What you need to know about IVF?

The following information explains briefly the procedures of In Vitro Fertilisation (IVF). This will give you an understanding of the treatments and an outline of methods we use here. We will be happy to discuss any questions you may have about the treatments.

What is IVF?

IVF is the technique of mixing the women's eggs (ova) with sperm from her partner in a small dish or test-tube in the laboratory to allow fertilisation to occur. Once the ova are fertilised, one or more fertilised eggs (pre-embryos) or developing embryos are replaced into the woman's womb through the cervix.

Who needs IVF?

Many cases of infertility can be helped with IVF. However, the chances of pregnancy are very variable and depend on the cause of your infertility. When you are seen at the clinic we will discuss the most suitable type of treatment for you and give you an estimate of your chances of becoming pregnant

For most couples, IVF treatment involves using your own sperm and eggs. Rarely we may recommend using donated eggs or sperm but of course this would never be done without your consent

What does IVF involve?

The precise details of your treatment will be sent separately and below is a short outline of the steps involved in IVF These include

Stimulation of the ovaries

In a natural menstrual cycle, a woman produces only one egg, but in order to increase the chances of pregnancy in IVF it is desirable to stimulate the ovary to produce several eggs. This is done by giving you medication as a nasal spray or injection for about 3 weeks to control your natural cycle then additional injections are given for about 12 days to make the eggs grow. The eggs need to be exactly "ripe" at the time of their collection and so their development must be carefully monitored. The drug treatment varies slightly to suit your circumstances but this will be fully discussed with you beforehand.

Monitoring of egg development

Development of the eggs is monitored by 2 methods. First the size and number of egg follicles growing in the ovary are observed by ultrasound scanning. The scan is obtained by passing a small transducer into the vagina and a clear picture of the ovaries can then be seen on a television screen.

The second method of monitoring is by measuring the hormones produced in the ovary This is done by a blood test. The blood test and scan will be done about twice during the 2 weeks before egg collection. At least three eggs must be growing before we can proceed to egg collection. Sometimes treatment will therefore fail at this stage. If the stimulation treatment has been successful, the eggs will be ripe at the right time and a final, different injection will be given to complete the ripening. Egg collection will be planned for about 38 hours after this injection. On rare occasions a complication of this treatment can occur (hyperstimulation syndrome). The ovaries may become large and painful and if severe, admission to hospital may be necessary. This usually only occurs if you become pregnant and gets better within a few weeks.

Egg collection

Eggs are collected from the ovary by suction through a fine needle. This needle is inserted into the ovary through the vagina using the ultrasound picture as a guide. Only a mild sedative is needed and you can go home a few hours later. We hope to obtain at least 3 eggs but usually larger numbers are obtained.

Sperm preparation

A fresh sperm sample is needed for IVF so that the sperm are of good quality. The sperm are specially prepared so that only the best, cleaned sperm are put with the eggs.

Fertilisation

After collection the eggs will be put into the incubator for a short time. A relatively small number of sperm are then added to each egg They will then be kept in the incubator for about 2 days. They are looked at daily and we will keep in touch with you by telephone and advise when to attend for embryo replacement.

Embryo replacement

An opportunity to discuss how many embryos should be replaced will already have taken place. The chances of pregnancy increases with the number of embryos replaced, but so does the risk of multiple pregnancy There is an increased chance of losing one or all of the babies in a multiple pregnancy and we are therefore anxious to avoid this complication. We are not allowed to replace more than 3 embryos and we usually recommend no more than 2 The procedure for replacement of the embryos is virtually painless and is little more than an internal examination. You will not need to lie down afterwards and then you can return to normal (but not too strenuous) activity.

Sometimes there are more embryos available than we can replace. Research is carried out at this clinic to try to understand and improve IVF treatment and "spare" embryos can be used for this work. However, this would only be done with your written consent and if you do not agree, it would have no effect on your treatment.

In a few circumstances, it may be possible to consider freezing and storing embryos.

Pregnancy outcome

After IVF further injections or pessaries may be needed to support the lining of the womb. We will see you about 2 weeks after egg collection, a pregnancy test will be done. If this is positive, a scan will be performed 5 weeks after egg collection to confirm that it is a good pregnancy and that a baby is growing. Many babies have now been born who were conceived after IVF during the past 21 years. Miscarriages can occur in any pregnancy but there is also no increased or decreased risk after IVF/GIFT There is a small (7%) chance that the pregnancy may stick in the tube (ectopic pregnancy) If this occurs an operation is required to remove the pregnancy and possibly the tube as well. We see everyone who becomes pregnant regularly at the hospital until we are sure that the pregnancy is growing normally.

Disappointments

Clearly these methods of treatment are complicated and stressful and they may fail at any stage. Sometimes we can explain why it has failed but often it is for reasons which we don't understand. If you are not successful we will arrange for you both to come back to the hospital to discuss what happened in detail. If you have any further questions about these treatments, the medical and nursing staff at the Centre are available to answer them You will be asked to attend for a further counselling/ information session at the Fertility Centre before treatment begins which will give you both an opportunity to discuss any problems.