The London Women's Clinic

IVF/ICSI treatment stages

Your step by step guide to IVF

IVF ICSI

IVF/ICSI treatment stages

The first step

The first step is usually the hardest - making that initial call. But remember, you are not alone; simply phone us in the strictest confidence and one of our friendly team will help guide you through the options open to you.

Whether you have recently become concerned about your fertility or have had treatment elsewhere and want another opinion, we will do our best to help you achieve a successful outcome.

We can generally offer an initial consultation within a few days, and for your convenience we offer appointments Monday to Friday from 8.30am until 5pm as well as some Saturday appointments.

Contact us

Your first visit

Initial consultation

At the first consultation you will have a pelvic ultrasound scan of your womb and ovaries and meet with one of our medical consultants who will complete a detailed review of your medical history. More importantly, the medical consultant will be able to answer any questions you have.

Nursing consultation

Following the initial consultation you will meet a specialist fertility nurse who will talk you though your plan of treatment, including any necessary drugs and further tests that you may need, and answer any further questions you may have.

Screening tests

You and your partner (where necessary) will undergo various straightforward screening tests prior to starting treatment to establish your reproductive health. These may include blood tests, swabs and a semen assessment for the male partner where appropriate.

Child welfare

Many factors are considered during assessment, including who will be legally responsible for and who will bring up any child born as a result of treatment. To address this it is our usual practice to ask the couple/individual seeking treatment to complete a questionnaire.

Counselling

We consider counselling to be a key element in the provision of fertility services for all patients. We are sensitive to the emotions experienced by people having difficulties conceiving and the stress of the treatment itself. Counselling is available to you at any time whilst you are a patient attending our clinic.

Your treatment will be overseen by a team of professionals including consultants, nurses, counsellor and coach, working together to provide a seamless journey from the moment you book your initial consultation.  It may not always be possible to see the same nurse or consultant but the clinic will do the utmost to make sure your treatment is stress free.

Preparation

Prior to treatment

On day two or three of your period, following successful completion of the medical review, you will have a blood test to determine that the required hormone levels are present and correct. A number of screening tests will follow. It is advisable, if you haven’t done so already, to start a course of folic acid and to continue until you are a minimum of three months pregnant.

Hormone suppression

The treatment begins on or around day 21 of the menstrual cycle. You will take medication to suppress your existing levels of hormones for around two weeks or until satisfactory levels are achieved. There are different options and you can decide which is most appropriate with your doctor.

Stimulation of the ovaries

The next stage is a course of ovarian stimulation involving injections. The purpose is to grow several follicles rather than the single follicle that is usually produced each month.

The treatment cycle is then monitored to test the development of the follicles, using ultrasound scans and by adjusting the dose of the drugs if necessary. When the follicles are large enough, usually after 10 - 12 days, you will have an injection that ensures the eggs in your follicles mature. It is carefully timed to allow egg collection to be performed at a mutually convenient time, about 36 hours later.

Egg collection

This procedure is usually performed under intravenous sedation (rarely a general anaesthetic). This simple procedure takes approximately 30 minutes. You will be awake during the procedure. A scan probe is passed through the vagina and into the ovary under ultrasound guidance; the fluid from each follicle, which contains the egg, is extracted. It is usual to obtain an egg from about 80% of follicles. You may feel a few twinges but should not be in pain. You will need to rest at the clinic for a short time before going home.

Fertilisation

If your partner's sperm is being used to fertilise the eggs, a sample will be required on the day of egg collection. Three days’ sexual abstinence is advised prior to the sperm sample. The sperm is washed and prepared in order to separate the sperm from the seminal fluid. The eggs are collected and each one graded by its development. The eggs are placed in an incubator for between three to eight hours before they are mixed with the selected sperm.

In an IVF cycle, the prepared sperm (whether partner or donor) and egg(s) are placed together into assigned dish(es).  In an ICSI cycle, a single sperm is injected into each mature egg and these are then put into an assigned dish.  The dishes are left in the incubator overnight to allow fertilisation to take place.

Usually about 60 - 70% of the eggs collected will be fertilised. Regrettably, a few patients will not achieve fertilisation of any eggs. It takes approximately 18 hours for the egg to be fertilised and about 12 hours later the fertilised egg will start to divide. After about 48 - 72 hours from egg collection, the embryos will usually consist of four to eight cells each, and are now ready for transfer to the uterus. At each stage of this important process, our team will keep you informed of how the embryos are developing and when you need to return for embryo transfer.

Embryo development

We will contact you the day after egg collection to let you know if fertilisation has taken place and to arrange a time for embryo transfer.

In the meantime, ‘cleavage’ or division of cells is occurring within the fertilised embryos. Although the mass of the embryo remains constant, the cells get smaller and smaller, increasing in number. The quantity of cells is not critical to quality, as each embryo develops at its own rate. Embryos may have up to six cells by the second day. Based on their regularity and appearance, the embryos are graded for quality. Good quality embryos that are surplus to immediate transfer needs can be frozen and stored for future use.

Embryo transfer

The embryo transfer procedure is similar to a smear test. It may cause some minimal discomfort. The culture medium containing one or two embryos is loaded into a thin catheter with a syringe on one end. The doctor carefully guides the catheter through the vagina and cervix, and deposits the embryo(s) into the uterus. Implantation begins three or four days later.

High quality embryos remaining after the transfer can be frozen for use at a later date if the usual consents are completed.  In accordance with the Human Fertilisation and Embryology Act, a maximum of two embryos can be transferred in any cycle, other than in exceptional circumstances.

Pregnancy

If you have not had a period fourteen days after embryo transfer, you should test yourself with the test kit provided by us. If you are pregnant, we may recommend hCG injections or further progesterone suppositories. An ultrasound scan will be performed at six or seven weeks’ gestation to confirm a visible heartbeat and ongoing pregnancy.

If, unfortunately, you do have a normal period, a follow-up consultation can be arranged to discuss options. Support counselling is always available.

Frozen embryos

Spare embryos from your treatment cycle may have been frozen for future use. Embryos are stored by removing the fluid from inside the cells before freezing them in liquid nitrogen. Embryos can initially be stored for up to ten years. Freezing is complex and success rates can be reduced. There is an initial charge for freezing embryos, which includes storage for one year. Storage is renewable annually.

IVF ICSI

IVF/ICSI treatment stages

The first step

The first step is usually the hardest - making that initial call. But remember, you are not alone; simply phone us in the strictest confidence and one of our friendly team will help guide you through the options open to you.

Whether you have recently become concerned about your fertility or have had treatment elsewhere and want another opinion, we will do our best to help you achieve a successful outcome.

We can generally offer an initial consultation within a few days, and for your convenience we offer appointments Monday to Friday from 8.30am until 5pm as well as some Saturday appointments.

Contact us

Your first visit

Initial consultation

At the first consultation you will have a pelvic ultrasound scan of your womb and ovaries and meet with one of our medical consultants who will complete a detailed review of your medical history. More importantly, the medical consultant will be able to answer any questions you have.

Nursing consultation

Following the initial consultation you will meet a specialist fertility nurse who will talk you though your plan of treatment, including any necessary drugs and further tests that you may need, and answer any further questions you may have.

Screening tests

You and your partner (where necessary) will undergo various straightforward screening tests prior to starting treatment to establish your reproductive health. These may include blood tests, swabs and a semen assessment for the male partner where appropriate.

Child welfare

Many factors are considered during assessment, including who will be legally responsible for and who will bring up any child born as a result of treatment. To address this it is our usual practice to ask the couple/individual seeking treatment to complete a questionnaire.

Counselling

We consider counselling to be a key element in the provision of fertility services for all patients. We are sensitive to the emotions experienced by people having difficulties conceiving and the stress of the treatment itself. Counselling is available to you at any time whilst you are a patient attending our clinic.

Your treatment will be overseen by a team of professionals including consultants, nurses, counsellor and coach, working together to provide a seamless journey from the moment you book your initial consultation.  It may not always be possible to see the same nurse or consultant but the clinic will do the utmost to make sure your treatment is stress free.

Preparation

Prior to treatment

On day two or three of your period, following successful completion of the medical review, you will have a blood test to determine that the required hormone levels are present and correct. A number of screening tests will follow. It is advisable, if you haven’t done so already, to start a course of folic acid and to continue until you are a minimum of three months pregnant.

Hormone suppression

The treatment begins on or around day 21 of the menstrual cycle. You will take medication to suppress your existing levels of hormones for around two weeks or until satisfactory levels are achieved. There are different options and you can decide which is most appropriate with your doctor.

Stimulation of the ovaries

The next stage is a course of ovarian stimulation involving injections. The purpose is to grow several follicles rather than the single follicle that is usually produced each month.

The treatment cycle is then monitored to test the development of the follicles, using ultrasound scans and by adjusting the dose of the drugs if necessary. When the follicles are large enough, usually after 10 - 12 days, you will have an injection that ensures the eggs in your follicles mature. It is carefully timed to allow egg collection to be performed at a mutually convenient time, about 36 hours later.

Egg collection

This procedure is usually performed under intravenous sedation (rarely a general anaesthetic). This simple procedure takes approximately 30 minutes. You will be awake during the procedure. A scan probe is passed through the vagina and into the ovary under ultrasound guidance; the fluid from each follicle, which contains the egg, is extracted. It is usual to obtain an egg from about 80% of follicles. You may feel a few twinges but should not be in pain. You will need to rest at the clinic for a short time before going home.

Fertilisation

If your partner's sperm is being used to fertilise the eggs, a sample will be required on the day of egg collection. Three days’ sexual abstinence is advised prior to the sperm sample. The sperm is washed and prepared in order to separate the sperm from the seminal fluid. The eggs are collected and each one graded by its development. The eggs are placed in an incubator for between three to eight hours before they are mixed with the selected sperm.

In an IVF cycle, the prepared sperm (whether partner or donor) and egg(s) are placed together into assigned dish(es).  In an ICSI cycle, a single sperm is injected into each mature egg and these are then put into an assigned dish.  The dishes are left in the incubator overnight to allow fertilisation to take place.

Usually about 60 - 70% of the eggs collected will be fertilised. Regrettably, a few patients will not achieve fertilisation of any eggs. It takes approximately 18 hours for the egg to be fertilised and about 12 hours later the fertilised egg will start to divide. After about 48 - 72 hours from egg collection, the embryos will usually consist of four to eight cells each, and are now ready for transfer to the uterus. At each stage of this important process, our team will keep you informed of how the embryos are developing and when you need to return for embryo transfer.

Embryo development

We will contact you the day after egg collection to let you know if fertilisation has taken place and to arrange a time for embryo transfer.

In the meantime, ‘cleavage’ or division of cells is occurring within the fertilised embryos. Although the mass of the embryo remains constant, the cells get smaller and smaller, increasing in number. The quantity of cells is not critical to quality, as each embryo develops at its own rate. Embryos may have up to six cells by the second day. Based on their regularity and appearance, the embryos are graded for quality. Good quality embryos that are surplus to immediate transfer needs can be frozen and stored for future use.

Embryo transfer

The embryo transfer procedure is similar to a smear test. It may cause some minimal discomfort. The culture medium containing one or two embryos is loaded into a thin catheter with a syringe on one end. The doctor carefully guides the catheter through the vagina and cervix, and deposits the embryo(s) into the uterus. Implantation begins three or four days later.

High quality embryos remaining after the transfer can be frozen for use at a later date if the usual consents are completed.  In accordance with the Human Fertilisation and Embryology Act, a maximum of two embryos can be transferred in any cycle, other than in exceptional circumstances.

Pregnancy

If you have not had a period fourteen days after embryo transfer, you should test yourself with the test kit provided by us. If you are pregnant, we may recommend hCG injections or further progesterone suppositories. An ultrasound scan will be performed at six or seven weeks’ gestation to confirm a visible heartbeat and ongoing pregnancy.

If, unfortunately, you do have a normal period, a follow-up consultation can be arranged to discuss options. Support counselling is always available.

Frozen embryos

Spare embryos from your treatment cycle may have been frozen for future use. Embryos are stored by removing the fluid from inside the cells before freezing them in liquid nitrogen. Embryos can initially be stored for up to ten years. Freezing is complex and success rates can be reduced. There is an initial charge for freezing embryos, which includes storage for one year. Storage is renewable annually.

Downloads

IVF information sheet

 

Contact us