we cannot guarantee an improved response yield any larger number of follicles/oocytes