IVF – In Vitro Fertilisation

The IVF treatment can be described as the uniting of egg and sperm in the lab. The embryos are transferred into the uterus through the cervix and pregnancy is allowed to begin. The process is done in conjunction with ovulation induction through drugs, monitoring of hormone levels and follicle scans via ultrasound.

‘In vitro’ is a Latin term literally meaning ‘in glass’. It refers to the glass container in the laboratory where fertilisation takes place. Although this is usually a dish, many people started referring to it as a test tube, which has led to the term ‘test-tube baby’. Thousands of IVF babies have been born worldwide since the technique was first used successfully in 1978.

Who is Suited to IVF?

  • Women with tubal problems, where the fallopian tubes are blocked or damaged, thus making it difficult for the egg to be fertilized or for an embryo to travel to the uterus.
  • Where a man may have a low sperm count, problems with sperm function or motility which can inhibit sperm from fertilizing an egg on its own.
  • A woman who has severe endometriosis which affects both fertilization of the egg and implantation of the embryo in the uterus.
  • If a woman has ovarian issues which prevent the release or production of eggs.
  • An abnormal uterus shape or fibroid tumors is found in a woman.
  • Or if there is unexplained infertility.

The IVF Process

1.       Ovulation Induction

Ovulation induction is the first stage. It is a type of medical therapy often performed alongside certain fertility treatments. Typically, medications that are used to help trigger the development of egg follicles are known as ovulation inducers. Ovulation induction can trigger the development of more than one egg during ovulation.

So ovulation is induced to help women who cannot ovulate regularly to produce an egg. Ovulation induction is also used to trigger the ovaries to release more than one egg during ovulation. Sometimes, inducing ovulation can allow two or three eggs to be released at once, therefore increasing your chances of pregnancy.

A variety of drugs are used and the doctor will decide which combination is most appropriate for you. You will be closely monitored while you are on these drugs because each woman responds to them in different ways and some have strong side effects.

Timing is very important when it comes to the IVF process. If the follicles develop too much then the egg inside will become too mature, which can seriously affect the IVF process. Therefore your ovaries will be monitored for the follicular development. This is typically done through ultrasound. When your follicles reach just the right maturity, egg retrieval can begin.

2.       Egg Retrieval

Egg retrieval is the process whereby a woman’s eggs are removed from her ovaries. These eggs are later mixed with a man’s sperm to facilitate fertilization. Follicles from both your left and right ovary will be removed in a process known as follicular aspiration. At the time of egg retrieval, you’ll be given a sedation anaesthetic.

During follicular aspiration a hollow needle is inserted through the top of the vagina and into the ovaries. This needle is then used to suction out any follicles that may be present in the ovaries. A transvaginal ultrasound will be performed to guide the needle into the appropriate area of the ovary. This will allow the doctor to insert the needle into your ovary at just the right place.

Once the needle is in the proper position, the doctor will use it to aspirate any follicles inside of the ovary. These follicles will be immediately examined under a microscope to ensure the presence of a viable egg. The follicles will then be placed in an incubator.

You may have between 5 and 20 eggs removed during the egg retrieval process. The quantity will depend on your age and the effect of the fertility medications,

This process typically takes between 15 and 30 minutes.

3.       Embryo Culture

Embryo culture is the process that immediately follows egg retrieval. It is during this process that your eggs and your partner’s sperm will be combined in order to produce a fertilized egg (known as an zygote). Once a zygote has been formed, the culture process will continue in order to encourage the growth of the zygote into an embryo. The embryo culture process lasts from 2 to 5 days and is vital to the success of any IVF procedure. Without accurate and controlled embryo culture, IVF transfer may not be successful.

4.       Fertilisation

Any aspirated follicular fluid will be transported to our laboratory immediately after the IVF retrieval. In the lab your follicular fluid will be examined under a microscope, in order to identify all eggs that are present. Each egg and its surrounding cells will then be washed in a special medium, in order to remove any toxins and impurities. The eggs are placed in separate dishes and transferred to a special incubator containing carbon dioxide. The eggs will remain in this incubator until fertilization is ready to take place. This usually happens between 2 and 6 hours after egg retrieval, depending upon the maturity of the eggs.

Your partner’s sperm will have to be washed and divided up into specific amounts. The matured eggs will each be combined with some of your partner’s sperm. The sperm and egg will be combined in a dish that contains special culture medium. This culture medium is designed to help the embryo during the first days of division. The dish is then placed back inside of the incubator.

Your developing embryos will be monitored carefully by an embryologist. After 24 hours of development, the embryologist will make the first check on your embryos. Your embryos will still be single cells. However, they will contain two clear bubbles (known as pronuclei) inside. These pronuclei are evidence that the embryo contains genetic material from both you and your male partner. Embryos without pronuclei are discarded.

Your embryos will then be left to develop for another 24 hours. At this point, embryos will be monitored for cell division. Most embryos have developed into two or four-cell embryos at this point.

5.       Embryo Transfer

During this final stage of the IVF procedure your embryos will be transferred into your uterus, in the hopes that you will become pregnant. Between 2 and 4 embryos are transferred during each IVF cycle. The number of embryos to be transferred will depend on the following factors:

  • the number of embryos formed after egg retrieval
  • the health of your embryos
  • your age
  • your risk level for multiple pregnancy

You and your partner will be asked to come in an hour before the transfer procedure. Your embryologist will let you know which embryos are the healthiest to have transferred into your uterus and how many embryos should be transferred. You and your partner will be able to see pictures of your embryos before the procedure begins.

Once your embryos have been selected, they will be immersed in a fluid and stored in a special catheter. You will be asked to lie down on an examination table and a speculum will be inserted into your vagina for the doctor to access your cervix. Your cervix will be cleaned of any cervical mucus, which could interfere with the placement of the embryos. A flexible, rubber catheter will then be inserted into your cervix and up into your uterus. The catheter containing your embryos will then be placed inside of this rubber catheter.

The doctor may perform an abdominal ultrasound in order to determine the best place inside of your uterus to deposit your embryos. This is usually in the space at the very top of your uterus. Once this location has been found, the embryos will be pushed out of the catheter and into your uterine lining.

What happens after the embryo transfer?

Your embryo transfer will be performed at the clinic and is a completely painless procedure, and you may receive some medication to relax the uterus.

It is usually recommended that you take it easy for a couple of days after the transfer. After 48 hours though, you can resume your normal activities as these will not affect implantation in anyway. You will be given progesterone supplementation which is to be used timeously. In 12 days, you and your partner will return for a blood test to find out if you are pregnant.

Remaining Embryos

Typically, most couples have leftover embryos remaining from the IVF process. You and your partner will need to decide what you would like to do with your embryos. There are a number of available options, including embryo cryopreservation and embryo donation. These options allow you to store your embryos for your own future use or to help other couples who are suffering from infertility to conceive

How long will treatment last?

One cycle of IVF takes 4 to 6 weeks to complete. You and your partner could spend about half a day at the clinic for the egg retrieval and fertilisation procedures. You’ll go back 2 to 3 days later for the embryos to be transferred to your uterus.

What is the success rate?

The success rate can vary depending on your fertility problem and your age. Younger women usually have healthier eggs and higher success rates. The national average success rate is around 35-40 per cent. This represents your average chance of delivering a healthy baby for each cycle of treatment.