For many clients In-Vitro Fertilisation (IVF) offers the best chance of achieving a pregnancy.
The IVF process involves retrieving eggs from the woman’s ovaries and placing these together with prepared sperm obtained from the partner’s sample. The sperm and egg develop into an embryo in special laboratory conditions and are then transferred back into the uterus (womb) a few days later.
The consultant may recommend IVF where a diagnosis for any of the following factors have been identified:
- Fallopian tubes which are blocked, damaged or even absent
- Polycystic Ovaries (PCO)
- Anti-sperm antibodies (females and males)
- Advancing female age
- Reduced ovarian reserve (elevated FSH levels in the blood)
- Male infertility
- Unexplained infertility or “idiopathic infertility” following a number of years of unprotected intercourse.
Steps involved in IVF
There are four key steps involved in IVF treatment:
- Stimulation of the ovaries
- Egg Collection
- Fertilisation of the eggs and culture of the embryos
- Embryo Transfer
Stimulation of the ovaries
In a normal menstrual cycle, the ovaries usually produce only one ripe follicle containing one mature egg each month. The aim of all IVF regimes is to stimulate the ovaries to produce more follicles and therefore more eggs. This is achieved by increasing the amount of follicle stimulating hormone (FSH) available to the ovaries in the form of specialised medication injected daily. In conjunction with stimulating the ovaries, the medication also prepares the lining of the womb.
In most cases after 10-12 days of FSH injections the ovaries will have produced sufficient follicles to schedule the egg collection. The eggs are finally matured by a late night injection of a drug called human chorionic gonadotrophin (hCG). This drug has the effect of causing the follicles to fully mature and the eggs are collected about 35 to 36 hours later.
There are three specific drug regimes used for IVF in Galway Fertility Clinic and your consultant will best determine which protocol is suited to you. Regular visits are required to assess progress using transvaginal ultrasound scans and blood tests to measure oestradiol levels.
Egg Collection Procedure
The Egg Collection is scheduled once the follicles have grown to the optimal size. This procedure is carried out on an out-patient basis and does not require a general anaesthetic. Mild sedation and pain killers are given in injection form to reduce discomfort and to relax the female partner.
A very fine needle is passed through the top of the vagina into the ovary under ultrasound guidance. The eggs are collected by aspirating each follicle in turn. The aspirate is passed to the embryologist who examines the contents using a microscope. If an egg is present then the next follicle is aspirated. If there is no egg present the follicle may be flushed (washed) with a special medium (liquid) a number of times. Not all follicles produce eggs and there are a small number of women whose follicles appear not to produce eggs at all.
Most clients are fully recovered and able to go home within 1-2 hours of the procedure. However they will be unable to leave unaccompanied as they cannot drive or return to work due to the sedation.
Fertilisation of the eggs and culture of the embryos
The retrieved eggs and sperm are placed in ideal conditions in the laboratory incubators. Galway Fertility Clinic uses the EmbryoScope® for all cases. Fertilisation then takes place over a number of hours and the early signs of fertilisation, the appearance of two pronuclei, can be detected early the following day. The fertilised eggs are grown (cultured) in the incubators for up to 5 days after the egg collection, during which time they change from a single cell on day 1 to cleavage stage embryos on day 2 and 3 and on to the blastocyst stage on day 5.
The male partner will be required to produce a sperm sample on the morning of the Egg Collection (usually after the Egg Collection procedure), unless prior arrangements were made to freeze a sample. In the laboratory the sperm are prepared for insemination. This involves extracting the best sperm and washing them to remove the seminal plasma (this is liquid produced by the body as a carrier medium for the sperm). The prepared sperm are added to the eggs about 4 hours after the egg collection. The inseminated eggs are returned to the incubator and kept there overnight, during which time fertilisation should occur.
The embryos are transferred into the woman’s uterus in a simple procedure called embryo transfer. The transfer involves passing a fine catheter containing the embryo(s) through the neck of the womb (cervix) into the womb (uterine cavity). In general 1 to 2 embryos at a time are transferred, with the number determined by a consultant. Additional embryos can be stored (cryopreserved) (see Cryopreservation section) for use in subsequent treatment cycles. Embryo transfers may occur two, three or five days after the egg collection.
Progesterone medication is taken by the female partner during the few weeks waiting for pregnancy results.
What is the Success Rate for IVF?
Galway Fertility Clinic has an average positive pregnancy rate of 50% and a take home baby rate of 40%, per IVF treatment cycle.
Chances of a successful outcome depend primarily on the woman’s age, declining significantly after 41 years of age.