In-vitro Fertilisation (IVF)

Introduction

In-vitro fertilisation (IVF) is the union of a sperm and an egg (fertilisation) outside the body within a culture dish in a laboratory incubator. This treatment method first came to public notice in 1978 with the birth of the first test-tube baby, Louise Brown. All IVF treatment clinics in the UK are licensed and regulated by the Human Fertilisation and Embryology Authority (HFEA), which is a public body set up by an Act of Parliament.
IVF involves stimulation of ovaries with injections, collection of the eggs, mixing the eggs with sperm in a laboratory dish. The fertilised eggs develop into embryos which are transferred into womb.

The IVF process involves the following steps:

Stimulation of ovaries to produce eggs: this involves a course of injections for between 9 to 14 days, sometimes a little longer. You will attend the clinic for serial ultrasound scans to monitor the ovaries and the lining of the womb (endometrium)
Egg collection: The eggs are then retrieved from the ovaries under ultrasound control using a needle that is inserted through the vaginal wall. The procedure is carried out under intravenous conscious sedation.
Fertilization: The retrieved eggs are mixed with sperm in a laboratory petridish (‘Test tube’) in an incubator with the expectation that fertilisation will take place and lead to embryo development.
Embryo culture: The resulting embryos are cultured in the laboratory for several days (between 2 to 6 days) to allow them to develop.
Embryo transfer into the uterus: the number of embryos to transfer into the uterus varies between 1 and 3 depending on you age and clinical profile. In many cases, we recommend single embryo transfer in other to reduce multiple pregnancy which is associated with more risks to the mother and baby.
Surplus embryos of good quality can be frozen (cryopreservation) and stored for you if you wish and have given written consent.
Pregnancy test – 2 weeks after embryo transfer
Pregnancy confirmation scan 2-3 weeks after a positive pregnancy test

Each of the above steps will be explained in detail at the initial consultation and at the treatment planning appointment.

Steps prior to starting IVF/ICSI treatment

Consultation: with a consultant / specialist in Fertility and Assisted Reproduction to discuss your fertility and medical history to ensure that IVF/ICSI treatment is appropriate for you. It’s an opportunity for you to ask questions.
Treatment Planning: To talk you through the regulatory and St Jude’s consent forms. The preliminary tests will be carried out. At this appointment you will be given a treatment diary where you clinic appointments and te activities carried out are documented.

Preliminary tests include:

Blood tests for both partners for viral screening – HIV, Hepatitis B & C
Blood test for Anti-Mullerian Hormone (AMH) to assess the number of eggs in your ovaries
High Vaginal swab (HVS) to check if any silent infection which should be treated prior to treatment
Semen analysis
Other tests may be required depending of patient’s clinical diagnosis/assessment

Counselling

There are many things to consider before starting your treatment. You can access our counselling service before, during and after your treatment cycle. Information about how to contact the counsellor is included in your information pack.

Drugs used in IVF treatment

Different drugs (injections, vaginal pessaries, and others e.g. nasal spray or oral tablets) are used to:

Stimulate the ovaries to produce several eggs
To trigger ovulation
To support the womb lining for implantation of embryos
Other drugs may be required depending on clinical diagnosis and medical history

The drugs are started at different stages in the treatment process.

side effects of the drugs

Some women experience side-effects including headaches, mood changes, breast tenderness, bloating of the lower abdomen. These are often mild and short-lived and are no cause for concern. You may get bruising on the skin following the injections but this usually mild and soon settles.

Possible risks & complications of ivf/icsi

No eggs /poor quality eggs
Failure of fertilisation
Failure of embryos to develop
Ovarian Hyperstimulation Syndrome (OHSS):This complication arises if your ovaries respond excessively to stimulation. Young women with polycystic ovary syndrome are particularly at risk of OHSS. Clinically the condition is characterised by grossly enlarged ovaries, varying degree of fluid collection in the abdomen, abdominal swelling and pain. If there is significant risk of OHSS the treatment cycles the embryos created will be frozen and used for your treatment after an interval 2-3months.

What happens to surplus embryos?

If you have surplus embryos and provided they of suitable quality for freezing, they can be frozen and kept in storage for you if you so wish.

What is involved in embryo freezing?

Embryo freezing, also knows as embryo cryopreservation using the vitrification method. is a process in which embryos are preserved at very low temperatures of -196 degrees, using liquid nitrogen. The embryos are stored in special containers called cryovials. The frozen embryos are thawed for treatment when required. There is no guarantee that embryos will survive when they are thawed. In our clinic embryo survival rate is approximately 95%.

How long can embryos be stored?

The law regarding the duration of embryo storage has recently changed from 1^st July 2022, as such that embryos and gametes can now be stored for up to 55 years, in periods of 10 years or less.

You will be required to pay an annual storage fee for your embryos to remain in storage regardless of how many embryos you have stored. You will be contacted each year asking whether you would like to continue with storage, pay your annual fee and you may be asked to renew your consents if applicable.

You must inform the hospital if there is a change in your circumstances, e.g change of name, address, telephone number.

Pregnancy test

You will be given a date to do a pregnancy test about 2 weeks after the embryo replacement. If the test is positive we will ask you to return two weeks later for an ultrasound scan.

If you are not pregnant, you will be given an appointment to attend for review consultation to discuss any issues you wish to raise and / or to plan for future treatment.

Chances of success

This depends on your individual circumstances, e.g. your age, the cause of your subfertility and the sperm quality will influence the likelihood of success. Please see the attached information sheet for our success rates.