During your initial consultation, we would have discussed the results of the semen analysis and both partners’ reproductive history. Those factors will help us choose one of the following fertility treatment options – IVF or ICSI – for fertilisation of your eggs.
- In-Vitro Fertilisation – IVF
- Intra-Cytoplasmic Sperm Injection – ICSI
IVF and ICSI are laboratory techniques by which a single sperm fertilises a single mature egg. The decision as to which treatment is the most suitable for you will depend on the quality of the sperm sample you provide on the day of the egg collection. Sperm quality can fluctuate on a regular basis.
In-Vitro Fertilisation (IVF)
What is IVF?
In Vitro Fertilisation (IVF) means “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.
The resulting embryos are cultured for 2-5 days, after which the best embryo/embryos are transferred into the uterus. It is a standard fertility procedure at the Herts & Essex Fertility Centre, and we are consistently one of the top performing clinics in the UK.
Who is it for?
The indications for recommending IVF treatment are as follows:
• Blocked or damaged fallopian tubes
• Unexplained infertility
• Following unsuccessful treatment with IUI or Ovulation Induction
• Polycystic Ovarian Syndrome
• Minor sperm abnormalities
When is recommended?
The IVF is recommended if the sperm sample on the day of the egg collection is within normal range.
The sperm sample is prepared by a washing technique in the laboratory, and a known concentration of the prepared sperm sample is added to a culture dish containing your collected eggs. The inseminated eggs are incubated overnight which gives the sperm an opportunity to fertilise the mature eggs. The following morning the inseminated eggs are assessed for signs of fertilisation by one of our embryologists. On average 60-70% of eggs will fertilise if the sperm sample is suitable for IVF treatment.
IVF with a sperm sample that is not within the normal range can significantly reduce the likelihood of fertilisation. If your sperm sample on the day of egg collection is no longer within the normal range, we can easily convert your treatment cycle from IVF to ICSI. We will help you make a fully informed decision by discussing your treatment and answering any questions you may have before proceeding.
IVF procedure steps
Step 1. Suppressing the natural monthly cycle (down-regulation)
Downregulation is by medication to make your ovaries temporarily inactive, for easier management of your treatment cycle during stimulation with daily hormone injections. This protocol is used in women with normal ovarian reserve. There is a different protocol for women with poor ovarian reserve.
Step 2. Boosting your egg supply
Once 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.
Step 3. Egg retrieval
During egg collection you will be sedated but slightly conscious, calm, relaxed and unlikely to feel any pain. Under sedation, our Fertility Consultant will extract your eggs using a special needle introduced vaginally under ultrasound guidance. Each follicle is aspirated
individually until all visible follicles are drained from both ovaries. The procedure will take approximately thirty minutes, after which you will return to the recovery room
to be cared for by our specialist nursing team.
Step 4. Collecting sperm
Following admission, the male partner will provide a fresh semen sample to be checked for quality and prepared by a special washing technique in the laboratory. A known concentration of the prepared sperm sample is added to your collected eggs in a culture dish and incubated. If you are using donated sperm, your selected donor sperm is removed from frozen storage, thawed and prepared in the same way.
Step 5. Fertilisation of eggs and sperm in the laboratory
Your eggs are mixed with the sperm and incubated overnight to allow fertilisation to take place. The embryologist will assess the inseminated eggs for signs of fertilisation the following morning. On average, 60–70% 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 easily convert your IVF treatment cycle to ICSI whereby a single normal sperm is selected and injected directly into each egg.
Step 6. Embryo selection
Over the next few days after egg collection the embryologist will assess your embryos’ development daily, recording the number of cells in each embryo as well as their quality. With a majority of our patients, the assessment made on the morning of Day 3 determines
whether the embryo transfer takes place that day or whether the embryos will 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.
Step 7. Embryo transfer
If you are to have a Day 2 or 3 transfer, with your permission, your excess embryos will be cultured on to Day 5 or 6, to see if they can progress to the Blastocyst stage. If they are good quality blastocysts and contain the visible and necessary structures known to give rise to a pregnancy, they can be frozen for use in the future.
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 the Herts & Essex perform embryo transfer seven days a week, on Days 2 to 5 following collection.
For women under the age of 40, one or two embryos can be transferred. If you are over 40, a maximum of three embryos can be returned. The number of embryos transferred is restricted because of the risks associated with multiple births. If the remaining embryos are suitable they may be frozen for future use.
Intra-Cytoplasmic Sperm Injection (ICSI)
What is ICSI?
ICSI is a fertilisation method that involves choosing a single sperm and injecting it into a mature egg using a very fine needle under microscopic control. ICSI assists the sperm to achieve fertilisation and is the recommended treatment for Male Factor Infertility.
When is ICSI recommended?
ICSI treatment is recommended in the following cases:
- Low sperm parameters (count, motility abnormal forms)
or the presence of anti-sperm antibodies within the
- No sperm in the ejaculate due to previous vasectomy,
blockage or absence of the Vas Deferens, early
testicular failure or problems with ejaculation.
Surgical sperm retrieval known as PESA and/or TESE, will
be required in those cases.
- Previous low fertilisation rate or failure to fertilise with
- When the female partner is over the age of 40, the age-related
thickening of the shell surrounding the egg may
make it harder for sperm to naturally penetrate.
Following the ICSI procedure, the injected eggs are incubated overnight and assessed the following morning by one of the embryology team for evidence of fertilisation. The average fertilisation rate following ICSI is similar to IVF with 60-70% of injected eggs fertilising normally. ICSI is the only treatment option for sperm samples that have been surgically retrieved.
Preparation for ICSI
Please note that the only difference between ICSI and conventional IVF is the laboratory procedure chosen once the eggs and sperm have been obtained. The preparation for the female patient for ICSI is identical to that of IVF. The woman will be required to undergo viral screening, drug stimulation, ultrasound monitoring and egg collection as for IVF.
The embryology team will be more than happy to assist you with any questions you may have regarding whether IVF or ICSI is the best treatment for you.
After the procedure
Your fertilised eggs are monitored closely and our embryology team will assess the best day to transfer the developing embryo(s) into the womb.
You can be assured of the best possible treatment throughout these procedures and of our continued support and care.
Our team of embryologists has been recognised by GameteExpert 2014
as one of the very best in Europe for their expertise in assessing embryos and sperm.
We are consistently one of the top performing fertility clinics in the UK.
It was announced in May 2014 that the Herts & Essex Fertility Centre came third out of 78 top performing laboratories for skills in embryo assessment. You can read more here.