What is involved in IVF and when should you seek IVF treatment?
The main strategy in IVF treatment is to stimulate the ovaries with hormones to produce multiple follicles containing eggs. These eggs are retrieved and mixed with sperm and embryos are generated.
Couples may that have been trying to fall pregnant for one year and have not fallen pregnant are advised to seek medical advice. Women over the age of 35 should consider infertility treatment earlier and seek professional advice from an IVF specialist. Gynaecological examination is very important in the research of infertility. The cervix as well as the structure of the uterus and ovaries is observed with the aid of an ultrasound during an examination.
The goal in infertility treatments is to determine the causes of as to why pregnancy is not achieved naturally and to administer the treatment at the appropriate time via the appropriate technique for the patient. The first meeting with a specialist, is where the patient is given the information about the tests that need to be performed so a diagnosis can be made and why pregnancy has not been achieved naturally can be understood.
IVF is the method, which involves creating an embryo in laboratory conditions, and transferring this embryo to the uterus on the appropriate date.
IVF treatment is a process which starts on the 2nd or third day of menstruation (depending on protocol) of the woman and ends with embryo transfer. In some cases, some preparatory treatments can also be done before the start of a bleed. IVF treatment can average to 15 to 18 days depending on protocol.
Stages of IVF treatment
The first consultation with your doctor and initial analysis that will take place before IVF treatment is started, this is very important. Couples will be asked to undergo tests including hormone tests, thyroid test, prolactin etc., FSH/Estradiol or AMH to assess egg capacity and Hysterosalpingography – (HSG) for the female, and a sperm analysis (spermiogram) for the male. A complete gynaecological examination and vaginal ultrasound will be carried out in order to decide on the most appropriate and individualised treatment protocol and timing. This process will identify whether or not there is any condition that would prevent treatment or if there is any problem that should be treated. In some cases hormone medication will be given in order to ensure cycle synchronisation. It is at this stage that a professional relationship can be formed with both the Doctor and the specialist nurse in charge of your care.
Drug induced ovarian stimulation will begin during your menstruation (usually within the first three days of the period). The drugs are administered via injections into the abdomen using a very short and fine needle. Once the first dose is administered and the injection procedure is explained, some patients may inject the remaining doses themselves, or if they request, can attend the clinic on a daily basis for the specialist nurse to do so. Although some variations occur from person to person, the stimulation treatment generally lasts 8 to 12 days. On certain days during the ovary stimulation procedure, scans are required in order to monitor the follicular development. The examination involves an ultrasound screening to evaluate the quantity and size of the developing follicles (fluid filled pouches inside the ovaries, which may contain an egg).
Blood tests (for Oestradiol and progesterone) maybe required especially on the final days of the treatment injections. The ultrasound and blood test results will help determine the best date for administering the ovulation injection (trigger) and egg collection.
If an adequate size and quantity of follicles (at least three,18 mm in size) can be seen in the ultrasound and blood hormone levels are suitable, then, in the final stage, a injection to cause ovulation (generally containing human chorionic gonadotropin- HCG) will be administered to ensure control the ovulation time. The timing of this injection is very important because egg collection will commence 35-36 hours after. Egg collection is performed under anaesthesia, the patient is sedated with a very mild anaesthetic, and follicle fluids around the ovaries will be aspirated with the help of an ultrasound to guide. The embryologist will then separate the eggs inside the follicles under a microscope, providing an oocyte count for the doctor and patient.
Approximately 2 hours after collection, the embryologist will re-evaluate the eggs under a microscope and perform the ICSI or IVF procedure on mature eggs (in metaphase 2). Once this is performed the embryos are monitored for fertilisation.
We prefer ICSI at our laboratories because success rates are higher
The day after egg collection (about 16-18 hours after collection), embryologists will assess how many of the eggs are fertilised before storing them, in an appropriate environment for daily assessment of embryo development under a microscope. Transfer usually takes place 3 to 5 days after egg collection. However, on some occasions embryos will be frozen because the transfer might have to be postponed due to multiple egg development (OHSS) and high Oestradiol levels. The patient’s bladder must be full for the procedure as this assists to straighten the cervix for ease of transfer and highlights the endometrium better. Once the patient is on the examination table, under sterile conditions a speculum will be inserted into the vagina to reveal the cervix. Embryos are then transferred into the uterus using a very fine specialised catheter. The transfer procedure is painless and does not require anaesthesia (slight sedation-anaesthesia might be necessary for patients who will not even allow vaginal examination- like patients suffering from vaginismus). After the transfer it is better to rest for between 30- 60 minutes, during this time the patient will be provided with detailed information about points of consideration and medication. A pregnancy test (Beta Hcg) or early morning pregnancy test may be performed 12 days after the transfer to determine if conception has been achieved.
IVF Treatment Methods
IUI method is an assisted reproductive method performed on patients who have not been able to fall pregnant despite regular unprotected sexual activity for a year and has received the diagnosis that they are infertile. Insemination method is quite simple and is almost painless application compared to other methods. Once the necessary controls and checks are in place i.e. the fallopian tubes are checked and are clear and open (with the aid of an HSG), sperm is active with a high count and motility and the ovaries seem to be developing follicles and there is no problem with ovulation. The next process would be to track follicular development after 7 days of a bleed and when ovulation occurs to inject the prepared sperm (prepared in the laboratory) via the uterus. If the sperm fertilises the egg itself then IVF is not necessary.
IVF is the procedure of creating an embryo in laboratory conditions and transferring the embryo to the uterus. In the conventional IVF method the egg collected from the female is brought together with an adequate quantity of sperm from the male in special laboratory conditions allowing the fastest and most fertile sperm to enter the egg naturally. About 16-18 hours will be allowed for fertilisation and then the situation will be evaluated under microscope. However this treatment method requires an adequate quantity of sperm and eggs. The method may fail if sperm quality or quantity is poor or if egg quantity is inadequate
In the ICSI method the only difference from conventional IVF is the method of fertilisation. In this method an embryologist uses specialised needles to inject only a single sperm into each egg. The fertilised egg is put into a special culture environment and will be examined about 16-18 hours later to see if fertilisation has been achieved. The procedure increases the chances of fertilisation and therefore conception especially in couples with male side factors (poor sperm count and motility) or inadequate egg quantity.
The IMSI method allows a much more accurate sperm selection by examining the sperm under considerably greater magnification (x6000-x8000). By doing this IMSI increased chances of success for couples suffering especially from sperm defects. Remaining IVF stages and microinjection procedures are exactly the same.