IVF / ICSI

What is IVF?

In vitro fertilisation (IVF) literally, means ‘fertilisation in glass’ – IVF

IVF treatment involves the fertilisation of an egg (or eggs) outside the body. The treatment can be performed using your own eggs and sperm, using either donated sperm or donated eggs, or both.

Is IVF for me?

Our clinic may recommend IVF if:

FEMALE FACTORS
1) Bilateral Tubal Block.
2) Repeated IUI failures.
3) Advanced maternal age.
4) Frozen pelvis.
5) Grade 3 and grade 4 Endometriosis.
6) PCOS not responding to treatment.
7) Premature ovarian failure.
8) Diminished ovarian reserve.

MALE FACTOR
1) Oligoasthanospermia ( Total motile sperms >1 million/ml and < 10 million/ml)

How does IVF work?

IVF techniques vary according to your individual circumstances and the approach of your clinic. Before your treatment starts, you will need to complete various consent forms (see p81). You and, if applicable, your partner may also need to have blood tests to screen for HIV, hepatitis B, hepatitis C and human T cell lymphotropic virus (HTLV) I and II.

Treatment then typically involves the following stages:

For women:

1. Suppressing your natural monthly hormone cycle
As a first step, you will be given a drug to suppress your natural cycle, which you can administer yourself in the form of a daily
injection or a nasal spray. The drug treatment continues for about two weeks.

2. Boosting the egg supply
After your natural cycle has been suppressed, you will be given a type of fertility hormone known as a gonadotrophin. You will usually take this as a daily injection for around 12 days. The hormone will increase the number of eggs you produce.

3. Checking on progress
The clinic will monitor your progress throughout the drug treatment through vaginal ultrasound scans and, possibly, blood tests. Between 34 and 38 hours before your eggs are due to be collected you will be given a hormone injection to help your eggs mature. This is likely to be human chorionic gonadotrophin (hCG).

4. Collecting the eggs
Your eggs will usually be collected using ultrasound guidance while you are sedated. A hollow needle is attached to the ultrasound probe and is used to collect the eggs from the follicles on each ovary. You may experience some cramps, feel a little sore and bruised and/or experience a small amount of bleeding from the vagina. After your eggs have been collected, you will be given medication in the form of pessaries, injection or gel to help prepare the lining of your womb for embryo transfer.

5. Fertilising the eggs

Clinician picking up a petri dish – IVFYour eggs will be mixed with your partner’s or the donor’s sperm and cultured in the laboratory for 16–20 hours after which they are checked for signs of fertilisation.

Those that have been fertilised (now called embryos) will be grown in the laboratory incubator for up to six days. The embryologist will monitor the development of the embryos and the best will then be chosen for transfer. Any remaining embryos of suitable quality can be frozen for future use.

6. Embryo transfer
If you are under the age of 40, one or two embryos may be transferred. If you are 40 or over, a maximum of three may be used.

The number of embryos transferred is restricted because of the risks associated with multiple births. Due to this, your clinic will recommend single embryo transfer (SET) if they feel it is the best option for you.

During the procedure, a doctor or nurse will insert a speculum into your vagina. This is similar to having a cervical smear taken when a speculum is used to hold the vagina open so the cervix is visible.

A fine tube (catheter) is then passed through the cervix, normally using ultrasound guidance. The embryos are passed down the tube into the womb.

This is normally a pain-free procedure and usually, no sedation is necessary, but you may experience a little discomfort because you need a full bladder if ultrasound is used.

Risks of fertility treatment
Freezing and storing embryos

For men:

Around the time your partner’s eggs are collected, you will be asked to produce a sample of sperm.

The sperm will be washed and prepared so the active, normal sperm are separated from the poorer-quality sperm.

If you have stored sperm, it will be removed from frozen storage, thawed and prepared in the same way.

Is ICSI for me?

ICSI enables fertilisation to happen when there are very few sperms available.

Our clinic may recommend ICSI if:
1) Repeated IVF failure.
2) Vasal aplasia.( TESA –ICSI).
3) Obstructive Azoospermia ( TESA—ICSI )
4) Severe OAT ( total motile sperms less than 1 million/ml ).
5) Poor ovarian reserve.

Before your treatment starts you will need to complete various consent forms and you, and if applicable your partner, may need to have blood tests to screen for HIV, hepatitis B and C and human T cell lymphotropic virus (HTLV) I and II.

Treatment then typically involves the following:

For women

Initial procedure is same as we have seen above in IVF Procedure for women and men.
A single sperm is then injected into each egg under a specific microscope. ICSI provides the opportunity for fertilisation to happen, but it is not guaranteed to succeed.
Finally, if fertilisation does take place, the embryos will be cultured in the laboratory for up to six days and then between one and three of the best-quality embryos will be transferred to the womb.

The next step depends on whether you are able to provide sperm without a medical procedure:

Or:

A single sperm is then injected into each egg. ICSI provides the opportunity for fertilisation to happen, but it is not guaranteed to succeed.

Finally, if fertilisation does take place, the embryos will be cultured in the laboratory for up to six days and then between one and three of the best-quality embryos will be transferred to the womb.

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