What is IVF?
Louise Mitchell, Nurse Manager London Women's Clinic Bristol
The first time you walk into a fertility clinic can be a scary, nerve-wracking experience. When you first meet the doctors and nurses within the clinic setting, you may hear terms and language that you are not familiar with and it can be daunting to ask questions when you are in consultation.
By helping to give accurate, easy to understand information about treatment options, this will hopefully, help with your understanding of treatment and processes involved, helping you to feel more empowered during your treatment so………………………………. what is IVF?
IVF stands for In-Vitro Fertilisation. It is a technique used to fertilise a woman’s eggs outside the body with sperm. Eggs are harvested from the woman and prepared sperm is added. The mixed eggs and sperm create embryos which are monitored in the laboratory until it is time for the embryo transfer.
Who does IVF help?
IVF can help many people with fertility issues including:
1. Fallopian Tube blockage, absence or damage
2. Male Factor Issues such as low sperm count or motility
3. Ovulatory problems such as PCOS or premature ovarian failure
5. Unexplained fertility
Step One: Hormone Injections
The first part of the treatment involves using hormonal medication.
This comprises of normally two injections daily – one injection allows us to suppress your body natural hormones which means you won’t ovulate naturally.
The second injection is hormones that stimulate your ovaries to create multiple follicles which will hopefully contain eggs. You can’t get any more that one egg per follicle, but some follicles will be empty.
You will take these injections for 10-14 days on average.
Once you are ready for your egg collection you will administer another injection called your trigger shot 36 hours before the egg collection. This mimics your bodies natural surge before ovulation and helps to get your eggs ready.
Step Two: Egg Collection
Your egg collection takes place 36 hours after your trigger shot. You are normally required to be at the treatment centre at least one hour before the procedure so you can be admitted to the recovery area and be prepared.
You will be asked to change into a hospital gown and you will be assessed by the doctor and anaesthetist doing the procedure.
The egg collection is normally done under conscious sedation and takes 20-30 mins. It involves having a transvaginal scan with a needle attached to the probe that is guided into the ovaries with ultrasound.
After the collection, you will be recovered by the nursing team and be ready to go home within two hours.
Step Three: Fertilisation
After the egg collection, you will be informed about how many eggs were collected.
During the afternoon in the lab, the sperm and eggs will be mixed together and placed into the incubator overnight.
The following morning, the lab team will check to see how many of the eggs have fertilised into embryos.
Step Four: Embryo Transfer
Normally 5 days after the egg collection, the embryo transfer will take place. This is called a blastocyst transfer due to the stage of development that the embryo is at. Occasionally embryo transfer will take place on Day 3.
Sedation is not normally needed for this procedure as it is like a smear test. It is carried out under an abdominal ultrasound with a full bladder. A catheter is passed through the opening of the cervix up into the uterus when the embryos are injected.
Step Five: Embryo Freezing
The London Women’s Clinic in Cardiff can freeze blastocyst (day5/6) embryos after the treatment cycle has finished.
On the embryo transfer day, the Lab team will advise you of the amount and quality of embryos that you have at that stage. If after the transfer of the best quality embryo, you have others that would have also be suitable for treatment, then we will freeze them.
The frozen embryos can be used in subsequent cycles of treatment. It also means that you don’t have to go through another fresh cycle of IVF.
The success rates with frozen embryos are as good as the fresh success rates and the cycle involves taking HRT medication for a couple of weeks to thicken the endometrium. Once it is at the optimal thickness, we then liaise with the lab team to arrange a time to transfer the embryos back to you.
It means that you can have a cycle of treatment, without having to go through ovarian stimulation and egg collection again.
Risks involved with IVF
Just like any medical procedure, IVF has its risks.
1. MULTIPLE PREGNANCY – Most clinics now have low multiple pregnancy rates due to the implementation of elective single embryo transfers. This does not stop it completely and there can still be a very small risk of multiple pregnancies with one embryo going back.
2. OVARIAN HYPERSTIMULATION SYNDROME (OHSS) – This is when the ovaries over-respond to the medication given to stimulate the ovaries. Most cases of OHSS are mild to moderate and you may suffer from side effects such as bloatedness, nausea and vomiting and abdominal pain. It can also occur after you have had the embryos transferred. OHSS will normally resolve quite quickly, but if you become pregnant it can persist for some weeks and may involve a hospital admission. Because of this, your clinic may make the decision to cancel your treatment, but it is rare for this to happen.
3. ECTOPIC PREGNANCY – Fertility treatment can slightly increase the risk of ectopic pregnancy; therefore, clinics will scan at 6-7 weeks to confirm viability and to check for ectopic pregnancy.
4. MISCARRIAGE – Having fertility treatment does not increase your risk of miscarriage, but it also does not guarantee that you won’t miscarry. The chances of this happening are about 1 in 6.
The Two Week Wait After IVF
For a lot of people going through the IVF Journey, they will often say that the worst part of it is the two weeks wait. After your embryo transfer, you will be given a date to perform a pregnancy test 11 to 14 days after transfer.
Some find this wait stressful and it can be quite lonely as you are no longer having regular visits to the clinic and being supported by your team. Fertility counselling can be an excellent resource to use during this time, the London Women’s Clinic offers this counselling free of charge.
Support groups run by organisations such as Fertility Network UK can also be helpful, and you can meet people in similar situations who can help to talk through the process.
Books and podcasts such as Making Friends with your fertility by Tracey Sainsbury and the Fertility podcast can offer invaluable help and advice during this time.