In vitro fertilisation (IVF)

In vitro fertilisation, or IVF, is where the ovaries are stimulated (using hormonal injections) to produce eggs. The eggs are harvested from the ovaries using ultrasound guidance and then fertilised with sperm in a laboratory incubatorThe fertilised eggs (called embryos) are then grown for up to five days. One or two of the best quality embryos are then transferred into the womb to achieve a pregnancy.

When is IVF advised?

You may be advised to have IVF for more than one reason, including:

  • One or both of your fallopian tubes are damaged or blocked
  • The sperm is reduced in quantity and/or quality
  • Your infertility is unexplained
  • Your ovarian reserve is low
  • To allow egg donation
  • As part of an egg or embryo freezing program

How does IVF work?

During natural conception, an egg is released each month from the ovary. It travels down the fallopian tube to meet sperm that have swum through the cervix and womb. Fertilisation of the egg will only occur if sperm have reached the egg in sufficient numbers and are of good quality.

Once fertilised, the egg starts to divide to form an embryo and travels down the fallopian tube to reach the womb about five days later. At this point, the embryo is called a blastocyst and tries to implant.

For implantation to be successful, the womb lining has to be prepared and thickened by the hormone progesterone.

The single most important factor enabling the blastocyst to continue to grow in the womb, leading to pregnancy, is the embryo’s genetic health. This depends on both the egg and the sperm.

What are the steps in an IVF cycle ?

Going through an IVF cycle is not as complicated as you might think. It involves a number of steps:
 

  1. Fertility MOT and Consultation
    2. Nurse Consultation
    3. Ovarian stimulation
    4. Egg collection
    5. Sperm Collection
    6. Laboratory processes
    7. Embryo selection and transfer
    8. Pregnancy Monitoring

Why are hormone injections used in IVF?

Each month, the ovary has a number of eggs available to be grown and released. This is measured in your ovarian reserve test, along with the hormone AMH during your Fertility MOT.

In a natural cycle, only one egg is selected to be grown by a hormone called follicle stimulating hormone (FSH). The egg grows and matures over the next 10-14 days before being released by Luteinising hormone (LH). All the other available eggs that month just die and are wasted.

Research has shown that, for IVF treatment to have a good chance of success, more than one egg is needed. IVF success rates increase as more eggs are collected (to a maximum of 15 eggs, with no further rise in the chances of success above this number). That’s why, during an IVF cycle, the ovaries are stimulated with daily hormone injections of FSH alone or with LH.

The eggs develop in tiny sacs of fluid within the ovaries called follicles. Their growth is carefully monitored over the next 10-14 days using ultrasound scans. This ensures the eggs are harvested at just the right time.

Fertility MOT and medical consultation

If you’re worried about your fertility, having an assessment, or Fertility MOT, can help us guide you in your parenting journey and help us decide if IVF is right for you.

Nurse Consultation

At this appointment, we’ll map out your treatment journey and agree on your start dates. It’s a good idea to attend with your partner if you are having treatment together, or to bring a friend or relative for support if you’re single. 

You’ll have two Nurse Consultations; one to set dates and a further one where we show you how to take your medication, including self-administering your injections. Some people worry about this, but our experienced staff will make sure you feel confident that you can take your medication safely. We also have demonstration videos that you can view at home in case you want to go over anything again. All your medication will be delivered to your home (or other address of your choice) via our home-delivery pharmacy.

Most of our treatment plans require you to fill out some detailed, and sometimes complicated, consent forms to comply with regulations of the Human Fertilisation and Embryology Authority (HFEA). To help you do this, we use an online fertility consent portal. That means you can complete your consent forms from the comfort of your own home (or wherever you happen to be) using a computer or mobile device.

We’ll ask you to watch some online videos about your proposed treatment before you attend your Nurse Consultation. The nurse will then check you’ve understood all the information in the consent forms and ask you (and your partner if they’re involved in the treatment) to sign these in the clinic.

During your consultations, you’ll also be given more information about our patient support options.

Before you leave, we’ll give you a fertility treatment identity card and a treatment schedule, which we’ll ask you to bring to every appointment.

Ovarian stimulation

You will need to take daily hormone injections that stimulate your ovaries to produce eggs. You take these for around 12 days. We’ll show you how to do these injections yourself, so you don’t need to make unnecessary trips to the clinic.

You’ll have three or four ultrasound monitoring scans and blood tests during your treatment cycle. These check the development of your follicles (the fluid sacs that contain the eggs).

Your results are reviewed by our medical team. They’ll advise you about whether you need to adjust the dose of your hormone injections. Once your follicles have reached the correct size, your Consultant will advise you to have an injection to mature your eggs ready for egg collection.

Egg collection

This is carried out at the Agora by one of our Consultants. You’ll be given sedation to help you sleep through the procedure which usually takes 15 to 20 minutes.

During the egg collection, a fine needle, attached to an ultrasound scanning probe, is passed through the vagina into each ovary to collect the eggs.

Once you have had the egg collection you will be transferred to our recovery bay where you will be cared for by our specialist nursing team. You will be given something to eat and drink and then you can go home. You should not drive or exert yourself unduly and just relax at home.

Egg collection is not usually a painful procedure but some women find need to take some paracetamol later in the day when they get home if they experience mild period like pains. You can go back to work the next day if you wish.

Sperm collection and/or preparation

Sperm needs to be provided on the same day as egg collection. This can be a fresh sample provided by your partner or a frozen sample if you are using donor or frozen sperm. The healthiest sperm are selected following a special process that is carried out in our on-site laboratory. Donor sperm, which has previously been frozen, is prepared using the same process. In some cases, we may advise you to have a process called surgical sperm retrieval.

IVF Laboratory processes

The eggs that have been collected are placed in a dish with sperm from your partner or from a sperm donor to fertilise. If the sperm is low in numbers or of poor quality, we may advise the eggs to be treated with intracytoplasmic injection (ICSI). This is a form of IVF where a single healthy sperm is injected directly into the centre of each egg to assist fertilisation. 

The treated eggs are then placed in an incubator. This provides the optimum conditions to allow fertilisation to take place.

Our embryologists will be in contact with you the next morning to let you know how many of your eggs have been fertilised. They will then keep you updated on how your fertilised eggs (now called embryos) are developing and answer any questions you may have.

Intracytoplasmic Sperm Injection (ICSI)

ICSI is when a single, healthy sperm is injected into each egg during the IVF Laboratory stage rather than just placing the sperm in a dish with the eggs.

For eggs to be successfully fertilised in IVF, at least 100,000 motile sperm need to be present in each petri dish with the egg. So, for men with low sperm count, low motility or other quality issues, IVF would not lead to a good chance of the eggs being fertilised. In these cases we may recommend ICSI.

We may also recommend ICSI if you have unexplained infertility, or when there has been low fertilisation in previous IVF cycles. It’s also used if DNA fragmentation levels in sperm are high.

Embryo development

The morning after your egg collection, the embryologists will examine the eggs for signs of fertilisation. Around 70-80% of mature eggs should have been fertilised. A fertilised egg normally has two little spheres in the middle, one from the egg and one from the sperm. If there are too few or too many spheres, fertilisation is considered abnormal.

On Day 2, the embryos are usually 2-4 cells in size. In most cases, 90% of the fertilised eggs will reach this stage.

On Day 3, the embryos are briefly checked for quality of growth. At this stage, the embryos should be between 6-8 cells. We would only advise transferring the embryo(s) into the womb on day 2 or 3 if you have less than three embryos and we can clearly identify which embryos are the healthiest to transfer.

On Day 4, the embryos should be developing into a compacted ball of cells called a morula. We usually don’t examine the embryos on day 4. But it’s not unusual to find that some of the embryos will have slowed down in their development or stopped growing altogether by this stage.

On Day 5, blastocysts should have formed. A blastocyst is an embryo which typically has over 150 cells. These have divided into two distinct cell types; the inner cell mass that will form the fetus (or baby) and the outer cell mass that will develop into the placenta. Most of the embryos will reach Day 3 and have 6-8 cells, but only 40% of these embryos will go on to reach the blastocyst stage.

Embryo selection and transfer

A fresh embryo transfer usually takes place five days after egg collection, once the embryo has reached the blastocyst stage. We will discuss with you how we have selected the best embryo to transfer.

The embryo transfer is a simple procedure. A speculum is inserted into your vagina (similar to a smear test), and a catheter which holds the embryo(s) is gently passed into your womb under ultrasound guidance. The procedure will be performed by one of our Consultants and takes about 20 minutes. It is not usually a painful procedure, and you can have your partner or a friend with you.

At the Agora, women under 40 will usually only have one embryo transferred. This avoids the risk of a multiple pregnancy, in line with the HFEA ‘One at a time’ campaign

“Our baby girl was born in December and without our ICSI procedure, we wouldn’t have become parents. To us she is an absolute miracle.”