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All Posts in Category: infertility

Endometrial scratch

Endometrial Scratch

What is endometrial scratch?

The patients who had failed cycles despite transferring good quality embryos, Endometrial scratch is the best procedure to help those embryos to implant successfully after the process of IVF, ICSI. Currently, the evidence suggests that superficially injuring (scratching) the lining of the womb in this group of patients may improve the chances of pregnancy.

Who is the procedure for?

This procedure is for the women who have the problem of not getting pregnancy even after the transfer of quality embryos. Currently, available evidence does not support the use of endometrial scratch in all patients, including patients going through IVF/ICSI treatment for the first time.  More research is required to evaluate the role of endometrial scratch in patients going through their first cycle of IVF treatment.

How does scratching help implantation?

New research and evidence suggests that scratching the uterine lining causes a ‘repair reaction’ in patients with recurrent implantation failure and this may increase embryo implantation rates:

The repair process releases growth factors, hormones, and chemicals. The new lining which grows after the procedure is thought to be more receptive to an implanting embryo and so increases the chances of pregnancy.

‘Gene switching’ – scientists believe that the genes which are responsible for implantation of embryos are sometimes not ‘switched on’ during the time when embryos are supposed to implant. This procedure may switch on the genes which are responsible for implantation and increasing the chances of pregnancy.

>Research is still being gathered to understand exactly how this works.

When is the best time to have the procedure?

The best time to perform the endometrial scratch is during the second half of the cycle before your IVF/ICSI treatment cycle begins.  The clinical team will advise on the best time for the procedure based on your periods.

What preparations are needed for endometrial scratch?

It is vital that you do not have unprotected intercourse in the four weeks before the planned endometrial scratch procedure. You should use a condom for contraception during the cycle of the scratch appointment to avoid the risk of a possible pregnancy.

We recommend taking some pain relieving medication ½ hour before your procedure, such as two paracetamol tablets (500 mg per tablet) as this may help to relieve any discomfort during the procedure.

Before the procedure food can be taken. You do not need to empty your bladder before the procedure unless you feel uncomfortable with a full bladder. You should wear comfortable clothing that gives easy access to the lower part of your body. You should bring a sanitary towel with you for use after the procedure.

What happens during my appointment and how is the procedure performed?

  • • The procedure should only take 15-20 minutes. You may experience a little discomfort but no anaesthetic is required. The procedure is similar to an embryo transfer or cervical smear test.
  • • The procedure will be explained to you by the doctor or nurse performing the procedure.
  • • Your recent Chlamydia screening results will be checked in the notes.
  • • You will be asked to sign a consent form or a verbal consent may be taken prior to the procedure. Following that you will be made comfortable on the examination couch.
  • • The cervix can be seen once a speculum is inserted into the vagina gently. Sterile gauze is used to clean the cervix.
  • • A flexible catheter is passed into the cavity of the uterus through the opening of the cervix and scratches the lining of the uterus.
  • • The catheter is taken out at the end of the procedure.

What happens after the procedure?

Some mild bleeding is common after the procedure. An hour or two after the procedure you will be able to continue your normal daily activities, but you may benefit from not going back to work the same day. You can eat and drink normally immediately after.

What risks are involved?

Endometrial scratch is a very safe procedure. For most women it does not require any anaesthetic. Some women occasionally experience some cramping pains during and after the procedure, but these will ease in a very short time. We recommend that you make arrangements for a relative or a friend to drive you home in case you experience more discomfort than usual during the procedure. We will ensure that you are well enough before you leave the clinic.

Very rarely, the procedure can cause pelvic infection. There may be an infection within the cervix that may be spread to the uterine cavity during the procedure. This would become apparent up to 10 days following the procedure. If you suspect and experience any of the following signs and symptoms within a few days of the procedure, please contact your GP and inform them that you have had an endometrial scratch (biopsy):

  • • Foul-smelling vaginal discharge.
  • • Persistent bleeding.
  • • Increasing lower abdominal pain.
  • • Unexplained fever.
  • • Feeling generally unwell.

Please note that it is recommended to screen all women for Chlamydia prior to endometrial scratch and you already would have been screened with the initial investigations at our department before starting your IVF treatment.

Your doctor or fertility specialist nurse will check this if you have already had a test for Chlamydia within the last 2 years.

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Antagonist Protocol

Antagonist Protocol

Please visit the doctor on the first day of your next period (the day you wake up bleeding). Inform the unit that you are on the short protocol, and you can have the medication at home. Once treatment is accepted, the instructions regarding when to start your injections will be given. On the 2nd or 3rd day, a blood test and ultrasound scan should be taken. The date will be given to start daily stimulation injection. There are different types of stimulation drugs some are Gonal F, Bemfola and Menopur. These injections encourage the development of follicles in each ovary. On the 5th day of stimulation injections, the one should have an additional injection called Cetrotide, which suppresses your Luteinizing Hormone (LH) surge which is used to prevent ovulation. The one should continue both of these injections until advised to stop. If Metformin tablets are prescribed following consultation, please continue to take these until the day of egg collection. For every 2 or 3 days, the blood test is to be taken for checking the oestrogen levels which indicates how ovaries are responding to the drugs. This will be continued still 3 or more follicles are at the optimum size of 17-20 mm. Usually, it takes 10 – 14 days. After stimulation, a final injection called Pregnyl is to be taken, which helps to mature the eggs. This injection is taken approximately 35 – 36 hours before egg collection. If the injection is not given at the specific time, consult the specialist. At the time of egg collection, the fresh semen sample is to be provided by the partner for ejaculation. After egg collection, the team informs about the details of eggs that are fertilized and to get ready for embryo replacement.

Don’t forget!

  • • Nothing to eat or drink from midnight the night before your egg collection.
  • • If you are storing embryos your partner is to abstain from ejaculation for 2-4 days before the day of egg collection.


What does it do?

Menopur with the aim of an egg developing within each follicle stimulates in ovaries.

Possible side effects:

  • • Local irritation at the injection site.
  • • Ovarian Hyperstimulation Syndrome (OHSS).

Signs/symptoms to look out for include:

  • • Abdominal swelling/pain.
  • • Shortness of breath.
  • • Extreme thirst.
  • • Nausea/vomiting
  • • Headaches
  • • Problems passing urine (small amounts or none at all).
  • • Local irritation at the injection site.

How to prepare Menopur:

  • • Remove the product from the box.
  • • Open the top tray, which will contain pre-filled syringes of water, a vial of powder and a needle.
  • • Remove the powder vial from the tray.
  • • Flick the blue cap off.
  • • Remove the grey lid off the pre-filled syringe of water and twist the orange needle on to the top.
  • • Push the needle through the grey bung on the powder vial.
  • • Push all the water into the vial of powder. If you have two pre-filled syringes of water, remove the needle from the first syringe and attach it to the second and inject it into the vial of powder.
  • • The powder should all dissolve. If not completely dissolved, give the vial a gentle roll. Do not shake.

How to inject Menopur:

  • • Take a needle from the large box.
  • • Remove the clear lid.
  • • Pierce the grey bung and tip the vial upside down.
  • • Pull down the plunger to just past your required dose.
  • • With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  • • Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
  • • Pinch an inch of skin below your belly button.
  • • Inject at a 45-degree angle.
  • • Inject the full dose.
  • • Remove the needle.
  • • Dispose in sharps bin provided.
  • • The remaining solution of Menopur can be stored for the next dose.

Storage Information

Store in a refrigerator (2°C – 8°C) before reconstitution, in its original container to protect from light. The solution may be stored for a maximum of 28 days at not more than 25°C after the reconstitution and also don’t freeze.

Gonal F

What does it do?

Gonal F is an injection that contains the follicle-stimulating hormone (FSH). It stimulates your ovaries to produce follicles, aiming to produce an egg inside each one.

Possible side effects:

  • • Local irritation at the injection site
  • • Ovarian Hyperstimulation Syndrome (OHSS)

Signs/symptoms to look out for include:

  • • Abdominal swelling/pain.
  • • Shortness of breath.
  • • Exteme thirst.
  • • Nausea/vomiting.
  • • Headache.
  • • Problems passing urine (small amounts or none at all).
  • • Local irritation at the injection site.

How to use Gonal F:

  • • Take out the Gonal F pen and one of the needles inside your box.
  • • Take the white lid off the Gonal F pen.
  • • Peel the paper cap off the needle.
  • • Twist the needle on the top of the Gonal F pen.
  • • Remove white cap off the needle.
  • • Look in the black window at the end of the pen (there should be a ‘0’).
  • • Twist the red end of the pen till you can see your required dose in the black box.
  • • Remove the green lid on the needle.
  • • Pinch an inch of fat below your belly button.
  • • Inject Gonal F at a 90-degree angle.
  • • Push the red plunger down and hold for 10 seconds.
  • • Remove pen and look in the black window (it should read ‘0’ if you have injected the full dose).
  • • Replace the white cap on the needle and unscrew it off the pen.
  • • Dispose of the needle into the sharps bin provided.
  • • Replace the lid of the Gonal F pen and store as advised below.

Storage Information

Store Gonal F in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.


What does it do?

The natural hormone which is called Gonadotropin-Releasing Hormone (GnRH) is effected by the blockage by cetrotide. GnRH controls the secretion of another hormone called luteinizing hormone (LH) which induces ovulation during the menstrual cycle.

Possible side effects:

  • • Mood swings.
  • • Hot flushes.
  • • Headaches/nausea.
  • • Vaginal dryness.
  • • Local irritation at the injection site.

How to use Cetrotide:

  • • Remove from packaging.
  • • Remove blue cap from vial of powder.
  • • Take a pre-filled syringe of water and remove the cap.
  • • Attach the yellow needle (larger needle) on the end of the pre-filled syringe of water.
  • • Pierce the grey bung with the needle and push all of the water into the vial.
  • • Draw up all the solution back into the syringe once the powder has been completely dissolved.
  • • Remove the large yellow needle and dispose in sharp bin provided.
  • • Attach on a grey smaller needle.
  • • With the needle pointing towards the ceiling, flick the syringe so that any air bubbles move to the top.
  • • Push the plunger up so no air is in the syringe.
  • • Pinch an inch of fat below your belly button.
  • • Inject at 45-degree angle.
  • • Push the plunger down to administer Cetrotide.
  • • Dispose of needle and syringe into a sharps bin.

Storage information:

Keep in the box in a dry cool place.


What does it do?

Pregnyl is your final injection and is used to mature the egg within the follicle.

Possible side effects:

  • • Headache.
  • • Feeling restless or irritable.
  • • Depression.
  • • Breast tenderness or swelling.
  • • Local irritation at the injection site.

How to use Pregnyl:

  • • Remove the two glass vials from the box.
  • • The black dot on the bottle is the weakest point of the vial, flick this dot to make the neck of the vial weak.
  • • Put your left thumb underneath the black dot and your right thumb above the black dot.
  • • Firmly snap the top of the vial.
  • • Repeat with the other vial.
  • • Remove syringe and green needle from the packaging.
  • • Twist green needle at the end of the syringe.
  • • Put the needle into the water and pull the plunger to draw up all the water.
  • • Remove the needle from the bottle and put the needle into the vial of powder.
  • • Push all the water into the vial.
  • • Leave to dissolve for a few seconds then pull the plunger back to draw up a dissolved drug.
  • • With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  • • Twist off the green needle and dispose in sharps bin provided.
  • • Twist on an orange needle and push the plunger up to remove any air.
  • • Pinch an inch of fat below your belly button.
  • • Inject at 45 degrees and push the plunger down to give yourself a full injection.
  • • Remove the needle and dispose into the sharp bin.

Storage Information

Store in a refrigerator until it is time to administer the injection.


What does it do?

Metformin is prescribed during IVF treatment for some people with Polycystic Ovary Syndrome (PCOS) or those with a high ovarian reserve. The use of Metformin can help to reduce the risk of Ovarian Hyperstimulation Syndrome (OHSS).

Possible side effects:

  • • Diarrhoea.
  • • Nausea/vomiting.
  • • Abdominal pain.
  • • Loss of appetite.

Storage information

Keep Metformin in the packaging in a cool, dry place.

Progesterone (luteal support)

Progesterone is given in the form of a rectal or vaginal suppository.

What does it do?

Progesterone, the natural female hormone produced in the body is used in IVF treatment. It helps to support the endometrium and possible early pregnancy.

Possible side effects:

  • • Diarrhoea.
  • • Flatulence.
  • • Soreness in the vagina or rectum.
  • • Headache.
  • • Leakage after the pessary gets dissolved after using progesterone.


Store below 25-degrees centigrade.


What does it do?

With the aim of an egg developing within each follicle, Bemfola stimulates the follicles in your ovaries,

Possible side effects:

  • • Local irritation at the injection site.
  • • Ovarian Hyperstimulation Syndrome (OHSS).

Signs/symptoms to look out for include:

  • • Abdominal swelling/pain.
  • • Shortness of breath.
  • • Extreme thirst.
  • • Nausea/vomiting.
  • • Headaches.
  • • Problems passing urine (small amounts or none at all).

How to use Bemfola:

  • • Take the syringe and needle out of the box.
  • • Remove the peel tab from the injection needle after washing your hands.
  • • Gently push after aligning the injection needle with the pen.
  • • Remove the outer needle protection cap.
  • • Remove the inner needle protection cap.
  • • Hold the pen with the needle pointing upright to make eventual air bubbles rise.
  • • Push the dosage plunger until it stops and a small amount of fluid is seen. If a small amount of fluid is not seen the pen should not be used.
  • • Turn the dosage plunger until the prescribed dose is aligned with the middle of the indent.
  • • Pinch an inch of fat below your belly button.
  • • Inject Bemfola at a 90-degree angle.
  • • Push the plunger until it stops.
  • • Remove the injection needle after 5 Sec.
  • • Dispose of the needle into the sharps bin provided.


Store Bemfola in the refrigerator and in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

Sedation in IVF

During the egg recovery, the surgeon places a scanning probe into the vagina. Then a needle is inserted alongside the probe. The needle is used to suck out the ripen egg where discomfort occurs. Then the person is sedated and not unconscious. During the procedure, she will be fully monitored. The sedation method is the preferable method after the egg recovery process.

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Before and After Surgical Sperm retrieval

Before and After Surgical Sperm retrieval

Sperm Retrieval

What time do I arrive?

On the day of the operation, please report to reception. The staff can then tell about the location of the bed.

What do I need to bring?

The one should bring slippers, socks, dressing gowns and toiletries and something to pass the time. Supportive jock strap style underpants should also bring by them, which are should be worn after 48 hours of the operation.

What happens next?

Your consultant and anesthetist will see you before your operation to ask you to sign the necessary consent form and answer any final questions you may have.

How long do I need to stay?

The team will test after the operation to ensure that you are fit for getting a discharge. Your condition will be checked by one of the IVF medical or nursing team to see you have sufficiently recovered from your anesthetic. We would need to know that you have passed urine comfortably, have been able to eat and drink without any nausea or vomiting, and that you can walk steadily without assistance. You will not be able to drive after the operation so please make sure you arrange for someone to take you home. Please take careful note of the following advice for after your discharge from the hospital.

Any Precautions to be taken after the operation?

Although you will probably feel fine, judgment is impaired after an anesthetic, therefore do not drive any motor vehicle, ride a bicycle, or operate any machinery including domestic appliances within 24 hours of the anesthetic. You should be driven home by your partner or another companion.

What should I expect following surgical sperm recovery?

You should be able to leave the hospital shortly after the operation and resume full normal physical activities after 4-5 days. We would advise you to wear your scrotal support (jock strap) continuously for 48 hours after your operation to minimize discomfort and protect your scrotum and testes. The stitches used are dissolvable and will not usually need to be removed. However, if the stitches have not separated away after 14 days, we would advise you have them removed either in the treatment in the IVF clinic. Most men will experience some mild discomfort or aching for a couple of days. It is advisable to take simple pain relief such as Aspirin, Paracetamol or Ibuprofen regularly, every six hours, for 48 hours after your operation.

Complications after the surgical sperm recovery

The most common complications are an infection or a hematoma (a collection of blood) within the scrotum. Both of these may cause pain, usually within 2-4 days after the procedure. The infection causes increasing tenderness and cloudy discharge around the stitches in the scrotum. A hematoma will usually cause swelling and deep purple discoloration but the risk of this is minimized by you wearing your scrotal support for 48 hours after your operation. If you suspect either of these problems is developing, you should contact the IVF clinic. Out of hours, you can contact the Prasad Hospitals: 8801233333.

Can I have a bath?

It is important not to soak the wound for the first 7 days after the operation. We advise you to kneel in a shallow bath for those 7 days, alternatively showering is fine.

Other information

During the seven days after your operation if you go for a long walk you should wear your scrotal support. Avoid lifting during the first seven days. You should resume a normal diet and increase your daily activities to a normal level over a 3 to 4 days’ period. You should abstain from sports activities, heavy lifting and sexual intercourse for approximately 10 days.

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Advice Before and After Egg Recovery

Advice Before and After Egg Recovery

Before egg recovery

  • • Before ready for egg recovery. As usual, the nurses will ring to inform about drug doses.
  • • An HCG injection must be given under the skin about 34 – 36 hours before egg recovery to complete the egg maturation. Along with the time of egg recovery, the nurses will confirm the date and time of HCG injection. It is very important that one should take the injection in the time stated. The next day the one will not need any injections.
  • • From the midnight before the egg recovery, no food or drink is taken.
  • • Slippers, dressing gown, toilet bags are recommended to bring. An embryologist will see the one before discharge. She will need somebody to take home and stay with her overnight.
  • • After the operation, symptoms like feeling tired, having mild abdominal pain, bloated, and vaginal bleeding for some days. Taking rest for a couple of days is mandatory.
  • • It is essential to inform the unit if one is admitted to another hospital after egg recovery.

After egg recovery

  • • After the egg recovery being successful, taking rest for a few days is needed. Symptoms like mild period pains, feeling tired are observed. For pain relief, Paracetamol can be used. If one experiences the symptoms (Ovarian hyperstimulation) like vomiting, persistent sickness, thirst, and reduction in the amount of urine, contact the specialists immediately.
  • • The team will explain how and when to use cyclogest pessaries. From the day following egg collection, pessaries should be used, by inserting one pessary vaginally first thing in the morning and the last thing at night.
  • • But on the day of embryo transfer, usage of pessary should be done after the confirmation of embryologists only. And the usage of pessaries is continued till the date of one go for a pregnancy test. If the test results positive, pessary usage is continued until the scan date. If the test results negative, one should stop using pessaries.
  • • In the event of an emergency outside of working hours, please telephone on 8801233333.
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