Ivf

IVF treatment

The In Vitro Fertilisation (IVF) or Test Tube Baby technique involves the fertilisation of eggs outside the human body in a test tube and the transfer of these fertilised eggs, or embryos, into the female partner's womb.

Your first appointment to discuss IVF will be with a nurse or doctor and will last about an hour. We expect both partners to attend this session. During this time we will discuss the medical and ethical issues involved in your treatment and you will have the opportunity to ask any questions you may have.

We will also ask you to sign consent forms. These advise us of your informed choice, but do not commit you to any form of treatment and you have the right to change your mind at any time.

We will also explain a typical IVF cycle. This will prepare you for what is involved.

What Happens During A "Typical" IVF Cycle?

Synarel treatment - The Synarel treatment involves using a nasal spray to suppress the hormones produced by the pituitary gland. This small gland at the front of the brain controls the ovaries and needs to be inactive before we begin to stimulate egg production. The Synarel is taken three times a day. Each dose consists of one sniff only.

The treatment starts around day 21 of your cycle, i.e. 21 days after the start of your last period. We would expect you to have a period while you are using the nasal spray, but do not worry if you do not have one. You may notice some symptoms such as hot flushes, headaches, flattening of mood and night sweats etc. These only last for a short time and will usually disappear once the hormone injections have started.

Approximately two weeks after the start of this treatment we will perform a vaginal scan to ensure that your ovaries are inactive and that the lining of your womb is thin. It usually takes about two weeks for the treatment to be effective, although it can take longer.

Stimulation drugs - If the nasal spray has worked you are ready to begin your hormone injections (Gonal-F, Puregon or Metrodin HP) on the same day as your scan. You must continue to use the nasal spray while you have your injections, until the last injection has taken place.

Usually, a woman's ovaries produce only one fertile egg a month. The hormones which we give you help your ovaries produce more than one egg and the dosage of the injections will be chosen to suit your own particular case.

The hormone injection is administered simply by subcutaneous injection (with a very short needle into the fat just under the skin, usually in your arms, legs or buttocks). We encourage you to do these injections yourself (or ask a relative or friend for help). We will teach you exactly how to do this.

The injection must be given once a day at approximately the same time. We will measure the response of your ovaries with an ultrasound scan after the first 9 days of injections.

Each patient is different, so we expect the ovarian response to vary both in terms of the number of follicles produced (a follicle is the fluid filled sac in which the egg grows) and the speed at which they mature. The follicles can be seen on the scan, whereas the eggs are microscopic and cannot be seen with the naked eye. We will be measuring the size and number of follicles produced.

Once we establish the growth of follicles, we will be able to estimate the day of your egg collection. We hope that you will have produced a number of follicles, however, this number is no guarantee of the number of eggs that will be collected. Sometimes the dose of hormones you are given may not stimulate your ovaries enough and very few, or no follicles are produced. This is called poor ovarian response and occurs in about 1 in 10 cycles. It can be detected when we scan you on day 9 of your stimulation. If you are found to have a poor ovarian response, your chances of success are reduced. In this case, we will discuss the situation with you and offer you one of two options; you may carry on with your treatment but must accept a low probability of success, or you may abandon the cycle and start again a few weeks later with a higher dose of hormones. The reason why we do not start everyone on a high dose from the start is that sometimes the ovaries will produce too many follicles. This condition is known as Ovarian Hyperstimulation.

The hCG (Profasi or Pregnyl) treatment - When your follicles have reached the correct size you are ready to be prepared for the egg collection. The Synarel and stimulation treatments should be stopped. You will be given written instructions about the precise time of your hCG injection.

The hCG injection is essential to bring the eggs to the correct stage of maturity for egg collection and is given as an injection deep into the muscle. (You will be given instructions on how to do this injection). IT IS ABSOLUTELY ESSENTIAL THAT THIS INJECTION IS GIVEN AT PRECISELY THE PRESCRIBED TIME. The injection is usually given late in the night, between 9.00 p.m. and midnight. This is specifically timed to be 36 hours before the time of your egg collection.

Egg collection - Approximately 36 hours after your hCG injection we will collect your eggs. The procedure is very similar to vaginal scanning when we looked at your ovaries. We recommend that you have a general anaesthetic but you may choose general sedation.

A needle is passed through the vaginal wall into the ovaries to suck out the fluid from the follicles which contain the eggs. The whole procedure takes about 20 - 30 minutes and we will tell you immediately how many eggs have been collected.

It will be another 2 - 3 hours before you are ready to go home. We recommend that someone (either your partner or a relative or friend) drives you home and stays with you for the rest of the day. You are likely to feel sleepy and may need to go to bed. There is a very small risk (less than 1%) of bleeding or an infection being introduced into the pelvis. If you are worried, please call the clinic immediately.

Sperm sample - On the day of egg collection, the male partner will be asked to produce a semen sample. We prefer you to produce your sample in the clinic. Ideally you need to have abstained from sexual activity for 2 - 3 days.

If, for any reason, it is likely that there will be difficulties in obtaining a semen sample, we will try to freeze some samples from your partner before the day of egg collection. If donor sperm are to be used, they will be prepared at this time.

Approximately 6 - 8 hours after egg collection, the sperm sample