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What is IVF?
IVF, or in vitro fertilisation, is a procedure in which eggs are fertilised with sperm in a laboratory. It was developed 40 years ago for the treatment of women with damaged fallopian tubes, and this remains an important reason for treatment today. However, it is also used in cases where a woman has endometriosis; the male partner has poor quality sperm, or when the cause of infertility is unknown.
Embryos that are created following IVF are then transferred, normally one at a time, into the female partner’s womb to implant and develop or frozen for transfer in a later non-stimulated cycle. Embryos are stored by removing the fluid from inside the cells before freezing them in liquid nitrogen, known as vitrification. Thanks to this technique success rates from a frozen embryo transfer are now as good, or better, than treatment in a fresh IVF cycle.
IVF treatment can take place using the patients own eggs and sperm or with the use of donor eggs or donor sperm. The London Women's Clinic provides IVF treatment for women and couples struggling to conceive and for same sex couples and single women using donor sperm.
How does IVF work
The IVF treatment process begins with a course of hormone therapy to stimulate the development of follicles in the ovary. These eggs are then collected, are then fertilised to create several embryos. After between two to five days in an incubator, one or sometimes two of these embryos are transferred through the vagina to the uterus, where implantation occurs, and pregnancy begins.
The IVF Process
To explain what happens in an IVF procedure we have divided the IVF process into six stages:
The ovaries are stimulated with a course of medication to produce eggs. During this period you will attend the clinic for a number of monitoring scans to check the development of your follicles that produce eggs. Once the follicles have reached the correct size, you will be given an injection to mature your eggs ready for collection.
On the day of egg collection, you will be given a small amount of sedation in preparation for the procedure. A fine needle attached to a scanning probe will be passed through your vagina into each ovary to collect the eggs. On the same day, your male partner will need to produce a semen sample, or if you’re using donor sperm, this will be thawed ready to be used.
Once the eggs have been collected, they will be placed in a dish with the sperm for fertilisation to occur. If there is a male factor issue or if the sperm is of poor quality on the day, the embryologist may suggest you use ICSI in which the sperm is injected directly into the egg to aid fertilisation.
The day after egg collection, an embryologist will call you to discuss the fertilisation of your eggs and how many embryos have developed. In most circumstances, embryos are cultured in the lab for five to six days after egg collection until they reach the blastocyst stage. Depending on your treatment plan, the embryologist will either freeze all your embryos for a Frozen Embryo Transfer in a later cycle or advise you when your fresh embryo transfer will take place.
Embryos are stored by removing the fluid from inside the cells before freezing them in liquid nitrogen. Thanks to improvements in the freezing of embryos through a technique called vitrification, success rates using frozen embryos are now as successful as a treatment in a fresh IVF cycle.
Using frozen embryos
Thawed embryos may be replaced during a natural cycle (without drugs) or in a cycle primed with hormone supplements. Depending on your medical history and age, your fertility specialist will be able to discuss with you which treatment will be most appropriate.
Using fresh embryos
A fresh embryo transfer normally takes place five to six days following egg collection once the embryo has reached blastocyst stage.
Today, most women will only have one embryo transferred to avoid the risk of multiple pregnancies. The embryo transfer is a simple procedure in which a speculum is inserted into your vagina (similar to a smear test), and a catheter holding the embryo will be inserted into the uterus.
Any good quality spare embryos left over from your treatment cycle can be frozen and stored for future use either if your treatment is unsuccessful or for a sibling. When you are ready to use your frozen embryos, your fertility specialist will plan a Frozen Embryo Transfer.
Following the embryo transfer, you will need to wait between 12 to 14 days to find out if your treatment has been successful. For most women and couples this two-week wait can be an extremely difficult time full of anxiety about whether treatment has worked. The London Women’s Clinic provides counselling and support throughout treatment at the clinic and runs a monthly support group for patients to meet others in a similar situation.
If your pregnancy test is positive, you should contact the clinic to arrange an early pregnancy scan. If unfortunately, your treatment is unsuccessful we will arrange a review consultation for you to discuss your cycle and any next steps you might like to take. During this time counselling and support will be available should you need it.