In vitro fertilisation (IVF) also called ‘test tube baby treatment’ is a treatment that has helped several thousand couples achieve the joys of parenthood. This information will tell you about the treatment this clinic offers with regard to IVF. If you have had this treatment elsewhere, some of what you read will be familiar, but the techniques we use may not be the same. IVF is carried out by a team consisting of gynaecologists, nurses, embryologists, semenologists and counsellors. Most of all these individuals will at some time be involved in your care.
What happens during IVF preparation treatment?
Before starting IVF treatment blood tests will need to be taken from each partner. The female partner will need screening for:-
- Rubella (German measles)
- Early follicular phase FSH (cycle day 1 – 4)
- Anti Mullerian hormone – this test has been commercially available since around 2008. It appears to give a much better indication of egg quality and hence chances of conception than FSH
- Hepatitis B
- Hepatitis C
- The male partner will need blood tests for:-
- Hepatitis B
- Hepatitis C
- Karyotype and cystic fibrosis (if sperm parameters are below average)
Preparation for treatment In order to take control of your ovaries during an IVF treatment, you will need to take some injectable drugs to switch off your own hormones. One of these drugs needs to be given on a daily basis starting about a week before your next expected menstrual period and continued through to the end of the stimulation phase of treatment. Alternatively a different drug can be given by injection on a daily basis from day 5 of ovarian stimulation through to the end of the stimulation phase of treatment. The type of medication used in your treatment cycle will be decided upon depending on your individual clinical situation and tailored to your requirements. The aim of both of these drugs is to stop you ovulating before the planned egg collection.
During a normal menstrual cycle 1 or occasionally 2 eggs are produced and mechanisms within the body stop the development of other eggs. However, during IVF treatment we wish to stimulate more eggs so that there is a greater chance of producing a healthy number of embryos.
Ovarian stimulation involves a daily injection of follicle stimulating hormone (FSH). The fertility drugs will need to be given every day for about 10 to 12 days. Most women prefer to give their own injections or ask their partners to give them. We provide a training session to show you how to give the injections which are given just under the skin either in the thigh or abdominal wall.
Approximately 36 – 37 hours after the HCG injection an egg collection procedure will be performed. In order to minimise any discomfort or distress that this may cause, you will be given intravenous sedation by a consultant anaesthetist. A fine needle is passed alongside the transvaginal ultrasound probe through the skin at the top of the vagina and into the ovary. The fluid in each ovarian follicle is gently extracted and given to the embryologist for examination. The procedure takes between 10 and 30 minutes.
Embryo tansfer normally occurs between 3 and 5 days after egg collection.
Fertilisation of the eggs is checked the day after the egg collection. Only eggs that appear to be fertilised normally are cultured in a specialized incubator that allows them to be monitored undisturbed. Computerised imaging using a system called Embryoscope helps determine which are the best embryos to replace.
In order to reduce the number of twin pregnancies (and hence the number of complications in pregnancy), it is recommended that only 1 (or sometimes 2 embryos) are replaced. The procedure is normally quick and painless.
A fine plastic tube containing 1 or 2 embryos is passed through the neck of the womb (cervix) and placed high into the womb. The embryos are placed in a special chemical called “embryo glue” to help them implant in the endometrium.
After your embryo transfer you will be given advice about your aftercare before going home.
It is recommend that you take a hormone called progesterone until you perform a pregnancy test 14 days after embryo transfer. Progesterone can be given in the form of a pessary/suppository, gel or more popularly now an injection. These drugs are used to ensure that the most favourable environment for implantation of embryos is present. If your pregnancy test is positive, you are recommended to continue progesterone treatment until week 12 of the pregnancy.
This can be performed 2 weeks after the embryo transfer process. We would recommend that you perform this on an early morning specimen of urine. Pregnancy tests can be performed in the privacy of your own home or at the unit depending on your wishes. We ask you to contact us with the result of your pregnancy test to arrange appropriate care. If you are pregnant we will be able to offer pregnancy advice and arrange for you to receive antenatal care.
If the treatment has not worked, there may be information that we have gained from the treatment cycle that may explain why you may not have become pregnant and there may be information that will alter the course of management in a future treatment cycle. If at any time you have any questions or queries, please do not hesitate to contact the clinic. If at any stage you wish to see one of our counsellors, this can be arranged.