Fertility Treatment: IVF

Approximately 85% of couples will achieve a spontaneous pregnancy within twelve months of unprotected intercourse. If pregnancy has not been achieved in this period of time, this is termed infertility.

In-Vitro-Fertilization (IVF) is one form of treatment for infertility and involves four basic steps: ovarian stimulation, egg collection, fertilization and finally embryo transfer. You will receive a detailed treatment schedule prior to commencing treatment.

THE IVF CYCLE

Ovarian stimulation

In IVF, the ovaries are stimulated to produce a number of eggs with a medication known as follicle stimulating hormone (FSH: Gonal F or Puregon). This medication is given as a self administered injection.

The response of the ovaries is monitored carefully by blood tests and/or transvaginal ultrasound scans over a period of nine to twelve days, involving a number of consultations with your specialist. These visits are usually short and are conducted early in the morning to minimise any impact on your daily routine. The scans and/or blood tests assess the number and size of the follicles and judge the timing of egg collection. About 36 hours before the egg collection is due, an injection of human chorionic gonadotrophin (hCG: Pregnyl) is given to initiate the final process of egg maturation.

The process of stimulation is usually combined with another medication (either as an injection or a nasal spray) that gives the specialist complete control over your hormones. This process is known as pituitary downregulation and is required to stop your body inducing premature ovulation. Downregulation is usually confirmed with a blood test or an ultrasound scan prior to commencing FSH treatment.

Egg collection

Egg collection is performed under a general anaesthetic using a vaginal ultrasound probe in an operating theatre. A needle is guided through the top of the vagina into the ovary and each follicle is aspirated using a suction device. Each egg is assessed by a scientist. In some circumstance, the egg collection may be performed under sedation.

Fertilisation

The eggs are identified in the laboratory and placed in culture dishes in an incubator. The male partner produces a semen sample (usually by masturbation), which is then prepared in the laboratory. Motile sperm are extracted and used to fertilize the eggs some hours later. Sometimes, if the quality of sperm is poor, a single sperm may be directly injected into an egg (Intracytoplasmic Sperm Injection – ICSI).

It takes about 18 hours for fertilization to be completed. Approximately 12 hours later the embryo starts to divide. Two or three days after egg collection, the embryos have reached the 2 - 6 cell stage. At this point, they are ready to be replaced into the woman's uterus.

Embryo transfer

This procedure is performed in the day theatres without anaesthetic or sedation. It may be performed under ultrasound guidance, and if so, you will be instructed to fill your bladder prior to the transfer. The procedure is virtually painless, similar to a gynaecological examination or a Pap smear. A maximum of two embryos may be replaced but couples should consider the replacement of a single embryo to prevent a twin pregnancy. Hormone supplementation in the form of hCG injections, progesterone pessaries or pessaries may be required after the embryo transfer to support the uterine lining. This is known as luteal support.

Embryo freezing and subsequent cycles

Spare embryos may be frozen and stored for future use. However, not all surplus embryos may be suitable for freezing and not all may survive the procedure. Should you not have conceived in the first cycle, you will need to contact the office as soon as your period starts. No drugs are usually required in a frozen cycle. The time of ovulation will be determined by an ultrasound scan at approximately twelve days after the start of your cycle and daily urine monitoring for the LH surge, which signifies impending ovulation. This is then confirmed by a blood test. The embryo is then transferred depending on the time of freezing.

Further Information www.qfg.com.au