In Vitro Fertilisation (IVF)
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 around2008. It appears to give a much better indication of egg quality and hence chances of conception than FSH (only available on a self funded basis at the moment)
- 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. The other drug is given on a daily basis from day 6 of ovarian stimulation through to the end of the stimulation phase of treatment. The type of medication used in your treatment cycle will be discussed with you at your initial consultation. 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 or 11 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.
If you would prefer us to administer the injections we can make the arrangements for you. During the stimulation phase of the treatment you will need to attend the unit for ultrasound scans to monitor the ovarian and endometrial response. At the end of the stimulation phase we will instruct you to give a final injection of human chorionic gonadotrophin (HCG). This matures the eggs which should be ready for collection 36 hours later. Since we collect eggs in the morning, this means that your final injection will need to be given late at night, almost always somewhere between 9pm and 1am.
Approximately 36 hours after the HCG injection we will perform an egg collection procedure. 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. This will be discussed with you in more detail before you start your treatment. At the end of the procedure the embryologist will place the eggs in a transport incubator which the male partner will then take to the central embryology laboratory in Liverpool (HFEA Code of Practice 8th Edition, section 15: T105, T106, T107, T108.
Semen Sample on the day of the egg collection
The male partner will be asked to produce a semen sample. The samples can be produced in a dedicated facility around the time of the egg collection and transported with the eggs to the Hewitt Centre. It is important the semen samples are not transported in the incubator with the eggs.
In the laboratory the semen will be prepared and the eggs will be inseminated. The day after the egg collection the eggs will be examined to see if fertilisation has occurred. Either the nursing staff or embryology staff will telephone you to let you know how many of the eggs have fertilised normally the day after the egg collection.
All the embryo transfers take place at the Hewitt Centre in Liverpool. This normally occurs between 2 and 5 days after egg collection. Only eggs that are fertilised normally are placed into the womb. 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. After your embryo transfer you will be given advice about your aftercare before going home.
We recommend that you take a hormone called progesterone which is given in the form of a pessary/suppository until you perform a pregnancy test 14 days after embryo transfer. 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 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 unit. If at any stage you wish to see one of our counsellors, this can be arranged.