Nursing presentation from Faculty of Nursing_Ismailia

1. I.V.F
Group 8
Under supervision of . D. Nahed

2. Group's members:
1.Mohammed Nabil.
2.Mohammed Yahiya.
3.Mahmoud Ahmed.
4.Mahmoud Metwalli.
5.Mansour Ibrahim.
6.Nourhan Hassan.
7.Hagar Sobhi.
8.Hanem El-Sayed.
9.Haidy Mustafa.
10.Heba Mahmoud.
11.Huda Osama.
12.Huda Kareem.
13.Hadeer Jamal.
14.Hadeer Mohammed.
15.Hamsa Reda.
16.Walaa Rezk.
17.Walaa Fayez.
18.Yara Mohammed.
19.Yasmeen El-Sayed.

3. -OBJECTIVES:
1 . definition of I.V.F.
2 . indications of I.V.F.
3 . advantages of I.V.F.
4 . disadvantages of I.V.F.
5 . process of I.V.F.
6 . complications of I.V.F.
7 . alternate methods for I.V.F.
8 . Nursing role in I.V.F.

4. Definition
In vitro fertilization (I.V.F) is one of several assisted
reproductive techniques used to help infertile couples to
conceive a child. I.V.F is a procedure in which fertilization of an
egg outside the body of a female by the addition of sperm, as a
means of producing a zygote.
A method of fertilizing human ova outside the body by
collecting the mature ova and placing them in a dish with a
sample of spermatozoa. After an incubation period of 48 to 72
hours, the fertilized ova are injected into the uterus through the
cervix. The procedure takes from 2 to 3 days.
Indications
mainly after 2 years of unprotectedidiopathic causes;1 .
intercourse with no obvious cause of infertility.
problem of fallopian tubes (obstruction orfemale causes;2 .
salpingectomy due to ectopic pregnancy) , endometriosis ,
ovulation problems , or antibodies that affect both eggs and
sperms.
defects in sperm quantity or quality,male causes;3 .
inability of the sperm to penetrate the cervical mucus , or no
sperms seen in the semen fluid.
preimplantation genetic diagnosis to rulegenetic causes;4 .
out genetic disorders.

5. Ethical considerations during I.V.F
1 . the husband produces for too few sperm with each ejaculate
to impregnate his wife.
2 . test tube, fertilization of the woman's egg with the husband's
sperm and the re-implantation of the fertilized zygote into the
same woman.
3 . to keep privacy about patient's data and results.
Advantages of I.V.F
1 . For most children conceived by IVF there are no long-term
problems.
2 . IVF can offer you a chance of having a baby if you are unable
to conceive naturally.
3 . reduce surgery on woman's fallopian tube.
Disadvantages of I.V.F
1 . can cause multiple birth, which can increase risk for
premature baby or baby with low birth weight.
2 . can result in ovarian hyper stimulation syndrome (OHSS)
especially in women have polycystic ovary syndrome.
3 . An increased risk of ectopic pregnancy, where an embryo
implants in a fallopian tube or in your abdominal cavity.
4 . slightly higher risk of the baby being born with a birth
defect but this is not common.
5 . can be costly and painful.

6. Process of I.V.F
Step 1 : Initial IVF Consultation & Preparing the
Ovaries for Stimulation
Allows the doctor to test the size and
placement of the catheter with your
particular anatomy before the big day.
During the procedure, an ultra-thin catheter
is inserted into the uterus while a sonogram
guides the process on a monitor. it is
relatively painless and takes only a few
minutes.
Following the completion of the pre-cycle testing, you will meet
with your physician to review the results and plan their
protocol for treatment
Step Two: Ovarian Stimulation and Monitoring
Goal 1 : one egg usually matures per month, In a normal
ovulation cycle
Goal 2: have as many mature eggs as possible,
In an IVF cycle (as this will increase your
odds of success with treatment)
In the stimulation phase of the IVF cycle,
injectable medications are used for
approximately 8-14 days to stimulate the
ovaries and produce eggs.
Stimulation medications are derivatives from the hormones
FSH and LH, which are the natural hormones involved in the
natural ovulation process.

7. during the ovarian stimulation phase, you will come into the
office approximately 7-8 times for morning monitoring
appointments. Monitoring appointments consists of:
 Transvaginal Ultrasound - Measures the growth of the
egg follicles and the thickness of the uterine lining, both of
which should be increasing as you take the injectable
medications.
 Bloodwork - Measures the estrogen level. The levels of
estrogen in the blood are another indicator of the growth
and maturation of the eggs – rising as the follicles grow.
Step Three: The Trigger Shot and Egg Retrieval
During this phase a very thin needle is passed through the
upper vaginal wall. With the use of vaginal ultrasound, fluid is
removed from the follicles under gentle suction.
Timing is crucial in this phase because the egg retrieval must
be preformed prior to the expected time of ovulation. The doctor
decides when you are ready to trigger based on the two key
factors that have been monitored during the stimulation phase:
 Size of the Follicles - The goal is to have as many follicles
as possible be 18mm or larger since these are the most
likely to contain mature eggs.
 Level of Estrogen (Estradiol) – While there is no specific
number the physicians are looking for, your estrogen level
should not be too high or too low. The level directly
correlates with the number of follicles in the ovaries. The
cells inside each follicle produce estrogen so a patient with
8 follicles will generally have a blood estrogen level that is
lower than a patient with 16 follicles.

8. Step Four: Inside the Lab: Embryo
Development
After the eggs and sperm are collected,
sorted, and prepared, the Embryology Team
begins the fertilization process. There are two
ways that fertilization can occur:
Conventional Fertilization Intracytoplasmic Sperm
Injection (ICSI)
 Frequently used in cases
such as blocked fallopian
tubes or unexplained
infertility. The
embryologist isolates the
healthy sperm, which are
then exposed to each egg
inside the embryology
laboratory where
fertilization occurs
naturally.
 Used in cases when the
quantity or quality of
sperm is poor and
therefore unable to
effectively penetrate the
egg on its own. The
embryologist selects a
single healthy sperm and
injects it directly into the
center of each egg. Since
fertilization only
requires one healthy
sperm, ICSI has become
one of the most
incredible advances in
treating severe male
factor infertility.

9. Step Five: Embryo Transfer
The embryo transfer is a simple
procedure that takes about five minutes
to complete.
The morning of the transfer, the
embryologist will make a final
assessment of your embryos and provide
a recommendation on the number to be
transferred
During the transfer, the doctor will insert the catheter
and push the embryo into the uterus with a small puff of
air. The procedure is guided visually on a monitor with an
abdominal sonogram. Once transferred, the doctor will
slowly remove the catheter to eliminate or decrease any
uterine contractions
Step Six: The Pregnancy
Test
The pregnancy test occurs around
18 days after the egg retrieval.
Unlike a home pregnancy test,
blood is drawn and the hCG level
is measured. An hCG level of over
100 is considered to be positive
although many ongoing pregnancies start out with a beta hCG
level below 100. You'll be asked to repeat the test in two to
three days.

10. Alternate methods instead of I.V.F
:(Intrauterine Insemination)IUI1 .
IUIis an option for an IVF
alternative. In this treatment procedure, sperm is inserted
shewhenthrough a catheter, all the way into a woman’s cervix
. This way the sperm do not have to try toovulatetodueis
make it through all the way to the cervix on their own. This
s, since IUIalso eliminates the problem of thin cervical mucu
will completely bypass that step.
A positive about IUI? It is less invasive than other forms of
fertility treatment, and it doesn’t have to be used in
combination with fertility drugs, although it can be if needed.
2 . GIFT (Gamete Intra-fallopian Transfer):
GIFTis, in some ways, very similar to IVF, in that the
woman will take fertility drugs to stimulate egg
production, and the eggs will then be removed from her
body. Then male sperm is collected and washed. The
eggs then are mixed together with a large number of
sperm, but there is no attempt made by a laboratory to
fertilize the eggs. That is where GIFT is different from
IVF. The egg and sperm, pretty much, are on their own
at that point. GIFT allows conception to happen in its
natural environment, with just a little bit of help,
without outside interference. Of course, with GIFT,
there is no way to be sure that fertilization will occur.

11. 3 . ZIFT and TET:
These are both pretty similar to GIFT in that the woman will
take fertility drugs to stimulate her egg production. ZIFT
(Zygote Intra-fallopian Transfer) and TET (tubal embryo
transfer) are both where the eggs are removed and mixed with
washed sperm. The difference is that the eggs are fertilized in a
laboratory setting. In ZIFT, the eggs are transferred back into
the fallopian tubes the day after they are fertilized. In TET, the
eggs are given a few extra developmental days before they are
placed in the fallopian tubes. Advocates of ZIFT and TET think
that by placing the eggs in the fallopian tubes rather than the
uterus, the eggs will follow the body’s path that it naturally
takes and will increase the chances of successful implantation,
and in turn, pregnancy.
4 . ICSI ( intra cytoplasmic sperm injection ):
Intra-cytoplasmic sperm injection (ICSI) differs from
conventional in vitro fertilization (IVF) in that the embryologist
selects a single sperm to be injected directly into an egg, instead
of fertilization taking place in a dish where many sperm are
placed near an egg.
Complications
1 . related to ovulation inductionstimulation:
-ovarian hyper stimulation syndrome.
-carcinoma (ovarian cancer, breast cancer, hormonally sensitive
tumors, cancer of thyroid gland - endometrium - melanoma).

12. 2 . related to trans vaginal ultrasound - guided
follicle aspiration:
-hemorrhage.
-pelvic infection.
-damage to pelvic structures (bowel - ureters).
-post-operative pain.
3 . ART pregnancy complications:
-miscarriage.
-ectopic pregnancy.
-heterotopic pregnancy.
-molar pregnancy.
-multiple pregnancy.
4 . maternal and fetal complications:
-obstetrics: 1st trimester bleeding.
-perinatal: preterm infants.
-congenital abnormalities: hypospadias – trachea-esophageal
fistula.

13. 5 . psychological complications:
-stress.
-mild or moderate depression.
-anxiety.
6 . financial implications.
Nursing role during I.V.F process
1 . nurse bears an extensive background in the fertility
industry.
2 . nurses have access to the information and the latest
research in a field that is ever charging.
3 . they can provide informed, medical, timely support so that
options and decisions are not overwhelming.
4 . they are a complement and an integral part of client care.
5 . provide support for patients emotional well-being.
6 . assist patients with the strains of infertility and ART.
7 . IVF nurses are bright, intelligent, and compassionate
individuals who have found their calling helping those in search
of family achieve their long-held dream of parenthood.
8 . play a major role in ovulation induction programs.
9 . The nurse takes the client through the whole IVF treatment
process step by step.

14. 10. She will repeat everything that she has told to make sure
that the client understands everything that is going on.
11 . check blood test and ultrasound appointments.
12 . She will be the client’s first port of call if anything goes
wrong during the treatment – like breaking a vial of medicine,
like having unusual pain when client shouldn’t.
13 . The nurses offer solace and advice when unusual things
happen during the treatment process.
14 . They will recognize when client is close to breaking point
and arrange to meet with a counselor if need be.
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