In Vitro Fertilisation (IVF)
In vitro fertilisation (IVF) is an assisted reproductive technology (ART) used to treat infertility that has failed to respond to other medical or surgical interventions. IVF literally means “fertilization in glass” and involves the fertilization of the egg by the sperm in an incubator outside the body, followed by transfer of the embryo back into the uterus.
Is IVF right for me?
IVF was developed to treat infertility caused by tubal damage, endometriosis, sperm disorders and unexplained factors. Whether the patient needs IVF will depend on the infertility diagnosis and the treatment plan required in addressing the condition.
Tubal factor/Sterilization
This can be for male or female.
Male Factor
Severe Endometriosis
The success rate of IVF is affected by several factors, a crucial factor being the age of the female partner.
Repeated Failed Insemination
Support is crucial as IVF treatment can be a very stressful and emotional.
Infertility and its treatment can be quite stressful from an emotional, physical and financial point of view. We encourage partners to be supportive and participate in the treatment process. It can also be helpful to develop a network of supportive friends and relatives.
The Process
IVF can be a lengthy and stressful process, but we’ve found that if our patients are prepared and know the process step-by-step, it’s a much smoother journey.
Follicle development or ovulation induction
On day 1 of menstruation an appointment should be scheduled for day 3. In an IVF cycle it is desirable for several eggs to mature simultaneously. To prevent early or natural ovulation a GnRH agonist or antagonist is used to temporarily turn off your own FSH and LH secretions. These medications are administered at various stages of the IVF cycle.
Daily Injections
Daily injections with FSH (Menopur, Gonal F, Fostimon or Puregon) is given for 6 – 8 days and most women administer it themselves. This stimulates the growth of several follicles instead of just 1 or 2. The response of the ovaries is monitored with ultrasound and will vary according to each woman’s ovarian reserve.
Egg retrieval
The egg retrieval occurs on the second morning after the injections (36 hours later). Egg retrieval is performed under conscious sedation by an ultrasound guided needle, puncture through the top of the vagina. The fluid is drained from each follicle and examined under the microscope, in order to determine the presence of an egg.
Fertilisation
The sperm sample is washed and concentrated, then added to the eggs a few hours after retrieval. The next day the eggs are examined for signs of fertilization. If the sperm sample looks normal 70% of eggs can be expected to fertilise. Not every follicle will contain an egg. Not every egg will fertilise. Not every egg that fertilises will continue to form a good quality embryo.
Hormone Therapy
The patient will receive a script for progesterone and an antibiotic to start on the evening of the egg retrieval. The embryologist will establish contact to schedule the date and time for embryo transfer.
Embryo transfer
Three to five days following egg retrieval the embryos are transferred to the uterus using a fine plastic tube. The exact number transferred depends on the patient’s age and embryo quality. This procedure takes only a few minutes and is usually not uncomfortable. The patient should report at the clinic with a full bladder at the given time.
(Optional) Embryo Freezing
Some couples have extra embryos that are suitable for freezing. The best quality embryos (those most likely to result in pregnancy) are usually transferred in the treatment cycle. To be selected for freezing, embryos must show minimal or no sign of fragmentation (cell breakdown) and no sign of abnormal development. Obviously not all embryos will meet these criteria. The patient is recommended to start with aspirin on the day of transfer (unless allergic) and to continue with the progesterone (Cyclogest).
Pregnancy test
The patient is advised to limit activity for 24 hours after the embryo transfer. Activity can be gradually increased over the next few days to non-strenuous activities. Some patients even return to work and continue with their normal routines.
Why does IVF fail for some people?
IVF was developed to treat infertility caused by tubal damage, endometriosis, sperm disorders and unexplained factors. Whether the patient needs IVF will depend on the infertility diagnosis and the treatment plan required in addressing the condition.
Embryo Quality
Many embryos are unable to implant after being transferred to the uterus as they are defective. Embryos are inspected in a lab and can look healthy, but may have defects that prevent theem from growing. In most cases this happens, it is down to the embryo and not the uterus.
Age of the Eggs
As a woman ages, the quantity as well as the quality of her eggs begin to decline. This has a significant effect on her chances of pregnancy with and without IVF. Older women have a better chance of success when using donor eggs rather than her own.
Ovarian Response
Sometimes, a woman’s ovaries fail to respond tp the IVF medication as they should and don’t produce multiple eggs. For women with high follicle-stimulating hormone levels or women over 37 years old, producing enough eggs may be difficult.
Chromosomes
If embryos have chromosomal abnormalities, it can result in IVF failure. This can be whether naturally conceived or in a lab. Chromosomal abnormalities are often the reason behind miscarriages and implantation failure during IVF. Women over 30 years old are more likely to experience chromosomal abnormalities in their eggs.
Smoking
If you are a smoker, you will likely be asked to quit smoking up to three months before the start of your IVF treatment. Women who smoke often need two times as many IVF cycles to conceive and are more likely to experience miscarriage.
Weight
If you are overweight or underweight, you should try to attain a healthy weight to increase the chances of a successful IVF treatment.
Contributing factors of IVF
IVF was developed to treat infertility caused by tubal damage, endometriosis, sperm disorders and unexplained factors. Whether the patient needs IVF will depend on the infertility diagnosis and the treatment plan required in addressing the condition.
Healthy Weight
Underweight or markedly overweight patients may have difficulties during the treatment cycle or a resulting pregnancy.
Non-Smokers
Women who smoke have a lower chance of becoming pregnant and higher rate for miscarriages.
Under 39 years old
The success rate of IVF is affected by several factors, a crucial factor being the age of the female partner.
Good Support System
Support is crucial as IVF treatment can be a very stressful and emotional.
Treatment Options & Techniques
There are different methods to approach IVF, and it’s not a once-size-fits-all solution. Treatment is customised to each patient’s needs.
ICSI (Intra-Cytoplasmic-Sperm-Injection)
This technique involves the embryologist picking up one sperm in a very fine needle and injecting it into the cytoplasm of an oocyte that is being held in position with a fine holding pipette. ICSI can also be applied to semen samples with a very low sperm count and/or poor motility or morphology.
Assisted hatching
Assisted hatching is usually performed on day 3 of embryo culture whereby three small openings are drilled into the zona pellucida of the embryo with the aid of a laser beam. This is done in order to assist the embryo with hatching once it has reached the expanded blastocyst stage on day 5 of embryo culture.
TESA
TESA can be applied as a diagnostic procedure to determine whether there are sperm in the testes of men with azoospermia (a condition whereby no sperm is present in the seminal fluid), or as a procedure to recover sperm from the testicles of men with obstructions or ejaculatory problems that cannot be treated by any other methods. TESA procedure involves a very fine needle being passed into the testicles under anaesthetic, in order to remove a tiny amount of material from the seminiferous tubules (network of tiny tubes where sperm is produced). These tubules are then processed in the laboratory and checked for the presence of sperm, which can be either used to fertilise eggs or frozen. Sperm retrieved from the seminiferous tubules in a TESA procedure are less mature and less motile than sperm found in ejaculated seminal fluid. As such, ICSI (Intra cytoplasmic sperm injection) – a specialised form of IVF is required to achieve fertilisation with TESA sperm. In some cases sperm need to be retrieved doing an open testes biopsy in theatre.