What is In-Vitro Fertilisation (IVF)?
IVF is a process that was first introduced in 1978 and since then thousands of babies have been born successfully as a result of this procedure. IVF is a complex technique in which eggs are removed from the female patient’s ovaries and are inseminated with sperm in the laboratory (“in-vitro”) to promote fertilisation.
Who Needs IVF?
IVF is recommended for patients who have had difficulty conceiving for many different reasons, including fallopian tube problems, ovulation problems, endometriosis and for those with unexplained infertility.
How does it work?
Women undergoing IVF will be given fertility drugs to try and produce more than the one egg usually produced in each cycle. These stimulation injections are given daily subcutaneously (under the skin). You will be taught and how to do this before you start. A second type of medication given as a nasal spray or injection depending on the protocol is also provided to stop you releasing the eggs (ovulating) before they are ready for collection.
Over a period of about two weeks, whilst taking these injections you will be scanned and have blood tests daily or on alternate days depending on your protocol. It is important to monitor the development of the follicles (the small collections of fluid where eggs develop within the ovary) as this will help to correctly plan the day of egg collection. This also enable us to increase/decrease the doses of medicine depending on your response to treatment. This will help to reduce the side effects of medication and optimise your chances of success.
When the scans and blood tests show that the eggs are ready for collection. A final hormonal injection of human Chorionic Gonadotrophin (hCG) is given approximately 36 hours pre-operatively. This stimulates the eggs to reach maturity.
The eggs are collected by ultrasound guided vaginal aspiration of the follicles. In the aspirate of the follicle the embryologist should be able to identify an egg. It is difficult to determine the number of eggs that will be collected until collection procedure. In rare cases no eggs are collected.
To minimise discomfort this is usually performed under light general anaesthetic or sedation.
On the same day as the eggs are collected they are incubated with the sperm sample provided. If the sperm quality is good, the sperm will be mixed with the egg and fertilisation will hopefully happen.
They are then checked for signs of fertilisation the next day (Day 1). On average about 65-75% of eggs will fertilise and the fertilised eggs are called embryos. In rare cases, there is failure to fertilise. If the sperm quality is poor, or there has been a previous history of failure to fertilise in an IVF cycle, then ICSI may be performed.
Once the eggs are fertilised, they are observed in the laboratory by the embryologist and allowed to develop. The embryo transfer may take place from day 2-6. If only a small number of embryos are available (one or two) the embryo transfer will take place on day 2. If there are more than two embryos, the transfer could be on either day three or day five or six (this is known as blastocyst transfer).
Depending on the number and quality of the embryos, the previous history, and the wish and age of the patient, one or two embryos are then transferred back.
Embry transfer is not painful and anaesthetic is not required. It is a simple and quick procedure. The best embryo(s) are selected by the embryologist and drawn up into a fine catheter, which is gently inserted through the cervix before being released into the uterine cavity.
In the days following the transfer you will be encouraged to rest for a few days and then resume normal activities. The pregnancy test will be two weeks after the egg collection.
Natural Cycle IVF
Natural cycle IVF is a type of IVF treatment where the aim is to retrieve the one egg that the body has naturally selected and no ovarian stimulating drugs are used.
It is usually offered to women where medication is either unlikely to help in recruiting a higher number of eggs (women with a suboptimal ovarian reserve) or women with a previous poor response.
Occasionally it is also suggested in those women who have a very high risk of over-stimulation of the ovaries if fertility medication is given. (Ovarian Hyper-stimulation Syndrome – OHSS)
The cycle may be cancelled if the hormone levels are too high at the start of the cycle, if the follicle arrests in its growth or if premature ovulation occurs. These problems are more commonly seen in women with a low ovarian reserve.
The egg collection is performed in the same way as a medicated IVF cycle.