In-Vitro Fertilization (IVF)

Indications for IVF
1- Originally designed for treatment of women with blocked Fallopian tubes.
2- Endometriosis and pelvic adhesions.
3- Ovulatory disorders.
4- Sub-optimal sperm parameters.
5- Unexplained infertility.


Preparation for an IVF cycle

You normally produce one egg in a cycle. As not every egg fertilizes and not every embryo progresses to implant, we aim to make you produce a reasonable number of eggs (8-12) through “Controlled Ovarian Stimulation”.

Through different protocols tailored to individual patient’s needs we prepare you for the IVF cycle using two types of drugs; one to stimulate your ovaries to produce eggs (FSH ± HMG injections) and the other to stop your pituitary gland from controlling your ovaries so that you would not ovulate before the time for egg collection. Before you start the stimulatory injections you will have a scan and blood test to make sure that you have a good starting point. You will have another blood test and scan 3-4 days later to assess the response of your ovaries. You will then have a blood test and a scan every other day to fine tune your response. On average it takes 10-12 days of injections until the eggs are ready. The time at which we give you a late night trigger injection to mature the eggs. The egg collection will take place about 36 hours later.

Egg Collection

Eggs are collected under ultrasound guide with a needle going through the vagina into the follicles to aspirate the eggs. You will not feel it as you will have intravenous sedation. You should not eat or drink anything from midnight before your procedure. Once the eggs are recovered, you will be transferred to the recovery room and usually ready to leave one or two hours later. However it is important to have somebody to accompany you. You should not drive a car for 24 hours. You need to start progesterone in the form of suppositories or deep intra-muscular injection from the night after the egg collection.

It is common to feel some lower abdominal discomfort and bloated for a couple of days. You need to drink fluids and you can take paracetamol tablets. A small amount of vaginal bleeding is normal and it is better to use sanitary towels.

Semen Production

We prefer that male partners produce their semen sample at the Clinic. In extreme circumstances, it may be possible for men to produce at home or in a hotel but it is essential that you discuss this with the doctor. You need to abstain from sex for 2 – 3 days (not more than 5) prior to the day of egg collection.

Fertilization

The eggs are taken to the laboratory and, a few hours later are inseminated with your prepared semen sample. About 18 hours later, they are examined for fertilization and then after 24 hours for division (cleavage). If cleaved embryos have developed, embryo transfer proceeds. Sadly, sometimes no eggs fertilise, either because the eggs are of poor quality, or because of an unsuspected semen factor, or even more rarely, for reasons that cannot be explained. If fertilisation does not occur it is disappointing but does not necessarily happen should conventional IVF be performed again. Usually, for a subsequent attempt we recommend ICSI.

Embryo Transfer (ET)

This is normally carried out 2 – 5 days after the egg collection. If you have reasonable number of good quality embryos by day three you might be advised to have the embryo transfer on day 5 (blastocyst transfer). A fine tube or catheter is passed through the cervix and the embryos are injected in a minute amount of culture medium. It does not usually need sedation. Most of the patients need a full bladder to make the delicate procedure of ET easier. You need to drink a litre of fluid an hour prior to your ET.

We can transfer a maximum of two embryos according to the HFEA code of practice except if you are above forty years old and using your own eggs where we can replace three (day 2 or day 3) embryos.

Embryo Freezing

If the surplus embryos after the transfer are of good quality they will be frozen and stored in liquid nitrogen. Embryos may be stored, if both partners give consent, for up to 5 years. In special circumstances this may be extended to 10 years. You must remain in contact with the Clinic as you are completely responsible for confirming that you wish the embryos to remain in storage. You are responsible for paying an annual fee to cover administration and storage. You must also inform The Fertility Academy of any change of address or any personal circumstances. Failure to establish any contact will result in the embryos being discarded at the end of the consented storage period, as required under the HFEA Act 1990.

Prior to replacement, frozen embryos are thawed when the womb lining is ready. Not all embryos survive the freeze/thaw procedure and the chance of pregnancy might be reduced when using frozen embryos when compared to fresh embryos.

After Treatment

It is wise to take things easy after the egg collection and you might need to take the following day off work. It is important relax and take things easy after the embryo transfer until implantation takes place (a week after egg collection) and preferably until you have your pregnancy test (14 days after egg collection). The embryos are safe in your womb and although you can walk, shower and undertake your normal daily activities it is best to avoid strenuous activity and heavy lifting. Although sexual intercourse is not prohibited most couple prefer to avoid sex until the pregnancy test.

The success rate of IVFSuccess rates vary depending on the type of problem and the factors personal to individual women. These include the age of the woman being treated, the number of eggs she produces, the quality of the semen, the number of embryos that result, and the number of embryos transferred.

Intra-cytoplasmin Sperm Injection (ICSI)

 
Technique

ICSI is a technique to fertilize an egg by micro-injecting sperm that would otherwise not be able to achieve fertilization. The fertilisation rate through ICSI per egg is about 60-70%. The female partner undergoes the same preparation and egg collection as in conventional IVF. The only difference is in the fertilization process in the IVF laboratory. Few hours after the egg collection, only mature eggs are injected with sperm under the microscope and checked for fertilization the following morning.

Indications of ICSI
1- Very low sperm count, motility or forward progressive motility.
2- High % abnormal sperm forms.
3- High levels of anti-sperm antibodies in the semen.
4- Surgically retrieved sperm from the epididymes (PESA) or testis (TESA).
5- History of poor fertilization (less than 30%) in a previous IVF cycle.
6- When there is doubt about fertilization eg unexplained infertility, we may split the eggs
between IVF and ICSI to avoid the disappointment of failure.

Risks that might be associated with ICSI

Inheritance of cystic fibrosis (CF) gene

Some men have no sperm in the ejaculate because the vas deferens, the tubes that carry spermatozoa from the testes to the penis, is absent; a condition called Congenital Bilateral Absence of the Vas Deferens (CBAVD). Such men are also more likely to carry the cystic fibrosis gene. You can be a carrier of cystic fibrosis without congenital absence of the vas as about 1 in 25 in the Northern European population is carrier of that gene. If you have congenital absence of the vas deferens we recommend that you have the test for CF gene. If you are a carried your partner would need to be checked too.

Deletions on the Y chromosome

Some men with very few spermatozoa in their ejaculate have an abnormality with their Y chromosome. This means that a son born to a man who carries such a problem may also have a damaged Y chromosome. We recommend chromosome testing to see if a sub-fertile man carries this minor abnormality. Most couple having ICSI prefer to use their own sperm rather than donor semen, which is the only other alternative.

Congenital abnormalities

It is natural for any parent to worry that there may be something wrong with their child. Without treatment, the risk of a child with a congenital abnormality is around 2 to 2.5%. Some researchers have suggested that the risk of a problem following ICSI is the same as in IVF or in women conceiving without treatment.