IVF Cycle Guide: Introduction to In-Vitro Fertilization

1. QUICK START: Introduction to IVF

2. Introduction to In-Vitro Fertilization (IVF) Cycle Congratulations on your cycle start! Everyone at RMA wishes you success. • In Vitro Fertilization Introduction • Stimulation & Trigger • Oocyte Retrieval • Embryology & Transfer

3. Introduction to In-Vitro Fertilization (IVF) Cycle Embryology & Transfer In Vivo • In Vitro Fertilization Introduction • Stimulation & Trigger • Oocyte Retrieval In Vitro

4. Introduction to In-Vitro Fertilization (IVF) Cycle • In Vitro Fertilization, or IVF involves bringing sperm and egg together in a laboratory dish. • Embryos are made and the best embryos are used to help couples conceive. • In Vitro Fertilization Introduction

5. Introduction to In-Vitro Fertilization (IVF) Cycle • Reasons for IVF: • Tubal factor • Severe Male Factor • Endometriosis • Ovulatory dysfunction • Ovarian failure • Diminished ovarian reserve • Fertility preservation • Unexplained infertility

6. Introduction to In-Vitro Fertilization (IVF) Cycle Please confirm the following is complete prior to starting your IVF cycle: • Checklist Blood Work • Consents are signed • Cleared by Finance • Cycle medications from specialty pharmacy

7. Introduction to In-Vitro Fertilization (IVF) Cycle There are many IVF protocols which are tailored to each patient specific diagnosis, age, diagnosis and prior responses to stimulation medications. Your physician may prescribe estrogen pills or birth control pills for pre- treatment prior. These medications help to synchronize your follicles prior to starting your stimulation injections. • Oocyte Retrieval • Embryology & Transfer • Stimulation & Trigger • Introduction

8. Introduction to In-Vitro Fertilization (IVF) Cycle Injection Training • Take the time to watch RMA’s injection training videos • Hormonal injections are administered for 8 to 12 days in order to grow the ovarian follicles and allow the eggs to mature • Expect to administer approximately 2-4 injections daily *Ask your nurse what injections your physician will be prescribing. Click here to view our Injectable Medication Training Videos

9. Introduction to In-Vitro Fertilization (IVF) Cycle • Frequent ultrasounds and blood work will be needed every 1 to 3 days through this time to monitor progress. • Your Nurse will call you with results and medication instructions by 7pm. • Please only page if you have not received a call by 7pm

10. Introduction to In-Vitro Fertilization (IVF) Cycle –Morning Monitoring

11. Introduction to In-Vitro Fertilization (IVF) Cycle Injections Ultrasounds Blood work

12. Introduction to In-Vitro Fertilization (IVF) Cycle • Trigger Injection • Novarel/Pregnyl/Ovidrel/Lupron Trigger • Stimulate ovulation (releasing of eggs) • ***Time specific injection • Retrieval 36 hrs. later (i.e. 7pm trigger time on Monday results in 7am egg retrieval on Wednesday) • Egg Retrievals take place in our Basking Ridge office

13. Introduction to In-Vitro Fertilization (IVF) Cycle Day of Egg Retrieval: • Nothing to eat or drink after midnight the day prior to retrieval • Partners are not allowed in the Operating Room • No children allowed • You will not be able to drive day of retrieval. A responsible adult must accompany you home. • Embryology & Transfer • Oocyte Retrieval • Stimulation & Trigger • Introduction

14. Introduction to In-Vitro Fertilization (IVF) Cycle Male Partner (if applicable) • 2-5 days of abstinence if producing a fresh semen specimen on the day of oocyte retrieval

15. Introduction to In-Vitro Fertilization (IVF) Cycle Egg retrievals are performed approximately 36 hours after the scheduled trigger injection.

16. What to Expect on the Day of Your Egg Retrieval • IV Sedation • Egg retrievals are an ultrasound guided procedure, which takes approximately 10-20 minutes • Learn how many eggs are retrieved that day

17. Introduction to In-Vitro Fertilization (IVF) Cycle Night of the Procedure Call the office if you experience: • Temperature above 101 • Persistent nausea or vomiting • Severe abdominal pain or swelling • Heavy vaginal bleeding • Shortness of breath • Fainting • Pain, burning, redness and or swelling in area around IV site Vaginal spotting and/or mild abdominal cramping may occur and is normal.

18. Introduction to In-Vitro Fertilization (IVF) Cycle • Embryology • Oocyte Retrieval • Stimulation & Trigger • Introduction The Next Day = Day 1 Fertilization Check

19. Introduction to In-Vitro Fertilization (IVF) Cycle - Embryology Day of Retrieval Day 1 Days 2, 3 & 4 Days 5, 6 & 7

20. Introduction to In-Vitro Fertilization (IVF) Cycle • The day after your egg retrieval, a nurse will call you with fertilization results or number of eggs we were able to freeze. • The next embryology update will be 7 days following your egg retrieval with how many embryos were available to freeze.

21. Introduction to In-Vitro Fertilization (IVF) Cycle Post Egg Retrieval • Please call your nurse with day 1 of your period following your egg retrieval • If your treatment plan involves screening your embryos for chromosomal abnormalities please expect results in approximately 2 weeks from the day of embryo biopsy.

22. Introduction to In-Vitro Fertilization (IVF) Cycle Please contact yournurse with any questions or concerns.