In-Vitro Fertilisation (IVF) Fertility Treatment

WHAT CAUSES OF INFERTILITY CAN IN-VITRO FERTILIZATION (IVF) TREAT?

IVF may be an option if either you or your partner has been diagnosed with any of the following conditions which may contribute to infertility:

1. Tubal factor – eg tubal damage from previous infections / previous ligation / salpingectomy
2. Endometriosis
3. Ovulatory problems and/or anovulation – eg in Polycystic Ovarian Syndrome (PCOS)
4. Early menopause (premature ovarian failure)
5. Male factor – eg low sperm count / absent sperm (azoospermia) / inability of sperm to penetrate or survive in the cervical mucous
6. Unexplained infertility

HOW DOES IVF WORK?

Video: http://www.youtube.com/watch?v=GeigYib39Rs

During the process of IVF, fertilization of the eggs with sperm occur in a laboratory—“ in vitro”. Before fertilization, hormonal injections are administered for about 2 to 4 weeks to stimulate the follicles within the ovaries. Eggs are then collected and inseminated (IVF) or injected (ICSI) with the husband’s sperm in the laboratory. After fertilization, the embryos are incubated for 2-5 days before being replaced into the womb in a process called embryo transfer. A successful pregnancy can be confirmed 17 days later via a blood test. There are other procedures involved in IVF which are suitable for specific problems. Your doctor will advise you if any of the following are necessary for you:

1. Intra-Cytoplasmic Sperm Injection (ICSI)
   ICSI involves injecting a single sperm into each egg to allow fertilization to occur in the laboratory. This is recommended if the man has poor quality sperm or if you have had difficulties with fertilization previously.


2. Blastocyst Culture
   Embryos are cultured for 5 days to become a blastocyst. The chances of pregnancy are much higher with a blastocyst transfer. This may be helpful for couples with repeated IVF failure, multiple eggs and if Pre-implantation Genetic. Diagnosis is required.

TYPICAL IVF CYCLE

1. Ovulation Induction Controlled Ovarian Hyperstimulation and Monitoring (Bold)
   Hormone injections are administered to stimulate the production of multiple eggs in each ovary (versus the usual production of a single egg per month). This stimulation process usually requires the initial use of a GnRH agonist injection to suppress the body’s spontaneous ovulation, and to ensure that the ovarian follicles grow in a synchronous fashion. Daily gonadotropin injections are then added to stimulate growth of the follicles in the ovaries. When the follicles have reached the desired size, an injection of hCG is given, with the discontinuation of GnRH agonist and gonadotrophins. The hCG is required for the final maturation of eggs before egg collection.


2. Oocyte Pick-up (Egg retrieval)
   Oocyte Pick-up (OPU) is performed under sedation by placing a special needle into the ovary and removing the oocyte-cumulus complex (containing the egg). Multiple eggs may be retrieved at a time depending on the success of the stimulation process.


3. Fertilization
   Following egg retrieval, sperm is added to the eggs in a dish to allow fertilization to occur by natural selection in the laboratory. For sperm abnormalities, ICSI (intra-cytoplasmic injection of sperm) is performed.


4. Embryo Transfer
   Fertilized embryos are transferred into the uterus between day 2- day 5 of fertilization using a fine catheter. Usually, a maximum of two embryos are transferred at a time. Up to three embryos may be transferred under exceptional circumstances (please ask your doctor for more information). You will be given hormones either oral, vaginal or even by injection to support the lining of the uterus for implantation of the embryos.


5. Freezing of Extra Embryos
   A proportion of patients may have excess good quality embryos. These may be frozen for future use. The survival rate for thawing these embryos is about 83%. An annual storage fee will be subjected for these frozen embryos, and they can be stored up to 10 years at our facility.


6. Testing for Pregnancy You will need to come back between 14 to 17 days after the embryo transfer for a pregnancy test, which measures the pregnancy hormone b-hCG in the blood. If you are pregnant, subsequent ultrasound scans and blood tests will be arranged to ensure that the pregnancy is proceeding normally. If you are not pregnant, you may consider proceeding to a frozen (thaw) cycle of IVF if you have additional frozen embryos in storage.