IVF/ICSI

In-Vitro Fertilisation (IVF) is a procedure where eggs are extracted and fertilised 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 Fertilisation:

The indications for IVF include damaged or blocked fallopian tubes, severe endometriosis, severe male infertility, advanced age / decreased ovarian function and unexplained infertility.

IVF Treatment:

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 Medications

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 most 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 eight 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 used protocol today is the GnRH-antagonist protocol. We use patient friendly protocols at Cape Fertility.

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 anaesthetist 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 Cape Fertility. The patient will need to stay approximately two hours at Cape Fertility.

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 fertilised 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 visualise 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 fertilisation) 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.

With ICSI, nearly every man has the possibility to have his own biological child.

Intra Cytoplasmic Sperm Injection:

Intra Cytoplasmic Sperm Injection (ICSI) is a type of IVF (see section on IVF). This is a procedure used in specific circumstances during in-vitro fertilisation.

Reasons to have ICSI:

The main reason to perform ICSI is because of a low sperm count or poor sperm morphology (shape of the sperm). Other reasons include sperm obtained by epididymal or testes aspiration or biopsy, previous failed fertilisation in conventional IVF, when performing PGT (pre-implantation genetic diagnosis), to reduce transmission of HIV or to increase fertilisation rates.

ICSI Treatment:

The embryologist will choose a single sperm cell (the best available) and inject it directly into the egg. This is done using a micromanipulation microscope. With ICSI, nearly every man has the possibility to have his own biological child. Our laboratory is equipped with the newest high-magnification ICSI microscope. This helps the embryologist in selecting the best spermatozoa. High-magnification ICSI can improve clinical outcomes in couples with previous repeated conventional ICSI failures.