In Vitro Fertilisation (IVF)

In Vitro Fertilisation (IVF) is a treatment where eggs are collected from the ovary, fertilised with sperm in the laboratory, and after a few days of growth, the resulting embryo is placed into the uterus.

As your Fertility Specialist, I will discuss the various fertility options available to you. I may recommend IVF if we feel this may be the best option for you. The IVF process can often seem complex and overwhelming, but I will always take the time to ensure you have a thorough understanding of what is involved.

Below is some further information on what happens during an IVF treatment cycle:

Step 1 – Egg Collection

The starting point of the IVF process is the retrieval of eggs from the ovaries. This is done by having injections that stimulate egg production within the ovaries. This process normally takes about 10-14 days. Your response to these medications is monitored with scans and blood tests. You should not have too many of these tests, and you can usually have them early in the morning so they do not affect your work too much.

Once enough follicles have developed and have reached a specific size, you will be instructed to take a trigger injection to mature the eggs in preparation for their collection. The eggs are collected from the ovaries using an ultrasound-guided needle. The follicles are visualised, and the needle is introduced into the ovary when the fluid from each follicle is aspirated. This is a simple day procedure performed in the theatre under anaesthesia. As you will receive an anaesthetic, I suggest you have someone with you to take you home and keep an eye out for you following your discharge.

Step 2 – Sperm Preparation

While the eggs are being collected in the theatre, the semen sample is prepared. Fresh or frozen sperm may be used, depending on various circumstances that will be determined prior to you starting your treatment. We can either use sperm from a partner or, if required, donor sperm. Once the sperm is obtained, we use various techniques to optimise the best quality sperm to be used for fertilisation.

Step 3 – Fertilisation of Eggs – Making Embryos

There are two broad types of fertilisation techniques. The first is called standard fertilisation and is generally used when the semen analysis parameters are within the normal range, and we anticipate normal fertilisation. With this technique, the ejaculate is concentrated and spun in a centrifuge machine, undergoing a “gradient preparation” which cleans the sperm and allows us to obtain a very high concentration of motile sperm to be utilised. The motile sperm are then added to the eggs and placed in a dish in a temperature-controlled and very specific environmental incubator overnight to allow fertilisation to occur. This allows a degree of natural selection, as the best sperm are randomly selected to fertilise each egg.

The other technique for fertilising eggs is called Intracytoplasmic Sperm Injection (ICSI). Under a powerful microscope, the best sperm would be selected with this approach. Selection of sperm would be based on various physical characteristics, including the sperm motility, to ensure they are swimming in an optimal way. We also select sperm based on their appearance or morphology, aiming to find the most perfect-looking sperm we can. There are other techniques we can utilise in the lab to select the best sperm and this will be discussed with you. Once sperm are selected, each individual sperm is isolated into a tiny thin glass needle and under the microscope, it is then directly injected into an egg. The injection process is not done randomly; this is a precise and highly skilled procedure that takes many years to perfect.

There are various ICSI-associated techniques employed to facilitate this. We would normally suggest the ICSI option to you when previous standard fertilisation is deemed to be either suboptimal or if frozen sperm is used. The other reason we may suggest ICSI is if the semen parameters suggest this would be a preferred option to employ. We always aim to maximise the number of eggs fertilised and thus the number of embryos we generate for you.

Step 4 - Fertilisation

The morning after the egg retrieval, the scientists check the eggs for signs of fertilisation. If fertilisation has occurred the fertilised eggs are now called ‘embryos’.

Step 5 - Embryo Culture

Embryos can be grown in the laboratory for up to 6 or 7 days after egg retrieval. They can be replaced in the uterus at a variety of stages, depending on what is right for you and your circumstances. I will have that discussion with you to decide on these options.

For the majority of my patients, I recommend, if appropriate, growing the embryos for 5 or 6 days following egg retrieval. At that juncture, should embryo development proceed as anticipated, the embryo should be at the blastocyst stage. Research has shown that embryos that reach the blastocyst stage of development are more likely to be chromosomally normal than 2/3-day (cleavage stage) embryos. Growing embryos to the blastocyst stage enables the selection of more developmentally advanced embryos, increasing the chance of a pregnancy. Another advantage of growing embryos to the blastocyst stage is that it allows the embryo to be biopsied and genetically tested.

From egg fertilisation to embryo formation

Step 6 – Embryo Transfer

On the day of your embryo transfer, a scientist will assess your embryos and pick the most perfect embryo for transfer. The embryo will then be loaded into a very soft, thin plastic tube (catheter) and placed through the cervical canal and into the uterine cavity. This procedure is very simple and generally does not require an anaesthetic. If, however, you would prefer the transfer to be done under anaesthetic, this can, of course, be arranged in advance. The embryos will then continue to grow in the uterus until they implant.

Step 7 – Pregnancy Test

Two weeks after your embryo transfer, a pregnancy blood test will occur to determine whether the IVF cycle resulted in a pregnancy.