What is IVF?
In Vitro Fertilization (IVF) and Intra Cytoplasm Sperm Injection (ICSI)
In vitro fertilization was introduced 30 years ago and since then millions of children have been born thanks to this unique use of science.
In vitro fertilization was originally developed to assist conception in women who have blocked or damaged fallopian tubes but, because of its success is now being used to treat other causes of infertility, such as sperm disorders, unexplained infertility and endometriosis.
In vitro fertilization involves adding prepared sperm to a dish containing eggs or injecting a single sperm inside the egg (ICSI). The sperm swims to the eggs and attempts to fertilize them. Once fertilize, the embryos are monitored and transferred back into the uterus at the correct time, typically between two and five days after the egg collection, depending on whether you have embryos implanted at the blastocyst stage.
The number of treatments performed in the UK has been rising steadily over the years, not only because more couples who are experiencing difficulties are coming forward for treatment, but also increasingly because women are delaying childbearing until their late 30s or even into their 40s. Women under 35 have around 50% chance of achieving a pregnancy while women in the early 40s have a reduced chance around 15 to 20% of achieving a pregnancy.
What is In Vitro Fertilization?
In Vitro fertilization was originally developed to assist conception in women who have blocked or damaged fallopian tubes but, because of its success rates, is now being used to treat other causes of infertility, such as sperm disorders and endometriosis. In vitro fertilization involves adding prepared sperm to a dish containing eggs. The sperm swims to the eggs and attempts to fertilize them. Once fertilized, the embryos are monitored and transferred back into the uterus at the correct time, typically between two and five days after the egg collection, depending on whether you have embryos returned at the blastocyst stage.
Is IVF for me?
IVF is often recommended if You have been diagnosed with unexplained infertility, Your fallopian tubes are blocked, You have been unsuccessful with other techniques, such as fertility drugs or intrauterine insemination(IUI) There is a minor degree of male subfertility – more severe problems are treated with Intra- cytoplasmic Sperm Injection (ICSI).
Semen sample production
It is LFC and Homerton policy that all partners, if applicable, produce their semen sample at the centre. We have rooms specifically designed for donation purposes. In exceptional circumstances home donation or donation in a hotel may be accepted but it is important that you discuss this with your fertility specialist during the consultation. Once the male partner has produced his semen sample he will be required to stay at the centre until our laboratory has analyzed the quality of his sperm. If the sample is not of sufficient quality the embryologist and doctor will discuss other options with you.
What to expect once you undergo treatment
Our individualized approach means that every couple will vary in how their treatment is planned and managed. However, the following information may help to give you an idea of what can be expected. When undergoing treatment, women will be given
A course of fertility drugs. Short protocol or the antagonist protocol
You may be advised to go on a short course of drugs, known as an antagonist protocol. In this instance, you will start your stimulation injections on day 2–3 of your menstrual cycle or with another type of injection added on day 6.Both will then be continued for an average of 14 days before you are ready to have your eggs collected.
Alternatively, if you are advised to go on a longer course of drugs, known as an agonist protocol, you will be given an ovarian suppressant injection seven days before your period is due and then injections of gonadotrophins for 10–14 days (starting on day 5–12 of the following period) to stimulate the development of follicles which contain eggs on the ovaries.
A final, single injection of hormone is given 36 hours before your planned egg collection to ripen and mature the eggs prior to their removal. During the cycle of drug treatment, you will be monitored very closely in order to determine the ideal timing for egg collection.
In-Vitro Fertilization (IVF)
Ultrasound scans are performed regularly (approximately two or three times per week) at the Spire Roding hospital or the LFC in the run– up to egg collection in order to see the developing follicles. Blood samples may also be taken to measure hormone levels along with the scans.
The egg recovery is a short procedure, taking approximately 30 minutes, and uses a fine needle inserted through the upper vagina, guided by a vaginal ultrasound probe, to collect your eggs. Sedation is given to aid relaxation and minimize discomfort. Most women will be able to leave the clinic within three to four hours of this procedure.
Your eggs are mixed with your partner or donor’s sperm and cultured in the laboratory for 16–] 20 hours. They are then checked to see if any have fertilised. Those that have been fertilised (now called embryos) are grown in the laboratory incubator for up to five days before being checked again.
The best embryos will then be chosen for transfer. The law allows a maximum of two embryos for women below 40 years of age and maximum of three embryos for women of 40 years and above. Embryo transfer is a simple and painless procedure, which involves the transfer of fertilised embryos via a fine catheter inserted through the cervix into the uterus. Embryo transfer is usually carried out with the use of an ultrasound scan. Following embryo transfer you will undergo additional hormone treatment, receiving progesterone until a pregnancy test is performed 14 days after the egg collection.
After Embryo transfer
Progesterone can be administered as an injection, or vaginal or anal pessaries or suppository. You will return to the centre for a pregnancy blood test 14 days after the egg collection has taken place, regardless of whether you have begun a period. Following a positive pregnancy test, you will have a scan three weeks later. If the pregnancy test is negative, you will be offered a follow-- up appointment with either Mr. Shah or Mr. Gudi to discuss your future fertility options.
Are there any risks with IVF?
It is very important that you are fully aware of all the potential risks involved prior to going ahead with IVF treatment. The risks associated with IVF are : A mild reaction to fertility drugs may involve hot flushes, feeling low of mood or irritable, headaches and restlessness. Ovarian hyperstimulation syndrome (OHSS) is serious over– reaction to fertility drugs used to stimulate egg production. It can cause symptoms such as a swollen stomach, stomach pains, nausea, and vomiting. If you start to experience any of these symptoms you must contact the centre immediately. The risk of miscarriage following IVF is the same as in natural conception. There is a risk of ectopic pregnancy following IVF. When an embryo develops in your Fallopian tube rather than your womb the pregnancy is said to be ectopic. Ectopic pregnancy can cause vaginal bleeding and low pregnancy hormone levels. Hormone tests and scans are used to detect ectopic pregnancies and you should tell your doctor about any vaginal bleeding or stomach pain. The biggest risk associated with IVF is the risk of multiple pregnancies. Please refer to Information on the Risks of Multiple Births for more information.
What is Intra Cytoplasm Sperm Injection and how does it work?
Intra-cytoplasmic sperm injection (ICSI) involves injecting a single sperm directly into an egg to fertilise it. The fertilised egg (embryo) is then transferred into the womb a few days later. The development of ICSI means fertilisation is possible even with semen samples that have a very low sperm count. In vitro fertilisation (IVF) insemination, as opposed to ICSI, involves adding prepared sperm to a dish containing eggs. The sperm swims to the egg and attempts to fertilise it. ICSI may be recommended if there is any reason to believe eggs will not fertilise with conventional IVF.
The average fertilisation per egg injected is about 60-70%, and more than 90% of patients have at least one egg fertilised. There is no difference between ICSI and IVF in terms of the treatment you undergo. The only difference is in the way the eggs are fertilised.
Is ICSI for me?
ICSI is often recommended if other problems with the sperm have been identified, such
- Which prevent sperm binding to the egg
- Failure to fertilise or an unexpectedly low fertilisation rate (below 20%)
- Have been collected from the testicles or epididymis (TESA/PESA)
- And ejaculating, which may include men with spinal cord injuries and men with diabetes
Are there any risks with ICSI?
ICSI was introduced in 1992. As such it is unknown whether there are any long-term consequences for children conceived by ICSI. However, since the technique was introduced, thousands of healthy ICSI-conceived children have been born.
Risks that have been associated with ICSI
- Recorded in a very small number of children born using this treatment. However, underlying infertility, such as inherited genetic abnormalities, rather than the technique may have caused problems that have been linked with ICSI.
- A slightly increased risk of miscarriage, because the needle inside the egg and damaged eggs will not fertilise.
- Inherit his father’s infertility. It is too early to know if this is the case as the oldest boys born from ICSI are still in their teens.
A low sperm count caused by genetic problems could be passed on to a male child so you may wish to undergo genetic tests before going ahead with ICSI. Infertile men with a very low sperm count, or no sperm in their ejaculate, may be tested for cystic fibrosis genes and for chromosome abnormalities. You may want to discuss the full implications of taking these tests with your clinician or the centre’s counselor before going ahead.
On the day of egg collection the male partner, if applicable, will be asked to produce a semen sample. If you are using donor sperm, this will be prepared for treatment. A second sample may be needed that day if the first sample is not suitable or sufficient.
ICSI treatment is the same during and after embryo transfer as for routine IVF.
Occasionally eggs from one patient are split into two groups with one-half undergoing conventional IVF and the other half ICSI. The purpose of this is to determine whether or not fertilisation by conventional IVF is possible. We try to avoid this option where possible though as the Human Fertilisation and Embryology Authority (HFEA) Code of Practice only allows embryos from conventional and ICSI cycles to be transferred together in 2% of all ICSI embryo transfers at all licensed clinics. The decision depends upon the number of eggs and quality of sperm available, and the fertilisation outcome in previous treatment cycles, if available.
Intra Cytoplasm Sperm Injection (ICSI)
ICSI is generally performed following an in vitro fertilization procedure to extract one to several oocytes from a woman.
The procedure is done under a microscope using multiple micromanipulation devices (micromanipulator, microinjectors, and micropipettes). A holding pipette stabilizes the mature oocyte with gentle suction applied by a microinjector. From the opposite side a thin, hollow glass micropipette is used to collect a single sperm, having immobilised it by cutting its tail with the point of the micropipette. The oocyte is pierced through the oolemma and directed to the inner part of the oocyte (cytoplasm). The sperm is then released into the oocyte. The pictured oocyte has an extruded polar body at about 12 o’clock indicating its maturity. The polar body is positioned at the 12 or 6 o’clock position, to ensure that the inserted micropipette does not disrupt the spindle inside the egg. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.