In Vitro Fertilization is a technique of reproduction that occurs under laboratory conditions when self-conception does not take place or in cases where follow-up treatment (such as vaccination) does not result in a viable pregnancy.
Fertilisation is when the sperm of the partner is microinjected (ICSI) into his partner`s eggs, the injected eggs are then left in an incubator over night to fertilise. In short the fertilised embryo is developed in laboratory environment and on a certain day of development is then injected back into the female.
What are the stages involved in IVF treatment?
The female and male should be assessed by a medical professional. Certain blood tests are needed to assess fertility levels in a couple.
Examples of blood tests for the female are Anti Mullerian Hormone (AMH), TSH, Prolactin etc. as well as gynaecological examinations, a trans-vaginal scan to monitor the egg reserve and a Hysterosalpingogram (HSG) to check the fallopian tubes and uterus. Male require blood tests but most importantly a Semen analysis. After the tests, if there is a problem then they will be corrected and then look to begin stimulation.
Based on the results from the blood test assessment and scans, a medication protocol is designed for the female, this will be daily hormonal injections with a combination of vitamins to stimulate the antral follicles and enable the follicles to grow. There are two types of stimulation protocols, Long and Short, the preferred protocol is generally the Short protocol (Antaggonist) as stimulation will begin on day two or three of the menstrual cycle and will last between 11-13 days. Ultrasounds and blood tests will be needed at certain stages of the stimulation, so the female will be closely monitored to check follicle development.
The hormone stimulation is a series of hormone daily subcutaneous injections (GnRH) and these encourage the eggs in your body to grow but the dose of the medication is also dependent on factors such as how may potential antral follicles are present, height and weight.
Trigger injection ready for Egg collection
Once the stimulation process is completed and the follicles are of a certain size to be triggered, the last injections are applied and these are to invoke ovulation and also help to increase the number of mature eggs collected. There are two different types of trigger injections that can be used individually or in combination (containing hCG / containing GnRH analogue) but these injections are also sold under different brand names in different countries. Based on your follicle development, your doctor will determine which trigger injections should. Egg collection (OPU) is performed, 34-36 hours after the trigger injection is administered at a certain time.
The egg collection itself is a very straight forward procedure, and anaesthesia is used to sedate the female, to make the egg collection less stressful. Prior to the egg collection we need the female to be nil by mouth (no food or water) for 4-6 hours because anaesthesia will be administered intravenously.
On the day of the egg collection, the sperm sample will also be needed we recommend a minimum of 2-3 days abstinence. The sperm sample will then be processed within the laboratory and then the one good looking quality sperm will be injected into each mature egg.
After the egg collection procedure, a new medication protocol will begin (e.g. Progesterone) to prepare the body for the transfer of the embryos to maximise the chances of pregnancy.
The fertilisation of bringing the egg and sperm together is carried out by the embryologists within the laboratory, there are different techniques that can be carried out:
In Vitro Fertilisation Method: The mature egg is placed in a laboratory dish with some of the sperm sample, they are left for 16-18 hours within the incubator and then monitored under a microscope to see if fertilisation has taken place.
Intra Cytoplasmic Sperm Injection (ICSI) Method: In this method, once the eggs are removed, each egg is placed under the microscope and a single sperm selected is microinjected by the embryologist into the mature egg. Nowadays this is the preferred technique as it maximises the chances of fertilisation. The eggs are left within the incubator and 16-18 hours after the microinjection, the eggs are monitored to see if fertilisation has taken place.
IMSI (Highly Powered Microscope to Select Sperm for Microinjection): The IMSI method is a technique used for selecting sperm in couples who have poor quality sperm, allowing more detailed evaluation of sperm the microscope magnifies the sample to enable the best looking sperm to be selected for microinjection. With this method, the anomalies of the head, tail etc. of the sperm cell are individually assessed, as they are magnified 6000-8000 fold, this means that sperm can be detected more precisely.
After Microinjection, the dishes are labelled and stored within special incubators with the patients ID and 16-18 hours after injection they are monitored to determine whether fertilisation has taken place.
Your doctor will advise you (based on embryo development) which day the transfer will be best to be carried out. Depending on egg count or endometrium thickness, your doctor may decide to freeze the embryos for transfer at a later stage.
If the embryo transfer process is carried out in the same cycle the transfer will take place on day 3 or on day 5 post egg collection. The day of embryo transfer will be determined by the physician and embryologist, taking into account the number of embryos, their quality and they will take into account your previous treatment results.
If after the embryo transfer, you have more good quality embryos, these can then be frozen for future transfer attempts.
The Transfer procedure is a straight forward and painless procedure, it does not require any anaesthesia or sedation. Patients who are sensitive maybe sedated for the transfer if needed. The transfer is carried out with a full bladder, so you are requested to drink plenty of water before the procedure. Once the bladder is full the endometrium can be clearly identified with the aid of ultrasound guidance. The embryologist draws the embryo into a catheter and passes it to the doctor and with the aid of the ultrasound the catheter is guided by a nurse the catheter is placed on to the endometrium and the embryo(s) are released. After the transfer, you are taken to the room and are asked to rest for approximately 1 hour. After the transfer, and resting for one hour, medication protocol will be adjusted and you will be discharged from the Centre as you will be treatment as an outpatient.
On the transfer day, the date of when the pregnancy test should be carried out will be advised, it is usually 12 days post transfer when a beta HcG blood test is advised to be carried out.
The most important factors to succeed in IVF is the quality of embryos and of course the hormonal and immune system of the female body, as the balance in the body is needed for a viable pregnancy. Even though the success of In-vitro fertilization is related to the age of women, there are also other factors to consider when faced with a failed IVF attempts.
It is confusing for patients to be faced with exaggerated pregnancy success rates, which is irresponsible and unfortunately to mislead patients for commercial advertisement. However, we know that the success rate of in vitro fertilization is based on age of the female and the chances of pregnancy diminishes with age. Although there can be exceptional circumstances, the possibility of a woman conceiving with her own egg after 45 years of age falls to around 5%, according to scientific research. In addition, the chance of having an IVF pregnancy reaching around 70% in twenties decreases from the second half of the thirties.
In order to maximize the chances of success in vitro fertilization, we perform a preliminary examination in couples at our center and prepare them for treatment with the aid of vitamin supplements and nutritional changes. When choosing which month to start treatment, your doctor should advise when this is possible after certain tests (i.e. it is important to determine the right time in terms of uterus-ovary-hormonal status and sperm specimen). Regardless of the treatment process, the psychological state of the couple is of great importance in terms of the success of treatment. The body and spiritual integrity should not be ignored. In our center, we provide dietician and psychologist support in case of needed during treatment.