In-Vitro Fertilisation (IVF) Treatment

IVF Treatment

IVF (In Vitro Fertilisation) means literally “fertilisation in glass”, and is so named as eggs are removed from the ovaries and fertilised by sperm in a glass dish in the laboratory. During IVF treatment, the ovaries are stimulated to produce a number of eggs which are then collected and mixed with sperm in the laboratory allowing fertilisation to occur. The resulting embryos are cultured for 2-5 days, after which the best embryo/embryos are transferred into the uterus allowing implantation to occur.
Couples who may require IVF treatment may present with some of the following issues:
  • Blocked fallopian tubes
  • Poor ovarian reserve
  • Unsuccessful IUI treatment
  • Male factor infertility (often require ICSI)

The IVF Treatment cycle

There are several steps to an IVF treatment cycle. There are different protocols for an IVF cycle and these will be discussed in more details with your Consultant. Generally the steps involved in an IVF cycle are the following
First Step of IVF treatment: Suppression of the natural monthly cycleThe suppression of the monthly cycle can be achieved either by a daily injection of gonadotrophin-releasing hormone (GnRH) analogue (Buserelin) or by using the common oral contraceptive pill. Either medication make your ovaries temporarily inactive, for easier management of your treatment cycle during stimulation with daily hormone injections. Some patients experience minor side effects such as hot flushes while taking Buserelin.
Second Step of IVF treatment: SuperovulationOnce your natural cycle is suppressed, you will have daily Follicle Stimulating Hormone (FSH) injections to promote the development of multiple follicles in your ovaries. FSH will increase the number of eggs you produce, allowing us to create more embryos and thus give greater choice for use in your treatment. Trans-vaginal ultrasound scans are used to monitor the growth of the follicles. When the leading follicles reach an appropriate size (approximately 17mm) the FSH +/- LH injections are stopped and an injection of hCG (human Chorionic Gonadotrophin) is given to trigger the final maturation of the eggs.
  • Third Step of IVF treatment:Egg Collection
The egg collection takes place approximately 36 hours after the hCG injection. This is a minor procedure carried out under local anaesthesia or light sedation in our procedure room. A slim trans-vaginal ultrasound probe is used to guide a fine aspiration needle, which is passed through the vaginal wall to drain the fluid from each follicle (which should contain an egg). The procedure takes 15-30 minutes and patients are allowed home approximately one to two hours after the procedure. Fourth Step of IVF treatment: Collecting the sperm and insemination of the eggs in the laboratory On the morning of the egg collection, the male partner will provide a fresh semen sample to be checked for quality and prepared by a special washing technique in the laboratory. The prepared sperm sample is added to the collected eggs in a culture dish and incubated overnight to allow fertilisation to take place. If you are using donated sperm, your selected donor sperm is removed from frozen storage, thawed and prepared in the same way. The embryologist will assess the inseminated eggs for signs of fertilisation the following morning. On average, 50–60% of eggs will fertilise normally with the sperm provided at egg collection.
If your sperm sample on the day of egg collection is not within normal range, we can convert your IVF treatment cycle to ICSI whereby a single normal sperm is selected and injected directly into each egg. In this case your consent will be sought before this change. The embryologist examines the eggs microscopically the following day to check for fertilisation. Under normal circumstances 80% of eggs will fertilise.
  • Fifth Step of IVF treatment: Embryo Culture and Transfer
Over the next few days following the egg collection the embryologist will assess your embryos’ development daily. With a majority of our patients, the assessment made on the morning of Day 3 determines whether the embryo transfer will take place on that day or whether the embryos can continue to be cultured on to the Blastocsyst stage for transfer on Day 5. This decision depends on the number of embryos being replaced, as well as the number of good quality embryos available for transfer. The embryologist will explain and guide you through this process. We strongly believe that embryos should be replaced at the optimum stage of development, after proving themselves by a process of self-selection. It is for this reason that at In-OVO Fertility Clinic we perform embryo transfer seven days a week, on Days 3 to 5 following collection. If there is a surplus of good quality blastocysts they can be frozen (cryopreserved) for use in the future.
For women under the age of 40, one or two embryos can be transferred. The number of embryos transferred is restricted because of the risks associated with multiple births.
Embryo transfer is a simple outpatient procedure and no sedation is necessary. Similar to a smear test, a speculum is used to visualise the cervix. A fine plastic catheter is used to pass carefully through the cervical canal and into the uterine cavity where the embryos are deposited. Sixth Step of IVF treatment: Luteal Phase and Pregancy TestThe implantation process is supported by the administration of luteal support medication prescribed by our Consultant. At least fifteen days after egg collection the female partner will attend the clinic for a pregnancy blood test (bhCG). In the week following embryo transfer, patients should avoid vigorous physical activity, swimming, bath and sexual intercourse.Twenty days after a positive pregnancy test, a trans-vaginal ultrasound scan is performed to assess the pregnancy.

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