IVF & ICSI Treatment Steps
1. Ovarian Simulation
After preparation, a scan confirms the ovaries are quiet (2-3 weeks in a down regulated cycle or during a period on the short cycle) and the lining of the womb is thin.
Women on the down regulation regime will continue their nasal sniff or down-regulation injection along with the stimulation injections until further instructions.
Injections are self-administered via dose adjustable pen, ampoules or vials which are mixed with water for injection. We show you the technique and will provide a DVD or written instructions. You will be given a detailed timetable with the days of injections and the dates for scans for you to take home.
Usual duration of treatment is 10-12 days. Regular interval scans and blood tests, if required, will be organised to monitor the response of ovaries to the injections. On a scan we see follicles which may contain eggs. We advise that you take these injections around the same time every day.
Common side effects of the stimulation injections include abdominal bloating, nausea, diarrhoea, weight gain, fatigue, and occasionally a localised reaction at the injection site. Most women feel fine on the injections and those who have had the down regulation phase usually feel much better once they start.
2. Egg Collection
The egg collection is the next step of the treatment cycle and it is performed in an operating theatre, under strong sedation and painkillers or occasionally a general anaesthetic.
When the follicles have reached the right stage of maturity and size on the scan, a trigger injection (Gonasi , Ovitrelle or Suprecur ) is administered exactly 35 to 36 hours before your scheduled egg collection. The timing of this injection is extremely important and should be adhered to very strictly. This injection is always administered in the evening. The day after the injection there are no medications, but you will be asked to fast that night.
On the morning of the egg collection, you will attend the centre at 08:30. You will have been advised to refrain from sex for 3-5 days beforehand to ensure that the sperm quality on the day is optimal.
Your partner will have to produce a semen sample around the time of your egg collection which must occur at the treatment centre and not at home as per the HFEA recommendations.
Identities are checked and once once under sedation or anaesthetic, our specialist(s), will spend 20-30 minutes retrieving the eggs from your ovaries. Each egg sac (follicle) in the ovary is located and punctured under ultrasound scan guidance using a fine needle and the fluid in each sac is drawn into a sterile warm tube that is examined under the microscope. A mature egg may not be retrieved from every follicle. Some ‘empty’ follicles contain eggs that stopped growing and disappear. Others contain eggs that are too young to fertilise.
You may feel slightly bloated and uncomfortable for up to 48 hours following the procedure. Painkillers such as paracetamol or ibuprofen can help and are safe to use.
Some light vaginal staining on the day of the procedure is normal and comes from the needle site.
You will be started on progesterone support (Cyclogest suppositories and/or Lubion injection) once or twice a day, as per your agreed protocol. Progesterone is a hormone that encourages good development of the womb lining in preparation for the embryos.
The suppositories continue to the day of the pregnancy test, and beyond if the test is positive. In some cases we may add oestrogen tablets, blood thinning injections (Clexane) and steroids to improve the chances of pregnancy if we feel you may benefit from it.
In IVF approximately 100,000 good quality sperm are added to each egg in a small dish and then placed in a specialised incubator to keep the eggs and sperm at body temperature.
ICSI treatment is different and involves a single selected sperm being injected into each egg. These are then placed in the incubator as above.
Laboratories are very strict at performing identity checks and at every stage double witnessing is carried out by 2 qualified individuals to avoid any errors.
The morning after the egg collection, the dish is examined under the microscope and fertilisation is studied. On an average, 70% of eggs injected (ICSI) or 60% inseminated (IVF) will fertilise normally.
The embryos which cleave are carefully replaced into the incubator for another 1-4 days. These are checked daily and the embryologist confirms the embryo quantity, quality and the likely time of transfer, which is dependent on embryo development.
5. Embryo Transfer
Embryos can be transferred on day 2, 3 or 5 or in rare instances on day 6 after egg collection. Embryos on day 5 are called blastocyst and if embryos reach the blastocyst stage in the laboratory, the chances of achieving a pregnancy increase substantially. Neither of the centres have any additional charges for day 5 or day 6 transfers.
Therefore embryo culture is assessed and embryos can be transferred on day 3 (When they become 6 to 8 cells) or if they are of good quality and can be cultured to day 5 embryos (Blastocysts) Dr. Mark, Dr. Tiri or Dr. Davis will discuss this in detail with you at the appropriate stage of your treatment after discussing it with the embryologists.
Usual practice is to choose the two strongest embryos for replacement but it may be more appropriate to transfer one or three embryos. Partners may be present for the embryo transfer.
A speculum into the vagina to view the cervix. The embryos that have been chosen for transfer are then drawn into a very fine catheter tube which is passed through the entrance to the cervix and onwards, into the womb cavity where they are expelled. The catheter is then slowly and carefully withdrawn and checked by the embryologist.
The procedure feels no different to having a smear test, takes about 10 minutes and there is no need to rest afterwards.