Procedures offered during IVF

Question 1

Down regulation and other regimens to avoid premature luteinising hormone surges in IVF

Answer 1

• Use either gonadotrophin-releasing hormone agonist down-regulation or gonadotrophin-releasing hormone antagonists as part of gonadotrophin-stimulated IVF treatment cycles
• Only offer gonadotrophin-releasing hormone agonists to women who have a low risk of ovarian hyperstimulation syndrome
• When using gonadotrophin-releasing hormone agonists as part of IVF treatment, use a long down-regulation protocol

Question 2

Controlled ovarian stimulation in IVF

Answer 2

• Use either urinary or recombinant gonadotrophins for ovarian stimulation as part of IVF treatment
• Use an individualised starting dose of FSH, based on factors that predict success, such as:
  Age
  BMI
  Presence of polycystic ovaries
  Ovarian reserve
• Do not exceed 450 IU/ day
• Clomifene citrate-stimulated and gonadotrophin-stimulated IVF cycles have higher pregnancy rates per cycle than ‘natural cycle’ IVF

Question 3

Triggering ovulation in IVF

Answer 3

• Offer women hCG (urinary or recombinant) to trigger ovulation
• Ultrasound monitoring of ovarian response

Question 4

Oocyte and sperm retrieval in IVF

Answer 4

• Give sedation

- Women who have developed at least 3 follicles before oocyte retrieval should not be offered follicle flushing

Question 5

Embryo transfer strategies in IVF

Answer 5

• In the first full IVF cycle use single embryo transfer.
• In the second full IVF cycle use single embryo transfer if 1 or more top-quality embryos are available. Consider using 2 embryos if no top-quality embryos are available
• In the third full IVF cycle transfer no more than 2 embryos

Question 6

Embryo transfer for women aged 37–39 years

Answer 6

• In the first and second full IVF cycles use single embryo transfer if there are 1 or more top-quality embryos. Consider double embryo transfer if there are no top-quality embryos
• In the third full IVF cycle transfer no more than 2 embryos

Question 7

Embryo transfer for women aged 40–42

Answer 7

Consider double embryo transfer

Question 8

Luteal phase support after IVF

Answer 8

• Give progesterone
• Do not give hCG to reduce risk of OHSS
• Does not need to continue beyond 8 weeks