What is In Vitro Fertilisation (IVF)?
Many couples have multiple infertility problems. Each problem may only be mild and not warrant IVF on its own. However, when combined, IVF becomes the most appropriate treatment to help you conceive.
IVF is a treatment in which fertilisation occurs outside the body. It involves the culture of eggs with sperm in a laboratory to create fertilised eggs, which develop into embryos. The embryos grow for five days in the controlled laboratory environment and the strongest embryo is then transferred into the womb.
Other quality embryos can be frozen and stored for the future, maximising the chance of pregnancy from a single egg collection.
Why has IVF been suggested to us?
It may be appropriate if:
- The woman has blocked fallopian tubes or moderate to severe endometriosis
- There is moderate to severe male factor infertility involved
- SIUI has not been successful
How can IVF help?
IVF increases the numbers of eggs and embryos available and enables us to select the strongest embryos with the greatest chances of implanting.
In some cases, IVF can actually uncover the cause of a couple’s infertility by identifying and pin-pointing a problem with the eggs, sperm or embryos.
How many treatment cycles will I have?
There is no recommended set number of treatments. Dr.Ong offers a follow-up appointment after each cycle to review and discuss in detail how the treatment progressed; and to offer support, trusted counsel and recommendations for future treatment.
Is all IVF treatment the same?
IVF is a science and there are a number of different drug regimes used for ovarian stimulation. Dr. Ong will ensure that you receive the most appropriate regime for your individual circumstances depending on a number of factors including your age, cycle length and baseline hormone levels.
What happens in a treatment cycle? (IVF in detail)
1. Stimulation of the ovaries
- Ovaries are stimulated with Follicle Stimulating Hormone (FHS) to produce several eggs
- FHS is the same hormone produced naturally in the body
- Eggs form in small fluid filled sacs in the ovary called follicles
- Follicles produce oestogen and reach 17mm in size before the egg matures
- Follicle growth and oestrogen levels are monitored by regular ultrasound scans and blood tests
2. Down-regulation of pituitary gland
- The brain’s pituitary gland is suppressed to prevent the premature release of Luteinising Hormone (LH)
- LH can cause eggs to be released before they have properly matured
- Without ‘down-regulation,’ early release would happen in one third of cases leading to cancellation of the cycle
3. Different treatment regimes
There are three main methods used to stimulate the ovaries and the most common is known as the “antagonist drug regime”. Dr. Ong will evaluate and explain the right regime for you…
a. Antagonist Regime
- FSH is given on day 3 of your cycle to stimulate the ovaries
- Drugs known as GnRH antagonists may be given in combination from the fifth day of FSH injections
- GnRH antagonists such as ‘Orgalutran’ can directly suppress the pituitary gland and possible LH surge
- Antagonists simplify the process and cut down time required to complete a cycle with less side effects
b. Long Protocol
- Gonadotrophin releasing hormone (GnRH) is taken daily as a nasal spray to begin the treatment cycle
- GnRH stimulates and then suppresses the pituitary
- This protocol starts on the second or the twenty-first day of your menstrual cycle and takes 2 weeks to fully suppress the pituitary
c. Boost Protocol
- Gonadotrophin releasing hormone (GnRH) is given at the start of the cycle closely followed by FSH injections
- This stimulates the pituitary causing a release or ‘flare’ of pituitary hormones FSH and LH to help stimulate the ovaries
4. Monitoring the cycle
- Response to treatment is monitored carefully with regular vaginal ultrasound scans and blood tests
- Your first scan and blood test occur on Day 2 of your cycle (providing your baseline measurement)
- Long protocol patients will have an additional scan after two weeks to ensure down-regulation has occurred
- All patients will be scanned on the 7th day of FSH injections
- Scans continue on alternate days depending on follicle sizes and hormone levels
- A treatment cycle may be stopped if too few follicles are developing or blood oestrogen levels are low; or if too many follicles are developing or blood oestrogen is too high to avoid the risk of Ovarian Hyperstimulation Syndrome (OHSS)
5. Triggering ovulation
- Ultrasound scan and/or hormone measurements will show an adequate number of follicles of correct size (usually after 9 to 12 days)
- A final hormone injection is given to complete the egg maturing process and cause follicle release
- Release of the eggs is timed 36 hours before egg collection, so eggs are mature but are still inside the ovary
6. Sperm collection
- Male produces sperm sample on same day as egg collection occurs
- Sexual intercourse should be avoided 2 days before to ensure best possible sperm sample
- Normal intercourse throughout your cycle will not interfere with your treatment
- Sperm can also be retrieved by a surgical procedure called (PESA/TESA) if necessary
- Frozen and stored sperm can also be used and is thawed on the day of treatment
7. Egg collection
- Egg collection is performed on a day-case basis routinely under general anaesthesia
- A fine hollow needle is passed under ultrasound guidance via the vagina into the ovary to remove each egg
- The procedure takes about 15 to 30 minutes
8. Fertilisation and embryo culture
- Eggs are placed in a carefully labelled dish in specialised culture medium and incubated
- Sperm is added after 3-6 hours and is known as insemination
- The following day, eggs are inspected under a microscope to see whether they have fertilised
- Fertilised eggs develop into embryos cultured in the laboratory in a controlled environment
- Embryologists select the best quality embryos for transfer and will contact you on a daily basis to update you on how your embryos are developing
9. Embryo transfer
- Embryo transfer takes place about five days after egg collection
- The simple procedure is quick and usually completely painless
- Embryos are gently transferred into the uterus using a specialised fine tube (catheter)
- Ultrasound guidance is used and a full bladder is required for this procedure
The number of embryos to transfer
The decision on the number of embryos transferred is extremely important. Risks associated with multiple pregnancy must be balanced with the best chance of achieving a pregnancy. The final decision may also be influenced by the quality of the embryos. We will discuss this in-depth with you before transferring the embryos.
10. Embryos remaining after embryo transfer
Good quality embryos remaining after embryo transfer may be frozen for future treatment.
11. Hormone or luteal phase support
- In the second half of the cycle, the lining of the uterus (endometrium) is supported with progesterone to help the embryo implant in the uterus
- Crinone pessaries will be prescribed to use for two weeks following egg collection
- Lifestyle advice will be given whilst waiting for your pregnancy test
- Usually, there is no need to change normal activities including sexual intercourse during or after treatment
12. Pregnancy test
- A pregnancy test will be given at the clinic 14 days after egg collection
- A blood sample is also required
- It is possible to have a positive test even if you have started to bleed
- The result will be provided on your preferred contact method; (Usually by telephone later the same day)