Understanding IVF

What is it?

IVF stands for In Vitro Fertilisation.

IVF is a type of Assisted Reproductive Technology (or “ART”) that is used to treat infertility, after other options have failed.

IVF uses laboratory techniques to manually fertilise an egg with a sperm, outside of the body. The fertilised egg (or embryo) is incubated and then transferred back into the uterus for implantation.

What happens in IVF treatment procedure?

Step 1: Starting Treatment

During a natural menstrual cycle, the pituitary gland releases two key hormones: Luteinising Hormone (or LH) and Follicle Stimulating Hormone (or FSH). These hormones stimulate the ovarian follicles to grow and release eggs. Several follicles will actually start to grow each cycle, but only one will mature to ovulation. A sharp rise in LH, occurring about 2 weeks before a period triggers the release of the egg (i.e., ovulation).

During an IVF cycle FSH is used to stimulate the growth of several eggs together, with a “trigger” injection to force release of the eggs for collection.

Step 2: Ovarian Stimulation and Monitoring

During this stage, there will be daily injections of FSH for 9-14 days. As patients respond differently to these injections, we will monitor you with ultrasound and blood tests, and adjust the injections according to your individual requirements. The dose of FSH we use for this stimulation of your ovaries is higher than your body naturally produces, because we are aiming to grow several follicles, rather than just one. Most women learn to give their own injections in order to reduce the number of clinic visits.

About 5 -10% of women do not proceed successfully through the Ovarian Stimulation Phase. If the ovaries do not respond to the FSH injections, and too few follicles develop, the best course of action may be to cancel the treatment cycle and consider other options for further treatment. We will always explain this to you so that you understand we are recommending a certain course of action. Remember that you can ask questions along the way!

Sometimes, there is an unexpected excessive response from your ovaries to the FSH injections. Some women who over-respond may develop Ovarian Hyperstimulation Syndrome (OHSS). Symptoms include severe discomfort, nausea, vomiting, abdominal distension (swelling) and dehydration. It is important that the clinic is notified immediately if any of these symptoms occur during your treatment, as hospitalisation may be required. This complication requires rest, close monitoring, intravenous fluids or even drainage of the abdominal fluid. For your safety, the cycle may be cancelled before egg collection or the embryos may be frozen rather than being replaced.

Step 3: Trigger Injection

After ovarian stimulation, and ultrasounds show us that the follicles are of an adequate size and number, the stimulation phase ends. We will confirm your procedure time with theatre and you will be informed when to administer your “trigger” injection. This trigger injection is extremely important so be sure to write the administration time down carefully with your instructions. It is an injection of Human Chorionic Gonadotrophin (hCG), which causes the final maturation and release of the egg from the follicle wall. Egg retrieval occurs on the second morning after this final injection (34-36 hours later).

Step 4: Egg Retrieval and Semen Collection

Egg retrieval is performed, under ultrasound guidance, using a probe with a fine needle. You will be sedated for the 20-30 minutes of the procedure (either general anaesthetic or light sedation). The needle is passed through the vaginal wall and into each mature follicle on the ovary. The fluid in the follicle is collected and examined under a microscope to look for eggs. It is not unusual for some follicles not to contain eggs.

After the procedure you will rest in recovery for about one hour. Some cramping and discomfort after egg retrieval is common, as is some vaginal spotting / bleeding. If this continues, a heat pack, hot water bottle or analgesic may be helpful at home. You will be given progesterone (a hormone) to continue to support the development of the endometrium (i.e., the lining of the uterus) in preparation for future embryo transfer.

At this point, we need the semen sample. Your partner will be asked to produce his sample on the same day as the egg retrieval. Some men have concerns about this part of the process, so please ensure you discuss any issues before you both begin the cycle. We understand that you are both feeling uncertain, embarrassed, anxious and concerned, but rest assured that you are not alone. We are here to help you, so please talk to us about your concerns – we can always find a solution together.

Step 5: Fertilisation (Insemination) and Embryo Development

The sperm sample is prepared for insemination by washing and concentrating, and added to the eggs in a special dish a few hours after retrieval. Those dishes incubated overnight and the eggs examined the next day for signs of fertilisation. It is unusual for all eggs to fertilise, and we expect 60 – 70% of eggs to fertilise. You will be contacted with the results, and given an opportunity to ask any questions you may have. The fertilised eggs are then kept in the incubator for an additional 48 hours.

If the sperm quality is low (i.e., a low sperm count or reduced motility), we may suggest Intracytoplasmic Sperm Injection (ICSI) as part of your treatment plan. ICSI is a specialised form of insemination that is used for the treatment of male infertility. ICSI involves the injection of a single sperm directly into a single mature egg.

Step 6: Embryo Transfer

Between 2 and 5 days after the egg retrieval, embryo transfer can occur. Exactly when, and how many embryos will be transferred will depend on each patient’s individual circumstances, as well as the quality of the embryos that have been incubated. Usually one embryo is transferred into the uterus.

In exceptional cases, two embryos may be transferred, after discussion with clinic staff, so risks of multiple pregnancy are clearly understood. The chance of multiple pregnancy increases with the number of good quality embryos transferred. All options should be thoroughly explored and discussed prior to any treatment; including the maximum number of embryos you and the treating doctor are comfortable with transferring.

This embryo transfer itself takes only a few minutes and is not usually painful. Clinic staff will confirm the number and quality of embryos with you prior to the transfer, and talk you through the process. You may be asked whether you would like to freeze any of the remaining embryos.

Embryos chosen for transfer are loaded into a device called a transfer catheter, which is passed through the cervix into the uterus, and the embryo gently released. The catheter is then slowly removed and checked to make sure the transfer has taken place.

After embryo transfer, women should continue to maintain good health and wellbeing, by avoiding smoking and alcohol, and extreme environments (such as spas and saunas) and dangerous activities (such as skiing). Be guided by your treating specialist about continuing any regular exercise you like to do. You will however, be encouraged to limit your activity for 24 hours, gradually increasing over the next few days to non-strenuous, non-aerobic activity. Many women do return to work the following day if their job is not strenuous.

All IVF patients are offered the option of freezing remaining embryos (this is called cryopreservation). Embryos must not show any signs of fragmentation (i.e., cell breakdown) or abnormal/slow development to be considered suitable for freezing,

Step 7: Luteal Phase and Pregnancy Test

This final stage is the two-week period between embryo transfer and the pregnancy test. This time is often understandably emotionally charged with expectation and anxiety. We understand this can be a difficult time and encourage you to speak to our staff for support if you are finding it especially hard to deal with the stress of waiting. We can also offer the assistance of professional counsellors as part of your IVF treatment cycle.

The progesterone treatment started following the egg retrieval, can sometimes cause symptoms such as cramping, nausea, bloating and tiredness. You may find a simple analgesic (painkiller) helps with this discomfort. If you are concerned about any symptoms, we recommend that you contact us immediately.

Vaginal spotting, or light bleeding, may occur before you are due for your pregnancy test. This does not always mean that treatment was unsuccessful.. Additionally, progesterone itself may delay your period, and this does not necessarily mean that you are pregnant. You should continue using any medications until a full period commences and/or the result of the blood test is known

What are the potential risks of IVF?

There are some potential risks and side-effects associated with IVF procedures.

  • You may experience exaggerated menstrual cycle symptoms (e.g., bloating, breast tenderness, and mood swings). This is related to the over-stimulation of the ovaries.
  • In about 1% of cases, Ovarian Hyperstimulation Syndrome (OHSS) develops. Symptoms include severe discomfort, nausea, vomiting, abdominal distension (swelling) and dehydration. It is important that the clinic is notified immediately if any of these symptoms occur during your treatment, as hospitalisation may be required. This complication requires rest, close monitoring, intravenous fluids or even drainage of the abdominal fluid.
  • For patients who have more than one embryo transferred into the uterus, a multiple pregnancy may occur. Multiple pregnancies carry a higher risk of preterm delivery as well as other potential problems. Twins can occur in 10-20% of cases.
  • While fertility drugs have not been proven to increase the risk of breast, ovarian or uterine cancer, women who have never been pregnant have a higher risk of breast or ovarian cancer. Past or future use of the contraceptive pill will lower your risk of ovarian cancer. We recommend annual health checks for the prevention and early detection of all diseases.

What are the IVF success rates?

The graph shows cumulative pregnancy results for patients who had day 5 single embryo transfers and at least one blastocyst frozen. Success rates help to give you an indication of your chances of achieving a pregnancy, but are not specific to you as an individual. Our Brisbane fertility specialist will give you a personalised assessment of your likelihood of conceiving.

How does IVF work at City Fertility?

There is a process that each IVF patient will be introduced to, to ensure appropriate treatment. Rest assured that our staff will support you every step of the way.

The female IVF treatment cycle generally follows these stages:

  • Pre-treatment tests and preparation
  • IVF treatment information and discussion
  • Preparation of ovaries and uterus by intranasal spray (in some instances)
  • Follicle growth treatment (stimulation by injection)
  • Ovulation timing (based on blood tests and ultrasound scans)
  • Egg collection
  • Insemination of eggs with sperm
  • Assessment of fertilisation
  • Culturing of the embryos for 2-5 days
  • Embryo transfer to the uterus
  • Pregnancy test (blood test)
  • Ultrasound if pregnant
  • Referral to your chosen antenatal care provider.

Initial Consultation with Dr Das.

All patients will undergo appropriate diagnosis testing, and be given a diagnosis, with the opportunity to ask questions. Following this, Dr Das will recommend the appropriate treatment plan for your individual circumstances.

When the decision has been taken to proceed, the next steps follow.

Ovarian Stimulation

As explained in the section above, your ovaries are stimulated with hormones, to promote the growth of the follicles, which contain the eggs.

The ovarian response to stimulation is monitored using ultrasound and blood tests, in order to control and manage the size and number of follicles, and therefore eggs.

A trigger injection of Human Chorionic Gonadotrophin (hCG) is then given to mature and release the eggs.

Egg Retrieval

The egg retrieval takes place 35-36 hours later, under ultrasound guidance, and while you are sedated.

Fertilisation

The sperm sample is prepared and added to the eggs (or, in some cases, injected into the egg using Intracytoplasmic Sperm Injection (ICSI)), a few hours after retrieval.

The mix of eggs and sperm is incubated for 1-2 days, and monitored for signs of successful fertilisation. An additional 2-5 days in the incubator assists growth.

Embryo Transfer

The selected embryo is transferred into the uterus..

Any viable embryos that are not transferred may be frozen and stored. Frozen embryos can be used in subsequent cycles if the first cycle is not successful.

Luteal Phase & Pregnancy Test

There is a 2 week wait, during which time you will be asked to limit physical activity. Your pregnancy blood test will take place after this time.

Using Partner’s Sperm – Fresh Sperm

An optimal sample can be collected from your partner, after 2 days of abstinence. The sperm sample is then analysed and tested.

Using Donated Sperm – Frozen Sperm

Sperm samples can be obtained from either:

  • Recipient Recruited Donors (known donor), or
  • Clinic Recruited Donors (unknown donor).

Couples who are unable to achieve a pregnancy due to male infertility will require donor semen. This is also an option for same sex couples and single women seeking our services.