In Vitro Fertilisation (IVF) is the process of fertilising eggs outside the body. Our individualised approach means that every couple will vary in how their treatment is planned and managed.
Prior to commencing any treatment at ARGC, we usually undertake a monitoring cycle on the female partner. This takes one month to complete. It involves measuring the hormones at the beginning of the cycle (day 2 or 3 of the period), a pelvic ultrasound scan mid-way through the cycle, and further hormone tests in the latter part of the cycle. This monitoring enables us to determine the ovarian reserve, asses the development of the uterine lining and identify the presence of any pelvic pathology if present. It also enables us to select the best protocol to use for your ovarian stimulation.
During the monitoring cycle we will also undertake any further investigations that may be required.
During the menstrual cycle, eggs develop in fluid-filled sacs within the ovary, known as follicles. In any natural ovulatory cycle, a woman normally releases one egg from a single follicle each month.
In IVF, however, fertility drugs are given to encourage the development of more than one follicle during the treatment. This process is called controlled ovarian hyperstimulation. The response to medication is generally determined by the antral follicle count which is assessed by ultrasound scanning. It is also determined by measuring the baseline hormone levels (day 2-3 of the cycle ) and the anti-Mullerian hormone (AMH). This assessment will help us to determine your drug protocol during the treatment.
Younger women and those who are likely to respond well to ovarian stimulation will be usually given drugs to suppress their own hormones prior to the commencement of controlled ovarian hyperstimulation. This is known as down-regulation, and it usually lasts around two weeks.
At the ARGC, we closely monitor our patients during the ovarian stimulation phase (which typically lasts between 10 – 14 days). This involves daily (and sometimes twice daily blood tests) and scans on alternative days. We adopt a flexible and individualised approach for each patient throughout the course of their treatment. We remain open all year round which enables us to do the very best for our patients whenever required.
When the follicles have reached the optimum maturity, an injection of HCG is administered in the evening and egg retrieval will take place around 36 hours later.
Following the administration of the HCG injection, ovulation will normally occur 36 – 38 hours later. Egg retrieval is therefore scheduled to take place just prior to ovulation. The eggs are collected vaginally under mild sedation using a fine, hollow needle guided by ultrasound.
Around the same time as the eggs are being retrieved, the male partner produces a semen sample. Frozen or donor sperm may also be used.
The eggs and the sperm are prepared in our laboratory and then put together in a petri dish. As in natural conception, once the eggs have been exposed to the sperm, many sperm will attach themselves to the egg and one sperm will usually enter it. This process is known as fertilisation and creates the embryos.
In some cases, particularly those associated with male sub-fertility, a variant of IVF known as intracytoplasmic sperm injection (ICSI) is used to achieve fertilisation. This involves the microinjection of a single sperm into each mature egg.
Following fertilisation, the embryos are then cultured in our laboratory under optimum conditions, which mimic the natural environment. Whenever appropriate, we aim to culture the embryos for five/six days, by which time, having reached the ‘blastocyst’ stage, it becomes easier to select the best embryos for transfer (which is likely to improve the chances of success).
The embryos are cultured in our laboratory and checked regularly by our embryologists to make sure they are developing normally. Whenever appropriate, we aim to culture the embryos for five/six days, by which time the embryos will have reached the ‘blastocyst’ stage, which will help us select the best embryos for transfer. If only a small number of embryos (less than four) are available, then the embryo transfer will be scheduled for day 2 or 3 following the egg collection.
Depending on the age and the individual characteristics of the patients, between one and two (occasionally three) embryos are selected. They are then transferred to the uterus using a soft catheter which is gently passed through the cervix. We always adhere to the professional bodies' criteria which determine the number of embryos to be transferred to each patient. Those criteria are based on the patients' age, their past reproductive history, and the quality and number of the embryos available for transfer.
Embryos that are not transferred will be assessed for suitability to be frozen for future use in a frozen embryo treatment cycle.
Our practice of close monitoring continues after the embryo transfer. We routinely aim to assess the subtle changes in the patient's hormone levels during this critical time of implantation prior to the pregnancy test. Medications are often adjusted as a result.
Patients are then asked to undertake a blood test (not urine) to measure the level of HCG (human chorionic gonadotrophin) fifteen days following egg collection. HCG is the hormone produced by the pregnancy and is more accurately assessed quantitatively by a blood test.
Should the test be positive, then we continue to monitor the rise of those levels on more than one occasion to establish a healthy pattern. We may also request other tests in order to make sure that the medication prescribed in early pregnancy is appropriate.
We remain in touch with our pregnant patients throughout the course of the pregnancy, often adjusting their medication and providing advice whenever necessary.
Should the test, unfortunately, be negative then we would invite the patient to attend a follow-up consultation. This is usually free of charge should it take place within six months of the treatment cycle.