In Vitro Fertilization (IVF)
In Vitro Fertilization (IVF) is a procedure where
eggs are extracted and fertilized in the laboratory.
Also known as a “test-tube baby,” The first IVF baby was born in the UK in 1978 (Louise Brown).
Reasons for In Vitro Fertilization:
The indications for IVF include damaged or blocked fallopian tubes, severe endometriosis, severe male infertility, advanced age / decreased ovarian function and unexplained infertility.
Treatment is usually started within the first 2-3 days of the period. A cycle sheet will be drawn up describing exactly how the medications should be taken and when monitoring needs to be done.
Step One: fertility injections
Medications are given to stimulate egg growth. These medications may include tablets containing clomiphene citrate e.g. Clomid, Fertomid, Clomihexal or fertility injections containing FSH (Follicle Stimulating Hormone) eg Gonal-F, Menopur. The nost commonly used medication is Gonal-F. This can easily be injected by the patient.
The most common side effect is enlarged ovaries, which can cause abdominal pain. Ovarian Hyperstimulation Syndrome (OHSS) is a rare but serious side effect caused by overproduction of eggs. Fortunately with the modern drugs this can be avoided in most cases.
The follicles containing eggs can be seen on ultrasound scan. Monitoring of the treatment cycles using blood tests and ultrasound scans usually starts on day 8 of the cycle.
Medications are also given to suppress ovulation. These medications suppress normal pituitary function to prevent ovulation prior to the time of the egg collection. The medications include Cetrotide, Lucrin and Zoladex. Common side effects of these medications include hot flushes, vaginal dryness, headache, insomnia, mood swings, and reduced libido. However, these side effects are uncommon and generally subside when you begin your FSH injections.
There are different stimulation protocols. The most commonly used protocol today is the GnRH-antagonist protocol. We use patient friendly protocols at the Cape Fertility Clinic.
The eggs are triggered 36 hours prior to the egg collection by using an injection called HCG (Human Chorionic Gonadotrophin) eg Ovidrel.
Step Two: egg collection
The egg collection procedure is performed in our procedure room with sedation. An anesthetist will make sure that you will not feel anything of the procedure. A transvaginal ultrasound is performed and a fine needle which is attached to the ultrasound is used to extract the eggs. The follicular fluid is examined under a microscope in the laboratory adjacent to the procedure room to check how many eggs have been collected. All the procedures are done at the premises of the Cape Fertility Clinic. The patient will need to stay approximately 2 hours at the Cape Fertility Clinic.
Progesterone hormone is given after the egg collection to prepare the lining of the uterus (womb) prior to embryo transfer. This may be given as a vaginal gel (e.g.Crinone), pills inserted vaginally (e.g. Uterogestan), vaginal pessaries (e.g.Cylogest) or an injection (e.g. Gestone).
A sperm sample is given on the same day as the egg collection, and the eggs are fertilized after collection. The embryos are grown in the laboratory for 3-5 days and then replaced into the uterine cavity. New techniques of embryo culture mean that embryos can be grown in the laboratory longer until they reach the blastocyst stage (day 5). This means that embryos that fail to grow can be detected and better quality embryos can be chosen for transfer into the uterine cavity. Fewer embryos (usually two) can be transferred with excellent success rates and less chance of multiple pregnancy (i.e. twins and triplets).
Extra embryos are frozen (cryopreserved) and stored in liquid nitrogen. They can be used in future treatment cycles.
Step Three: embryo transfer
Embryo transfer is performed in a special procedure room. This is a painless procedure and no anaesthetic is necessary. The legs are supported by a gynaecological examination bed and a speculum inserted into the vagina to visualize the cervix. A thin plastic tube is used to transfer the embryos directly into the uterine cavity. A ultrasound scan is performed to ensure the embryos are transferred into the correct place in the uterine cavity. The embryo transfer is performed three of five days after the egg collection.
After the embryo transfer the progesterone medication, as well as folic acid vitamin tablets should be continued. In addition the doctor may sometimes recommend baby aspirin or heparin injections.
Step four: pregnancy test
A blood test to check for pregnancy will be performed 14 days after the egg collection. We wish you good luck.
A typical IVF (in vitro fertilization) plan is as follows:
- Day 1 of your cycle: the first day of the period.
- Day 3 of your cycle: Start with fertility injections on day 3 of the cycle.
- Day 8: First scan by your doctor.
- Day 10: Second scan.
- Day 12: Third scan. Trigger injection in the evening.
- Egg retrieval on day 14. (This day we need a fresh sperm sample).
- Transfer the fertilised egg(s) back on day 17 or day 19.
- Pregnancy test can be done around day 28.