The following information relates to the first phase of IVF treatment.

Hormonal Support after the Embryo Transfer

On the day of embryo transfer, you will be given a letter which will explain further essential hormonal support in the second half of your cycle. Firstly this helps your uterus prepare for the embryos better. Secondly we know that without any support, some women will bleed too early after an embryo transfer and before the embryo implantation has declared itself in the form of hormonal signals. Hence medication is given after the egg collection or embryo transfer to ensure that premature bleeding does not occur and that you have the best chance of maintaining an embryo implantation.

This support can be given in several ways and clinicians as well as patients can have their preferences:

Progesterone pessaries (Uterogestan or Cyclogest):

These are given in the dose of 200 mgms, 6 hrly or four times every 24 hours. They can also be used rectally as a suppository.
Advantages: Apart from the inconvenience of frequent vaginal and rectal administration, it is painless and easy to administer.

Disadvantages:

  1. The medication can flow out of the vagina or the rectum and hence not have the full benefit.
  2. The absorption of the hormone from the vaginal skin into your body can also vary between patients.
  3. Some patients may thus experience premature bleeding despite this support.
  4. Occasionally women can develop an allergic reaction to progesterone in the form of urticaria or skin rashes and sometimes the allergy can be severe.

Progesterone Injections (Gestone or Prontogest):

This is a daily intramuscular injection of progesterone.

Advantages:

  1. For some once daily administration is an advantage.
  2. It also ensures that premature bleeding does not occur. In fact most women would not have had bleeding until we do the pregnancy test 14-16 days after the embryo transfer.
  3. We have an unpublished observation that it provides some protection against the risk of OHSS. This has not been scientifically tested and hence we are conducting a prospective trial.

Disadvantages:

  1. This is a painful injection and causes local discomfort. We advise you to rotate sites of injection in order to ensure that no one site becomes excessively inflamed.
  2. Occasionally women can develop an allergic reaction to progesterone in the form of urticaria or skin rashes and sometimes the allergy can be severe.
  3. When you become pregnant, we continue this support in early pregnancy until placenta is well established in the uterus (normally at 9-10 weeks gestation).

Human Chorionic Gonadotrophin (Pregnyl, Gonasi, Ovitrelle):

This is a very potent hormone injection. One Injection is given on the day of embryo transfer and another is given three days later.

Advantages:

  1. It ensures that premature bleeding does not occur and there is no need for continued support in early pregnancy.
  2. There are only two injections and no other medication is needed during the 2nd half neither of the cycle nor in early pregnancy.
  3. There are no incidences of allergies.
  4. When given to all patients, this has been associated with an increased risk of ovarian hyperstimulation OHSS). NICE recommends that it should not be used.

The Pregnancy Test

When to come?

The pregnancy test

The pregnancy test

You are asked to come to TLCRM, 14 to 16 days after the embryo transfer for a pregnancy test, irrespective of whether you have menstruated or not. This involves you bringing an early morning urine sample. If this test is positive then we will ask you to return to us 2 or 3 weeks later for an ultrasound scan.We obviously hope that every patient will become pregnant but in reality 55-70% patients depending on your age group do not conceive. You will understandably feel a sense of grief in the event of failure. Please do not hesitate to ask for help in the form of counselling support with our psychologists. We will also arrange a review consultation after the completion of each treatment cycle. At this time we will have an opportunity to discuss those factors that may have become apparent during your treatment and consequently may require modification in further attempts.

Common causes of failure

These are as follows:

  1. Failure to recruit optimum number of follicles with or without poor hormone levels.
  2. Premature release of the eggs (very uncommon)
  3. Unexpected illness in either of the partners.
  4. Failure to Fertilise: This may be due to defective sperm, low number of sperm, functional abnormalities of the sperm, unknown technical failure and infection in the seminal sample (uncommon).
  5. Failure of Cleavage: Occasionally fertilised eggs fail to divide and continue their development. Not all fertilised eggs will cleave to form embryos.

Although these are common causes of failure, sometimes failure also occurs even when everything has apparently gone well. Sometimes we may not have an explanation for why a pregnancy fails to occur. Mostly in these cases the embryos have failed to maintain their growth and development because of indigenous, not necessarily repetitive genetic abnormalities. We know that the risk of genetic abnormalities in naturally formed embryos and In normal couples is nearly 50%. Embryos created in IVF cycles have the same incidence overall but this risk exponentially increases with age and is substantially increased in women at or above the age of 40 years. Most genetically abnormal embryos fail to implant, maintain growth to become pregnancies or may miscarry after a positive test. In this situation usually the prognosis for future attempts is good and we will discuss any specific predisposing factors that you may have. We may consider the removal of hydrosalpinges (swollen tubes), endometrial polyps or fibroids (if present) in some cases before repeating the treatment cycle.