What is IVF – In-Vitro Fertilisation?
In-Vitro Fertilisation is the process where eggs are removed from the ovaries and fertilised with sperm in the laboratory. One or more of the embryos created are then returned to the woman’s uterus (womb). IVF is used for a wide range of infertility causes; however it still remains the most effective treatment for female subfertility due to tubal factors. To enhance success rates fertility drugs are used to stimulate the ovaries and at the same time prevent premature ovulation. The response to these drugs is monitored by regular ultrasound scans and blood tests. At the end of the stimulation stage an HCG injection is given 36 hours before egg retrieval to trigger ovulation.
Egg retrieval is performed vaginally under ultrasound scan guidance, using sedation. All follicles are aspirated using a fine needle, and the fluid obtained is examined under the microscope for the presence of the eggs. The number of eggs collected might not correspond to the number of follicles on the scan. In the rare situation we fail to collect any eggs in spite of the presence of follicles on the scan picture, you will be given an appointment to see the doctor.
The ability of a woman to be able to conceive, declines with age. When using your own eggs, on average, the younger you are the higher your chances of success. Please refer to HFEA website for the most current statistics www.HFEA.gov.uk.
After egg collection, the eggs are incubated for a short time and the prepared sperm is then added to the eggs and incubated in the laboratory for a further 18-24 hours. Fertilisation rates are variable but on average a 65% fertilisation rate is expected. The first signs of fertilisation are shown by the presence of two pronuclei within the egg. If this has occurred, the fertilised egg should then divide into cells, the fertilised eggs (now called embryos) are transferred to the uterus 2-6 days after egg collection. A maximum number of two embryos are transferred in women under 40. We will be aiming to transfer embryos at the blastocyst stage (5-6 days after egg collection). In this situation it is recommended that one embryo is transferred due to the increased chance of multiple pregnancies.
It is important that you are aware that there is always a possibility that a low proportion or even none of the eggs fertilise. If this occurs you will be seen by the clinician to discuss your future options.
The final stage of the treatment is embryo transfer, one of the most important events in IVF cycle, partners are encouraged to attend if they wish to do so. It is generally a painless procedure and similar to a cervical smear and on average takes up to 15 minutes, but can take longer in difficult transfers. Occasionally an abdominal scan may be required to confirm the correct position of the transfer catheter within the uterine cavity prior to replacement.
There is no evidence to suggest that bed rest has a positive effect, hence women are advised to carry on with their normal daily routine after embryo transfer. Additional progesterone in the form of vaginal pessaries or injections are given following egg collection until the pregnancy test is done 2 weeks later.
Who can benefit?
In vitro fertilisation (IVF) is considered the most effective treatment for patients when:
- Unexplained infertility has been diagnosed
- Fallopian tube are damaged or blocked
- Previous use of fertility drugs or intrauterine insemination (IUI) has been unsuccessful
- A degree of male subfertility has been identified
How long does it take?
At Newlife clinic we pride ourselves on the fact that every patient is treated as an individual case and their treatment plan is formulated accordingly, to maximise their chance of success. The timeline below represents a typical IVF, ICSI or egg freezing short protocol cycle.
We have provided this so that patients can be aware of what they may need to plan for, once they have decided to commence treatment. This should be regarded only as a guide to the likely sequence of events, as there are other protocols that will be advised on an individual basis at your consultation.
Day 1: Contact the clinic on the first day of your period (which we call day 1) to organise a scan and blood test for day 1-3 of your cycle.
Day 1, 2 or 3: At the scan, your consultant will perform an internal ultrasound scan to measure the lining of your womb and observe your ovaries to count the number of follicles. A blood test will also be required to form a baseline for monitoring oestrogen levels. You will be given medication and taught how to administer the injections.
Day 6-12: You will be required to have more scans and blood tests, usually every 3-4 days. This is to check your response to medication and alter it accordingly. A nurse, who will inform you of any adjustments to medication required, will contact you. If the hormone levels are suitable you will commence your stimulation injections.
Day 10-14: This is the typical day for the trigger injection and you will be given a time to take it. Your egg collection will normally be arranged for 36 hours after the trigger injection and so you will also be given a specific time for the egg collection.
Typically the trigger will be in the evening and the egg collection in the morning two days later. On the day before egg collection you shouldn’t eat after midnight and shouldn’t drink after 2 am.
Day 12-16: Egg collection takes place around 36 hours after the trigger injection. The egg collection procedure requires only light sedation, not as strong as a general anaesthetic, however you will probably not be aware of the procedure taking place. You can expect to be at the clinic for about four hours and will need someone to take you home afterwards.
A fertilisation check is made the next morning and the resulting embryos are carefully cultured.
After egg collection your progesterone level will be supplemented by vaginal pessaries (usually Cyclogest) every morning and night, or Gestone injections daily until at least your pregnancy test two weeks after transfer. Progesterone helps to maintain the lining of the uterus (endometrium) in a receptive state for implantation of the embryo.
The clinic will keep you informed on the progress of your embryos, which will develop for 2-5 days in the laboratory under very strictly controlled conditions, prior to transfer.
Day 13 – 18: Transferring the embryos back into the uterus is a simple procedure, similar to a cervical smear test. Any extra, suitable, good quality embryos are usually frozen at this time, if that is your wish.
Day 27-31: Pregnancy testing is usually 15 days after egg collection; this is a blood test, which is included in your package price. You will be given a date after your embryo transfer has taken place.
What is included in your IVF treatment cycle fee?
- All monitoring cycle scans whilst in treatment
- Doctor’s fees (excluding Initial consultation fee)
- Standard Embryology laboratory services
- Theatre procedures (Egg collection and Embryo Transfer)
- Anaesthetist charges (Egg collection only)
- Post-op recovery where needed
- 1st Pregnancy blood test
- Follow-up appointment (if the treatment fails)
HFEA Fee and medication are charged separately.
Cancelled treatment cycles
Unfortunately not all patients respond to the medication and sometimes it may be necessary to abandon the treatment cycle before egg collection. Future management will be discussed and another treatment cycle may be arranged for a later date, perhaps with a different protocol and different medications.
Drugs used in IVF treatment
A variety of drugs are used in the treatment cycles and different combinations of drugs will be given to different patients as treatment is tailored and personalised to each patients’ needs. These combinations may also differ from cycle to cycle. Your doctor will decide which is the most suitable for you.
There are two groups of drugs used, one group is to suppress the pituitary hormones using a Gn-RH agonist or antagonist, and the second group to stimulate egg production, known as fertility injections or follicle-stimulating hormone (FSH).
The drugs most commonly used are administered by injection and most women find it easy to inject themselves once they have been taught by our nurses. The Gn-RH agonist or antagonist is administered either as an injection or as a nasal spray. All of the drugs used during your treatment can be ordered via Newlife for home delivery Monday-Friday only. Details can be obtained from a member of staff.