Long Protocol Pre-Treatment Investigations include:
CBC, Urine R/M, Sugar PP, HIV, HBsAg,
Day 2 FSH,LH. T3,T4,TSH,TPO, Prolactin
Semen analysis, Sugar, HIV… one semen sample is tested and cryopreserved as a backup sample.
Antichlamydial treatment like cap azotic 500 mg on empty stomach to both partners is given.
Day 2 of the IVF/ICSI cycle wife is started on Tab Yasmin once at night after dinner for 21 days, this tab may cause acidity like symptoms then one may take tab acidic or Gomez.
On 17 the day of the IVF/ICSI cycle down-regulation of a pituitary-ovarian axis is started using Inj Lupride 20 units subcutaneously with 40 units/ ml insulin syringe to taken every morning by 11 am.
The inj phial needs to be stored in the chiller tray of the refrigerator. Generally, one inj phial of 4 ml lasts for 7 to 8 days [depending on the spillage during administration].
Wife will complete Yasmin tabs by 5 the day of inj but do not stop injections till she gets menses. Even on day 1 of menses, she takes the lupride injection.
On day 2 of menses please do sir E2, LH in the morning the report will be available by 3 pm and then meet the doctor who will scan you to evaluate the thinness of endometrium.[ should be less than 5 mm thick ]
Downregulation Confirmation Endo < 5mm, E2 < 50 pg, LH < 5 miu.
Ovarian stimulation started with inj HMG / FSH 225 to 450 iu every day and continue lupride at 10 iu dose by insulin syringe.
After 5 days of stimulation scan on day 7 of menses for recruitment of follicles and triple line endometrium though< than 5 mm.
Stimulation continued …day 9 ser e2 level in the morning meet doctor in the evening
Commonly one needs 9 – 12 days of stimulation.
Once > three follicles are 18 mm diameter we give inj HCG 10000 iu and oocyte pick up is planned 34 hrs later.
Oocyte pick-up generally did in the morning hrs … done under GA … 15 – 30 min procedure…you are admitted for ½ a day.
After pick up you can have water after 2 hrs and coffee after 3 hrs.
Husband’s semen is freshly obtained and sent to lab for further processing
Lab work for IVF/ICSI Long Protocol:
- Semen preparation
- Oocyte denuding if IVF/ICSI.
- Insemination if IVF / Injecting sperms if ICSI … 2 – 3 hrs after pick up.
- Monitoring embryo development and accessing their growth grading them etc done by embryologist you can call upon him to know the progress.
- Once 6 cellar stage is ready embryos are ready for transfer/freezing/vitrification.
- All the above options will discuss with you before deciding to start the long protocol procedure.
- Plan Embryo transfer.
- Luteal support like progesterone vaginal pessary for 14 days followed by Ser beta-HCG testing.
- Luteal support may include steroids, eco sprin’, folic acid, B-complex, margin. Heparin etc which shall be discussed with you.