In Vitro Fertilisation (IVF)

IVF is a treatment option used for couples with infertility that cannot be treated using simple methods.

Step One

Ovulation Induction

Hormone injections are given to stimulate multiple egg production. This is because the normal cycle usually produces one egg only and pregnancy rates in IVF are better if a number of eggs can be collected. These injections are usually given sub-cutaneously (under the skin) and are much less uncomfortable than previous generations of medication. We then monitor the progress of ovulation induction with ultrasound and measure of blood oestrogen levels over several days.

Step Two

Egg Retrieval

Egg retrieval is performed by inserting a special needle into the ovarian follicle and removing the fluid that contains the egg- a relatively minor procedure which is performed by visualising the follicles with a vaginal ultrasound probe. A needle is directed alongside the probe, through the vaginal wall and into the ovary. A strong, short acting intravenous sedation is provided so any discomfort can be avoided.

Step Three

Fertilisation and Embryo Culture

Once the follicular fluid is removed from the follicle, the eggs specified by the embryologist are placed into an incubator. The eggs are fertilised with sperm later that day by conventional insemination or by Intracytoplasmic Sperm Injection (ICSI)

During conventional insemination, approximately 50,000 sperm are placed with each egg in a culture dish and left together overnight to undergo the fertilisation process. The ICSI technique is used to fertilise mature eggs in the event of sperm or egg abnormalities. Under the microscope, the embryologist picks up a single sperm and injects it directly into the cytoplasm of the egg using a small glass needle

ICSI allows couples with very low sperm counts or poor quality sperm to achieve fertilisation and pregnancy rates equal to traditional IVF. It is also recommended for couples who have not achieved fertilisation in previous IVF attempts. Special urological procedures are available for cases where it is difficult to obtain sperm or for men with no sperm in their ejaculate

The eggs will be checked the following day for fertilisation and again the next day for early cell division. Until recently, embryos were cultured for three days and then transferred to the uterus and/or cryo-preserved (frozen). We now have the ability to grow the embryos for five or six days until they reach the blastocyst stage. For some couples, these blastocysts may have a greater chance of implantation, permitting us to transfer fewer embryos and to lower the risk of multiple births while, at the same time, increasing the chance of pregnancy

On day 2 or 3 following fertilisation, the embryos will be evaluated for blastocyst culture. If there is a sufficient number of dividing embryos, they will be placed in special blastocyst media and grown for two or three additional days.

Step Four

Embryo Transfer 

Embryos may be transferred on day 3, 5 or 6 following egg retrieval. Transfers on day 5 or 6 are called blastocyst transfers. They are placed through the cervix into the uterine cavity using a small, soft catheter. This procedure usually requires no anaesthesia. It is similar to the Mock Embryo Transfer which will be performed prior to the actual IVF cycle.

The essence of the IVF procedure is to get mature oocytes from female ovaries and to fertilise these oocytes with the husband’s spermatozoa (or donor sperm, if both spouses agree) and to develop in the incubator the embryos created for a period of 48-72 hours and then to transfer the embryo to the patient's uterus.

Starting from day 2 of the menstrual cycle, the patient receives stimulating tablets and injections. When placed into the ovaries, this helps to produce as a rule not one but several oocytes.

In ultrasonic examinations of ovaries and uterus conducted approximately from the day 8 to the day 14, a doctor cares for the growth of the follicles in the ovaries and the oocytes maturing in them. At some point of the cycle (from day 10 to 16) injection is prescribed, which determines the moment of the final maturing and punction of the follicles.

In the thirty-six hours after that injection, all oocytes are taken from the patient (these oocytes are sucked out using the thinnest possible needle) and on the same day the man donates his sperm for IVF completion.

Before fertilisation, the sperm needs to be handled carefully to obtain as much active spermatozoa as possible, to clean them of semen plasma, leukocytes and other sperm elements which can affect the fertilisation.

Following this processing, spermatozoa will be added to the wife's oocytes. Oocytes rest in the nutrient medium in special 4-well dishes. These dishes with oocytes and spermatozoas (with detailed data about husband and wife) will then be placed into the incubator. Electronic devices control strictly the temperature, humidity and composition of the atmosphere, which is necessary for normal fertilisation and embryo growth.

After 18 hours, the embryologist selects dishes from the incubator to define whether fertilisation has taken place. If fertilisation has been completed successfully, oocytes will be placed into a special nutrient medium where oocyte cleavage takes place which means they become embryos. This process takes an additional 16-18 hours.

Embryo transfer to the patient's uterus will be undertaken, if the embryologist sees normally growing embryos. Embryos should become acclimatised in the uterus. In a successful case, 3 weeks after embryo transfer, ultrasonic studies are undertaken to check the number of implanted embryos.