Frozen Embryo Replacement

Transcription

1 Frozen Embryo Replacement (FET Cycle) Dr Scott Salisbury Obstetrician & Gynaecologist Watkins Medical Centre Level Wickham Terrace Brisbane Q 4000 Appointments After Hours

2 FROZEN EMBRYO TRANSFER CYCLE There are 3 ways of performing a Frozen embryo Cycle. 1) Natural Cycle FET This involves monitoring with blood test, urine kits and/or scans to predict when ovulation occurs or alternatively triggering ovulation. Usually this option will only be performed if you ovulate consistently otherwise we would consider options 2) and 3). Natural cycle FET involves have a blood test on day 12 (assuming a 28 day cycle) having notified us of the start of your cycle. You would then be required to ring us each day you have a blood test to establish if you need to have a blood test again to establish when ovulation is occurring. You would also be required to have a scan to determine endometrial thickness. In other words when the physical environment ie the endometrial lining and the hormonal environment is right the embryos will be transferred usually 4-5 days later. 2) Mildly stimulated cycle FET This usually applies in people who do not ovulate or if there have been problems with obtaining adequate endometrial thickness in the past. Usually FSH is utilised rather than Clomiphene citrate because Clomiphene through its anti-oestrogenic action may have some deleterious effects on the endometrium. Small doses of FSH are therefore utilised and close monitoring is undertaken in a similar way to your stimulated IVF cycle both to establish ovulation and to check endometrial thickmenss. 3) Hormone Replacement Therapy HRT In this cycle we try to mimic the hormone patterns of a natural cycle. It is commonly used if you don t ovulate spontaneously or we have difficulty monitoring ovulation because of work or geographical reasons. It serves to have the same pregnancy success as in 1) or 2) above.

3 Before you start Frozen Embryo Cycle a) Please contact the Rooms on prior to commencing your frozen embryo cycle to ensure it can proceed. b) As your cycle commences you need to make sure you have contacted QFG to book the frozen embryo cycle and arrange any appropriate out-of-pocket expenses. For HRT FET Cycle Commence synarel one sniff in the morning and one at night when I instruct you to. This will either be on day 20 on the previous cycle asuming a 28 day cycle or on day 2. You would then commence on day 2 on Progynova 2 mg daily and you would continue that on day 3. For days 4 and 5 increase to 2 tablets a day (1 tablet in the morning and 1 tablet in the evening). Days 6 and 7 increase to 3 tablets per day (1 tablet in the morning, 1 tablet at lunchtime and 1 tablet in the evening). Days 8 and 9 increase to 4 tablets per day (2 tablets in the morning and 2 tablets in the evening). Day 10 increase the tablets to 5 per day (2 tablets in the morning, 1 tablet at lunchtime and 2 in the evening). (if you are using Ethinyl Oestradiol 50 micrograms then where Progynova is used substitute Ethinyl Oestradiol, there is no need to use Synarel in this situation. Ethinyl Oestradiol requires to be compounded at special compounding pharmacists which can be found in Wickham Terrace.) Progynova requires a prescription along with Ethinyl Oestradiol if using it instead. Synarel and Progesterone Pessaries can be purchased at QFG or alternative they can occasionally be sourced from outside pharmacies ( they will require a script if purchased outside QFG)

4 Approximately day of your cycle you will have and ultrasound to establish endometrial thickness and a blood test at QFG to ensure that synarel has achieved the result of of suppressing your natural cycle. If these are normal your FET date is planned and you will commence progesterone pessaries 3-4 days before your transfer, however you will also continue on your 5 progynova tablets / day (you can however stop the synarel once 5 progynova tablets a day are reached). The transfer will occur at QFG day OT usually no anaesthetic is required. You need to have evidence of cycle payment to present to the day theatres. Usually you will arrive 30 minutes prior to the procedure. The exact time will be known the day before the transfer. Usually the QFG day theatres would ring you prior to inform you of the time to arrive and the time for your transfer. (Please ring my office the day before if Tuesday to Saturday or Friday if it is a Monday if no call from the day theatres is forthcoming. At the scan appointment we will establish how many embryos to thaw and how many to replace (usually thawing would occur 2-3 days prior to the transfer) Partners are welcome and the procedure itself is exactly the same as for the transfer with your stimulated ivf cycle. Following the transfer you will continue with all of your drugs until a pregnancy test is performed 14 days from your transfer. If you are pregnant you be asked to have a repeat blood pregnancy test 2-3 days later and a scan 2 weeks after that. You will be required to stay on your medications until 8 weeks post transfer ie 10 weeks of pregnancy. Good Luck

5 Frozen Embryo Cycle