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Thread: Curious about Assisted Conception?

  1. #1

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    Question Curious about Assisted Conception?

    Ever wondered what OI, IUI, ICSI mean?

    Think it's odd when the IVF ladies talk about being on the pill but to scared to ask why?

    Who has ever been curious about AC (assisted conception) but never been game enough to venture into the LT TTC forum to ask a question? I was before I started!! So here's the place to do it! Feel free to ask any questions you like, whether you are new to AC, considering it or even if you're just curious about the process. There's no big secret here, I'm more thn happy to answer questions, as most of the others would be too.



    Who's going to be first?!

  2. #2

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    just subscribing to this one Sarah - i've been asked a number of questions in live chat - happy to answer whatever questions anyone might have!

  3. #3

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    Same here. Those of us going through AC get so immersed in it that we forget that others don't speak the language or understand what we're talking about. Sometimes it seems that they are a bit intimidated by the strangeness to actually ask... Whether it's here or elsewhere, please ask! We're only too happy to answer.

    BW

  4. #4

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    Well... I'll start...
    I am actually really curious (but have never asked ) to know why some people have to go on the pill during IVF... And when...

    And actually another one (geeeez, being a member so long you'd think I'd know something, but embarassingly I don't) is what is all the different terms... like is IVF different to ICSI... what does that mean for the people doing IVF, does it mean different medications or transferring at different times or does it have to do with what the lab people do...?

    Hopefully this will help someone starting out with AC too.... but I am curious... I don't know a lot about IVF...

  5. #5
    slyder Guest

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    Hey Leasha,

    Here's my answers quickly, but others may wish to elaborate:

    - The pill is to regulate the menstrual cycle so that an AC cycle can commence at a certain time. At least in our case this is what happens.

    - IVF is where the best sperm and eggs are placed in the same dish and left to do their thing. ICSI is where the sperm is injected directly into the egg. This is done either because of the quality of the sperm (ie, limited motility, other defects) or where the egg is difficult to penetrate. Basically, IVF and ICSI run exactly the same except the meeting of the sperm and egg is different.

    Hope this helps

  6. #6
    paradise lost Guest

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    ME! I'm learning slowly, thanks to the kind patience of BG and BW, but i always have more questions... Shall i see what i know already...?

    OI - ovulation induction? Like with Clomid?
    IUI - inutero insemination? Where sperm is washed and then put straight into the uterus when ovulation (induced or natural? DO they do IUI with natural O?) is imminent to maximise chance of fertilisation?
    ICSI - don't know what the letters mean, but i think this is where the sperm is physically injected into the egg, rather than having to find its own way, a way to fertilise when the conditions in the uterus aren't brilliant or when the sperm count is low or the sperm quality means the little guys struggle to get into the egg?
    Varicocele - a varicose vein in the scrotum which can cause problems with sperm count/quality, i think because it can make the area too warm? Is that right?

    um...the Pill, is that so the FS can "get control" of a woman's cycle, so they can start with a hormonal flatline before the injections for an IVF cycle start?

    OH!

    IVF - invitro fertilisation - where the egg is taken out, fertilised and put back.
    Stim cycle - stimulation cycle? Where the woman goes through multiple injections to stimulate the ripening of hopefully lots of follicles rather than one or two, so they can be collected in...
    Egg collection - sounds dreadful from what has been mentioned (mentally hugs and applauds all the AC women who have been through this - you are incredible!) vaginal ultrasound and long needle used to collect eggs.
    OHSS - ovarian hyperstimulation syndrome, where the woman's body produces too many follicles and eggs which might or might not mature to the point they can be collected, the ovaries get very inflamed and the pelviv cavity fills with fluid - very painful and dagerous - potentially fatal? I get the impression diet and exercise can play a role for some but ultimately some women's bodies do this in response to the drugs no matter HOW careful they are?
    FET - frozen embryo transfer - where an embryo created in a stim cycle which was frozen is thawed and transferred into mummy?

    You can mark me on that - i probably need to do more homework!

    Things i'd LOVE to know more about:

    Some of the tests for infertility - there is one has been mentioned where dye was put through the tubes to see if they're clear/healthy? What is it called and how does it work?

    Also, BW and BG you have both mentioned a drug (possibly a pessary?) which is a nasty colour and put in after transfer or at least during a stim cycle? What is it for?

    What are the drugs used in a stim cycle? What are they called and what does each one do?

    Phew! Thanks so much for this thread guys, i am excited to know more!

    Bx

  7. #7

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    Yep, the pill is basically used to control the cycle so that things can begin at the whim of the clinic. For those of us who don't ovulate, it's to ensure that we actually DO have a cycle so we aren't waiting forever to be able to start things. The other option is to use a drug to force ovulation and create a natural cycle that way. I switch between the two depending on whether I need to manipulate timing or not.

    BW

  8. #8

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    Bec... I think on rare occassions they do an IUI procedure without OI... sometimes ovulation induction is done for convieniance... you know roundabouts when you're going to ovulate. Though for me, I didn't ovulate without it, so it was necessary. Plus you have that extra boost for egg and endometrium lining quality.
    If there were issues of hostile CM, but no ovulation issues, IUI might be done on an unmedicated cycle.

    Some of the tests for infertility - there is one has been mentioned where dye was put through the tubes to see if they're clear/healthy? What is it called and how does it work?
    This is a HSG... or (geez I'll have to google the long name!!!) hysterosalpingogram.
    You go into an xray clinic, and they insert a small catheter through your cervix and then squirt dye through the catheter and take xrays of the dye to see if it flows freely through both the tubes, and if there are any blackages. (A seemingly simple procedure, as long as you don't have a cervix that prefers to be closed constantly..... they used a screw to open my cervix... OUCHY!).
    They can also do a basic dye study while doing a lap, they don't use xrays they just look and see if the dye flows through.
    Last edited by Indadhanu; March 13th, 2008 at 08:32 AM. Reason: typo.... whoops!

  9. #9

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    Leasha - i'm the same as Slyders wife - i was only put on the pill for the purpose of forcing a visit from AF when the FS was good and ready for her (pity my body is more stubborn than the doctor and she was STILL late)

    it basically means they can get your body to fit in with the time frame that they need for introducing the drugs and things. for me, being a country bumpkin, there is only a one week window every 2 to 3 months when they can do any of the procedures, so it's key to bring everyone's cycles together

    just for anyone's reference, thought i'd add here what i've been through

    3 cycles of clomid for OI (ovulation induction) - all failed
    2 cycles of down reg and OI for IUI (insemination) - cancelled as my body didn't respond to the OI
    3 cycles of IUI (intrauterine insemination) - 2 BFN's, 1 Chemical Pregnancy
    1 full stimulated cycle of IVF - failed - BFN
    1 FET (frozen Embryo transfer) - BFN


    Bec - there are a couple of Luteal Phase support drugs that are sometimes used after a stim cycle or transfer - they are basically progesterone supplements that help stop AF arriving too soon. i've used both crinone gel and the pessaries. crinone is a white gel that is delivered in a tube, while the pessaries are a waxy pellet. both are inserted into the vagina as the progesterone take up from the meds is best through the walls of the vagina. some people have injections for LP support - have to go out and help DH in the garden - will come back, and if no one has answered, will answer after that!

  10. #10

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    The pessaries are to administer progesterone. When eggs are collected in an IVF cycle, they are sucked out before natural ovulation. Thus, no corpus luteum, no progesterone (or at least not enough) produced by the body - we need to get it artificially.

    More later - I have to shut down the laptop and switch rooms.

    BW

  11. #11
    paradise lost Guest

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    YES! Crinone! THAT's what i was thinking of!

    Of COURSE - i never thought of that (re: corpus luteum) - i had a corpus luteum cyst for months during PG (was 11cm across at 11wks, but never felt a thing).

    Thanks

    Bx

  12. #12

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    ICSI stands for Intra cytoplasmic sperm injection. Med-speak for injecting the sperm directly into the egg.

    To go a little further with it - it's possible for this process to actually damage the egg and thus form a dodgy embryo.

    To explain - Each egg has a polar body, which is where the excess genetic information is ejected during the formation of the egg, and a spindle, which is where the genetic information of the egg is located. The polar body can be seen with a regular microscope, but the spindle can't. In traditional ICSI, they assume the spindle is located directly underneath the polar body, and inject the egg in order to avoid that area. Problem is, not all spindles are located in such a place, and regular ICSI then damages the egg and the embryo will often fail to progress well.

    By using a microscope with a special polarised light source, they can see exactly where the spindle is located and avoid damaging it. Two thirds of mine are located in the wrong spot, which explains why we had much better results with the polscope (also known as extended ICSI), than without.

    BW
    Last edited by butterfly_warrior; March 13th, 2008 at 06:24 PM. Reason: Double checked my info

  13. #13

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    And in plainspeak, ICSI is an add-on treatment to IVF. So people having ICSI are also having IVF, but IVF does not have to include ICSI. Did I just make it more confusing? Lol!

  14. #14

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    What are the drugs used in a stim cycle? What are they called and what does each one do?
    ok - i'll list the ones i know - and how they work (as far as my understanding goes) - anyone else that wants to correct me, go for it!

    OCP/Pill - as mentioned before, it helps to get AF to visit when you need her to, and is the first step in a fully down regulated cycle. i get the feeling this tends to apply more to people that have something of a cycle of their own (however irregular), as they have natural production of hormones that the clinic don't want them to produce. the clinic likes to have full control over hormones being introduced to the body so as they can expect (well, hope for!) a specific response. it's also an additional step to ensure that no early, undetected pregnancy, is trying to take hold when other drugs, far more detrimental to a developing fetus, are introduced

    Synarel (nasal spray) or Lucrin (injections) - these are the drugs that basically shut your ovaries down before starting a stim cycle - as it was explained to me, the drugs basically put your ovaries into a drug-induced menopausal state. the clinic want your hormones (estrogen and progesterone) at non-existent levels (as they would be day 1 of AF) naturally, so that they can introduce the synthetic hormones in a controlled manner. These continue along until very close to egg pick-up or insemination as they also prevent the bodies ability to have a surge ot luteinising hormone (LH) - which is the hormone that naturally causes ovulation. for those of us that can't use these meds (or some that do, but need extra help to stop OHSS developing etc, they may use antagonist meds which i'll explain below)

    for some people, this step is excluded - this is what happens with me. i have relatively flat-lined hormones all the time - and when my body is forced into the menopausal state, my ovaries refuse to wake up again!

    Puregon or Gonal-F (injections) - for a lot of the drugs, there are two main manufacturers - so a lot of them have two names, but essentially the same action! these are an injection of follicle stimulating - basically it's used to encourage the development of a uterine lining, and, more importantly, the follicles on your ovaries. the hope is that each follicle would contain a nice little egg that is maturing nicely - unfortunately, that's not always the case - sometimes, a follicle will develop that contains only fluid - others will not mature enough to be a viable egg. the injections are administered daily, and the follicular development monitored. the aim is to get a number of dominant follicles that are large enough to include a mature egg.

    for some people, they have a nice number of healthy mature follicles that give them nice mature eggs - for others, particularly those of us unfortunate enough to have PCOS - this can be a very difficult tight rope to walk - need enough meds to encourage follicular development, but not so much as to overstimulate the ovaries and develop OHSS.

    Cetrotide/Orgalutron (injections) - these are the antagonist meds i mentioned earlier. for those of us who don't have the synarel or lucrin, these meds are injected after about a week of the stim drugs. basically, they're used to prevent the LH surge. you have them every 24 hours to stop the body naturally trying to ovulate. it helps to give the follicles the extra few days to develop nicely , the eggs to mature, and to stop ovulation occuring before the doctors want it to happen! for IVF in particular, the timing of ovulation is really important - without that level of control, ovulation may occur too early, or too late, and everything you've been through would be a waste of time!

    Pregnyl/Ovidril (injection) - this is the shot that "triggers" ovulation. it forces the LH surge, finalises the maturation of the egg, and, in IUI, it will allow the release of the egg. In IVF, it is used to force the maturation of the eggs, but before the eggs are released, they're collected (egg pick-up or EPU). in some cases, pregnyl (in particular, haven't heard of it with ovidrel) is used as a "booster" during the luteal phase. basically it's there to help you maintain the luteal phase long enough for the embryo to take hold before the progesterone levels drop off and AF arrives. as BW explained before, progesterone support is important as you don't have a corpus luteum after EPU to help keep the levels high enough to sustain a pregnancy

    Crinone or progesterone pessaries have been explained before...


    when you move onto FET's and the like, there are more options again. for some people, they ovulate naturally, so may need no additional meds - this happens more often when there is male-factor or unexplained infertility. some natural cycles the clinic will automatically use the progesterone support (crinone/pessaries/pregnyl). for others, drugs such as clomid are used to induce ovulation. for others again (like me) the drugs don't work to force ovulation, so i go into a fully medicated FET. Hormone Replacement Therapy (HRT) is often used by post-menopausal women to ensure they're hormone levels aren't too low - it can often be used to help treat the nasty side effects of menopause (hot flushes etc) - for IVF purposes, it's used to artificially create a uterine lining. basically HRT is an estrogen supplement, so it will help to develop a lining. after a certain amount of time, the thickness of the lining is checked to make sure it's dense enough to support an embryo. progesterone support is started on what the clinic will label as ovulation day (even though no O occurs) - then depending on the age of your embryo's (day 3, day 5 etc) - they'll be transferred when appropriate.


    hmmm, i think i've waffled enough - hope that helps!! anyone that wants to add to, or correct, anything i've said - feel free

    BG

  15. #15

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    If anyone had trouble with my gobbledygook ICSI/polscope information - it's all fixed and sensible now.

    BW

  16. #16

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    Great thread guys, well done!!

  17. #17

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    Quote Originally Posted by Kimnastics View Post
    There is a plasma-based solution (I think - BW/BG??) that is in with the eggs/sperm which makes conditions good for making embies.

    as far as i know, the sperm sample is "cleaned" to make sure they're in a friendly solution with no "debris" from when it was produced - and the eggs and sperm are placed together in a dish which i believe contains a medium that includes Human Serum Albumin (HSA) - not sure how it works - just know i had to sign something to say i was ok with it being used!

  18. #18
    slyder Guest

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    Quote Originally Posted by Kimnastics View Post
    I just wanted to clarify that in IVF without ICSI the sperm and the eggs are placed in a plastic dish with the hope that the next morning the sperm will have fertilised the eggs. The condition of the uterus is not a factor for ICSI as the fertilisation is done outside the uterus anyway. There is a plasma-based solution (I think - BW/BG??) that is in with the eggs/sperm which makes conditions good for making embies.
    Kim, that's correct. Where the sperm sample in the dish (typically some tens of thousands) is judged to be normally motile and normally shaped, they are generally left to their own devices, unless the egg/s are know to have a particularly tough zona (exterior).

    As for ICSI, it isn't really to do with the environment of the uterus (or vagina etc), as straight IVF overcomes any potential issues there.

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