Fertility

1st November 2022

Your Fertility Journey – IVF

What is IVF?

In Vitro Fertilisation (IVF) is an advanced fertility treatment designed to help facilitate pregnancy by creation of embryos by mixing egg and sperm in a laboratory and then transferring the embryo into the uterus. For this to be more efficient, the person undergoing treatment is given medication to stimulate the production of more eggs. More eggs lead to more embryos from which the best embryo/s can be selected for the best possible chances of pregnancy.

Who is it for?

As explained by Dr. Abha Bhat, Consultant Gynaecologist, the ideal indication of IVF is blocked/damaged tubes. However, this treatment would be advised to any person or couple who have failed to conceive over a period of more than two years. They may have tried naturally or have had unsuccessful treatment with IUI or ovulation induction. They may have a reason such as irregular periods, endometriosis, or have no reason at all to explain the delay in conception.

It is important to understand that suboptimal sperm quality may be present either alone or in combination with other factors. In these cases, a special type of fertility treatment called Intra-Cytoplasmic Sperm Injection (ICSI) is recommended.

When is IVF recommended?

IVF may be used in general to describe fertility treatments involving the creation of embryos in a laboratory. However, scientifically IVF refers to the technique of creating embryos by mixing eggs with ‘washed’ sperm of a specific concentration on the day of the egg retrieval. Therefore, to make it up to the requisite concentration, the sperm quality must meet specific criteria on the day of egg collection. Since sperm quality varies from time to time, it is not possible to guarantee that IVF is the optimal technique based on prior sperm parameters. IVF with a sperm sample that is not within normal range can significantly reduce the likelihood of fertilisation. In this event, the optimal treatment modality would be ICSI. You will be informed about this, and the necessary procedure will be done only after your informed consent.

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.

What are the steps of IVF?

The most common protocol used for IVF is called short protocol or antagonist protocol. The protocol that was previously considered as a gold standard is called long protocol. Currently short protocol is considered the ideal treatment protocol of almost all patients. The steps are:

Step 1: Stimulation

This starts on the second or third day of your cycle when a scan is done to assess the ovaries and uterus and to decide/confirm the dose of daily injections of Follicle Stimulating Hormone (FSH). As this hormone works on the small follicles (called antral follicles), these start growing. A daily (antagonist) injection designed to prevent a premature ovulation is also started once the follicles become bigger. Once the follicles reach the right size, a last ‘trigger’ injection is given to prepare the eggs and follicles for egg collection.

Step 2: Egg collection

Egg collection is done in deep sedation 36 hours after the trigger injection. Eggs are retrieved 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 be transferred to recovery to be cared for by our specialist nursing team.

Step 3: 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 4: Fertilisation of eggs 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. Depending on the number of eggs that have been fertilised, your transfer will be scheduled for either Day 3 or Day 5 of culture.

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 5: Embryo transfer

Embryo transfers can take place on day 3 or day 5. If there are still embryos in culture after embryo transfer, or if a transfer is not planned for your cycle, then embryos are assessed on days 5 and 6 for their suitability to be frozen for future use.  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 Herts & Essex perform embryo transfer seven days a week, on Days 3 and 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.