IVF – In Vitro Fertilisation
These days most people have heard of In Vitro Fertilisation (IVF). We helped achieve North Karnatake’s first IVF baby in 1998. The revolution in technology over the years now means your chance of taking home a baby from IVF is better than ever.
Tip: It can take more than one cycle to get that positive pregnancy result. It’s no one’s fault. Try to stay positive.
An introduction to IVF
IVF is about taking eggs and sperm, putting them together in a lab and letting the natural process happen. If they fertilise, an embryo will form. The tiny embryo (0.1 mm) is then inserted into the uterus. If it grows and develops, you’ll take your baby home 9 months later.
So, how do we get there?
• We stimulate your ovaries to help your body to produce eggs it has created naturally. This might involve a series of injections which are easy to manage
• We remove those eggs in a day procedure called the egg collection or egg retrieval
• Within the same day, your partner will provide us a sample of his sperm, or we prepare the donor sample in the laboratory
• Our expert scientists mix the eggs and sperm in the lab. We try to create as many embryos as we can to give you the best chance of healthy embryos
• If the embryo/s fertilise, you will be back about 5 days later to have the embryo/s transferred into your uterus
• Any extra little embryos are frozen and can be used for another cycle
• You’ll have a 2-week wait while we see if the embryo takes
• We do a blood test to see if you’re pregnant.
Our team makes sure you understand what’s going on and why, and have the support you need through your treatment.
The eggs stimulated to grow would have grown or died during your natural cycle that month. The stimulation mimics your body’s natural processes. It doesn’t affect future egg supply or lead to premature menopause.
Will I need IVF?
Your fertility specialist gets to know your medical history and your individual circumstances. There’s lots of reasons they may recommend IVF, and create the best treatment plan for your body.
Some common reasons why IVF may be required include:
• Blocked Fallopian Tubes
• Fallopian Tube Damage/Tubal Factor/Tubal Ligation
• Male Infertility Relating To Sperm Quality Or Quantity
• Uterine Fibroids
• Polycystic Ovarian Syndrome (Pcos)
• Increased Difficulty Of Conceiving Naturally As Women Age
• Unexplained Infertility
• Recurring Miscarriage
• Potential Genetic Issues Where Embryo Screening May Help.
The IVF Process
Step-by-step through an IVF cycle
An IVF ‘cycle’ is how we describe one round of IVF treatment starting with the first day of your period.
As part of your fertility plan, you may start medication or injections before the first day of the cycle.
Step 1: Day 1 of your period
The first official day of your IVF treatment cycle is day 1 of your period. Everyone’s body is different, and your fertility nurse will help you understand how to identify day 1.
Step 2: Stimulating your ovaries
The stimulation phase starts from day 1. In a natural monthly cycle, your ovaries normally produce 1 egg. You’ll take medication for 8-14 days to encourage the follicles in your ovaries (where the eggs live) to produce more eggs.
Your specialist prescribes medication specific to your body and treatment plan. It’s usually in the form of injections, which can vary from 1-2 for the cycle, or 1-2 per day. It can be daunting, but your fertility nurse will be there to show you exactly how and where to give the injections. You can get your partner involved too and watch and learn together to get it right. It quickly becomes a habit and you’ll be an expert in no time.
The most common hormones in the medications used to stimulate the follicles are:
• follicle-stimulating hormone (FSH)
• luteinizing hormone (LH).
Both hormones are produced naturally in the body. The eggs are already there; the medication boosts the natural levels to encourage more eggs to develop.
We keep an eye on your ovaries and how the follicles are developing with blood tests and ultrasounds. Your medication will be adjusted if needed. You will have some transvaginal ultrasounds (a probe is inserted internally). Our team will support you through these processes and make you as comfortable as we can.
We’ll track you more frequently towards the end of the stimulation phase to time the ‘trigger injection’ perfectly.
The trigger injection gets the eggs ready for ovulation – the natural process where eggs are released and you have your period. Your fertility nurse tells you exactly when to do the trigger injection. Your fertility specialist will schedule the egg retrieval before you ovulate.
Step 3: Egg retrieval
Egg retrieval, or egg ‘pick up’, is a hospital day procedure where the eggs are collected from your ovaries. An anaesthetist will get you ready for a general anaesthetic. You’ll be asleep and the procedure takes about 20-30 minutes.
Your fertility specialist uses the latest ultrasound technology to guide a needle into each ovary. It’s delicate work where every millimetre counts, and this is where the experience of our specialists pays off. You can’t see an egg with the naked eye; they’re contained in the fluid within the follicles in your ovaries. The specialist removes fluid from the follicles that look like they’ve grown enough to have an egg inside.
Your fertility specialist should have a fair idea from your ultrasounds how many eggs there are before retrieval. The average number of eggs collected is 8-15.
Recovery takes about 1 to 2 hours and you’ll be able to walk out on your own. It’s a good idea to have a support person with you as you won’t be able to drive after the procedure.
Step 4: The sperm
If you’re a couple planning on using fresh sperm, the male will produce a sample the morning of the egg retrieval. If you are using frozen or donor sperm, our scientists will have it ready in the lab.
The sperm is graded using 4 different levels of quality. It’s washed in a special mixture to slow it down so our scientists can spot the best ones under the microscope. A perfect, healthy sperm is not too fat or thin, with a tail that’s not too long or short. The best sperm are selected, and they’re ready and waiting in the lab to be introduced to the eggs.
Step 5: Fertilisation
Your fertility specialist gives our scientists the eggs they have retrieved, still in the fluid from the follicles of the ovaries. The scientists use powerful microscopes to find the eggs in the fluid so they can be removed.
It’s important the eggs are fertilised quickly. The eggs and some sperm are placed in a dish. They have the chance to find each other and fertilise like they would naturally within your body.
Step 6: Embryo development
If the sperm fertilises the egg, it becomes an embryo. Our scientists put the embryo into a special incubator where the conditions for growth and development are perfect.
We create the perfect growing conditions using a mix of amino acids, just like your body would use to nurture the embryo.
Our scientists keep an eye on the embryos over 5-6 days. What we want is:
• a two- to four-cell embryo on day 2 and a six- to eight-cell embryo on day 3 (called the cleavage stage)
We know implanting embryos at the blastocyst stage into the uterus boosts your chances of a successful pregnancy.
Unfortunately, not all eggs will fertilise and reach embryo stage. The eggs might not be mature or the sperm not be strong enough. We know you’ll be waiting on news, so we’ll keep you up to date with the progress of your egg, sperm and embryo development.
Stage 7: Embryo transfer
If your embryo develops in the lab, you’re ready for it to be transferred into your uterus.
Your fertility nurses will contact you to explain what you will need to do to prepare.
The embryo transfer is a very simple process, like a pap smear. It takes about 5 minutes, you’ll be awake, there’s no anaesthetic, and you can get up straight away. You can continue with your day, the embryo can’t fall out if you stand up or go to the toilet.
A scientist prepares your embryo by placing it in a small tube called a catheter. It’s critical this is done by an expert to disturb the embryo as little as possible.
Your fertility specialist places the catheter through your cervix and into your uterus.
It’s common practice at our centre to transfer one embryo at a time. Other embryos are frozen using our advanced technology, to use in future treatment.
Step 8: The final blood test
Approximately two weeks after your embryo transfer, you’ll have a blood test to measure your levels of the hormone hCG (human chorionic gonadotropin). hCG in your bloodstream usually means a positive pregnancy test. Your nurse will let you know exactly when you need to have your blood test, as it may vary for some patients.
ICSI – Intra Cytoplasmic Sperm Injection
What is ICSI?
Intracytoplasmic Sperm Injection (ICSI) is a technique where a single sperm is given a helping hand to ‘enter’ the egg.
Since it only takes one single sperm to fertilise the egg, the embryologist catches a single sperm and injects it directly into the centre of the egg. This method is far more successful when there is male infertility problems.
ICSI sounds pretty simple but is one of the most technically challenging roles for an embryologist.
Who can use ICSI?
ICSI can be an option for patients who have:
• an abnormally low sperm count or poor motility
• a high percentage of abnormal sperm or few healthy sperm
• sperm obtained via testicular biopsy or micro TESE
• previously low fertilization rates with standard IVF
It is important to note that there is growing evidence that IVF success rates are actually better when standard insemination techniques are used instead of ICSI in couples who don’t fit the above categories.
ICSI can be used with fresh or frozen/thawed sperm. Our scientists will choose the best sperm from the sample, based on it being a normal shape, size and motility (movement).
Metgud IVF tip: The treatment process is exactly the same as a standard IVF cycle; the only difference is the fertilisation technique the scientists use in the lab on the day your eggs are collected.
Sperm Selection Process
The healthiest sperm cells tend to have a certain shape and size, particularly an oval head and a long tail which they use to push themselves along as they swim. Infertile men often make fewer such sperm so that sperm selection for ICSI is important.
Next consideration is sperm motility – a sperm cell’s motility is its ability to move itself around and penetrate an egg. This depends on the length and size of its tail. Tails that are curly or doubled up aren’t as efficient when it comes to swimming.
Routinely in ICSI, a small amount of washed and prepared sperm is placed into thick viscous media that slows the sperm down so that they can be selected according to their shape, motility and trajectory.
The most “normal” looking and vigorous sperm are selected and then immobilized by squashing their tails with a glass injection needle. One these sperm are sucked into the needle tail-first ready to be injected.
How is an ICSI done?
The egg is placed in customized dishes under a microscope and moved using a leading micro-manipulator. A holding pipette secures the mature egg and then a thin, sharp glass micropipette, loaded with a single sperm, pushes first through the zona pellucida (outer egg casing) and then the oolemma (the cell membrane of the egg) to enter the centre (cytoplasm). The sperm is most delicately deposited into the centre of the egg.
In other words, we do all of the work for the sperm – no swimming or penetration of the egg involved. The only thing left for the sperm to do is make the ‘spark’ of fertilisation happen.
After the ICSI procedure, the egg is placed into the incubator and checked the following day for signs of fertilisation.
As ICSI is more invasive and requires more handling than standard IVF insemination techniques, there is a small chance (less than 2%) that the egg may be damaged during the procedure – resulting in a non-viable egg.
Only our most experienced staff are trained in ICSI – embryologists with a degree of mastery and high technical proficiency
All fertilised eggs are monitored daily for their growth and development.