IVF In Vitro Fertilisation
In vitro fertilization (IVF) is a procedure in which a physician will remove one or more eggs from the ovaries that are then fertilized by sperm inside the embryology laboratory. Like many clinics in the USA we have now replaced IVF with ICSI due to the overwhelming improvement in success rates that we achieved with adopting ICSI for our patients. Confirmation of this was performed by analyzing more than 140,000 cycles from across the UK which confirmed that live birth rates rates could be improved by 27% by using ICSI rather than IVF.Get in touch
The IVF timeline
In a normal ovulation cycle, one egg matures per month. The goal of an in vitro fertilization (IVF) cycle is to have many mature eggs available, as this will increase your chances of success with treatment. In order for there to be more than one egg available, stimulation of the ovaries needs to occur. It's important to note that the eggs being stimulated would have grown or died that month, so stimulating the ovaries does not deplete eggs for the future. This is a common question that patients ask, so rest assured.
Step 1: Stimulation of the ovaries
In the stimulation phase of an IVF cycle, you will use injectable medications for approximately 8 to 14 days to stimulate the ovaries to produce eggs. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both produced naturally within the body, comprise the medications. During this phase, you will come into the clinic approximately 5 to 6 times for morning monitoring, which allows the team to track the progress of your cycle and adjust medication dosages as needed. The trigger injection is the final step in the stimulation phase of treatment. Depending on your individual protocol, you will either have a human chorionic gonadotropin (hCG) or a buserelin trigger. This injection helps the developing eggs complete the maturation process and sets ovulation in motion. Timing is very important here, as the doctor must perform the egg retrieval prior to the expected time of ovulation.
Step 2: Egg retrieval
A doctor will perform your egg retrieval procedure at Glasgow Royal Fertility Clinic. On the morning of your egg retrieval, a doctor will meet with you before the procedure to review your protocol. You will also meet with an anaesthetist, who will review your medical history and will administer the intravenous fluid you will receive prior to the start of the procedure to sedate you.
Obtaining the sperm: If you are using a fresh sperm sample, a member of the embryology team will come to accept the sample. If you are using a frozen sperm sample or donor sperm collected previously, the embryologist will verify those details with you. Our andrology laboratory will wash and prepare the sperm, so that the healthiest sperm are brought together with the eggs for fertilization (after the doctor performs the egg retrieval).
Obtaining the eggs: The egg retrieval itself takes about 20 to 30 minutes. During the procedure, the doctor will guide a needle into each ovary to remove the egg-containing fluid in each follicle. The doctor uses ultrasound during the procedure to see where to guide the needle. Recovery will take about 30 minutes and you will be able to walk out on your own. It's important that you are accompanied home after the procedure, as it is unsafe to drive after receiving anaesthesia. The person who is driving you will not need to stay at our clinic during your procedure—he or she should anticipate coming back to the clinic after approximately 3 hours.
Step 3: Fertilization
After the egg retrieval, the embryologist will prepare the eggs and sperm. There are two ways that fertilization can take place: conventional insemination or intracytoplasmic sperm injection (ICSI). The doctor will discuss with you which method to use based on sperm quality; this is traditionally planned in advance. In some cases, the embryologist may see that semen parameters for conventional insemination are not being met, so they will recommend the switch to ICSI to produce the greatest chance of success. Your clinical team will let you know if they recommend an unanticipated ICSI procedure. For conventional insemination, the embryologist takes the prepared sperm sample and isolates the healthiest sperm. He or she will then incubate approximately one hundred thousand sperm with each egg in a Petri dish. This gives the egg and sperm the opportunity to find one another and fertilize.
Step 4: Embryo development
Embryo development begins after fertilization. After initial fertilisation the embryos will be placed within our Embryoscopes which enables them to continue to develop completely undisturbed. An embryologist examines each developing embryo over the course of the following 5 to 6 days. The goal is to see progressive development, with a two- to four-cell embryo on day 2 and a six- to eight-cell embryo on day 3. After the eight-cell stage, rapid cell division continues and the embryo enters into what is called the blastocyst stage at day 5 or 6. It is your doctor’s goal to transfer the highest-quality embryo(s) to give you the greatest chance of reproductive success and with the EmbryoScope we can personalise this for you.
Step 5: Embryo transfer
The embryo transfer is a simple procedure that only takes about 5 minutes to complete. There is no anaesthesia or recovery time needed. When your nurse arranges your transfer, she will notify you and provide instructions on when to arrive and how to prepare.
You need to have a full bladder for the procedure as a full bladder ensures good visualization of the lining of the uterus and proper placement of the embryos. It's important to drink the specific amount of liquid recommended 30 to 40 minutes ahead of time. You will review your cycle with the doctor and the number of embryos recommended for transfer.
Upon entering your procedure room, the embryologist will again confirm your last name and the number of embryos for transfer. The embryologist will load the transfer catheter in the embryology lab with the embryo(s) and then the doctor will insert the catheter into the uterus and push the embryo through with a small amount of fluid. An external abdominal ultrasound provides visual guidance via a monitor to the doctor throughout the procedure. Once the doctor transfers the embryo, he or she will slowly remove the catheter. Since the embryo is invisible to the naked eye, the embryologist will then examine the catheter under a microscope in the lab to ensure that the catheter did indeed release the embryo. The nurse will give you instructions for the following 2 weeks until it's time for the pregnancy test.
Step 6: The pregnancy test
Two weeks after the embryo transfer, you will perform a pregnancy test. This test is frequently called a "beta" because it measures the beta chain portion of the hCG hormone emitted by the developing embryo. We let you do this test in the privacy of your own home using a urinary pregnancy test and you then let us know the outcome so we can plan the next steps.
Why does GRFC just do ICSI and not IVF?
We have had consistently had higher success rates with ICSI, and when Prof Nelson analysed more than 140,000 IVF and ICSI cycles from the all across the UK he found that you were 27% more likely to have a baby if you had ICSI irrespective of the cause of infertility. This initial finding was confirmed in another 100,000 cycles. Knowing this national and local data we are delighted that the move to only using only ICSI has helped us achieve the highest success rates in Scotland.
Are there any restrictions on physical or personal activities during an ivf cycle?
- Smoking: Stop smoking before ovulation induction begins. It is best to discontinue tobacco at least 3 months prior to an IVF cycle. If you cannot stop “cold turkey”, seek the care of your general practitioner. By products of tobacco have been demonstrated to be toxic to eggs. Numerous studies have also demonstrated that smoking during pregnancy results in reduced birth weight and fetal compromise. There is some data that smoking can also lower pregnancy rates. We strongly recommend that all women and their partners, especially those undergoing fertility treatment, cease smoking.
- Drinking: Alcohol is a drug, and should be avoided during fertility treatment and pregnancy. Please do not drink alcohol from the time fertility medications are started.
- Medications: If you are taking any medication, prescription or over-the-counter, please inform your doctor. Some medications may interfere with the fertility medications prescribed, some are not safe to use before an operation or medical procedure, and others might interfere with ovulation or pregnancy implantation. A prenatal or multivitamin will be prescribed; if you are not taking a vitamin with folic acid, please inform the GRFC nurses. Please do not use herbal supplements during your IVF cycle.
- An IVF cycle can be an emotional and stressful time. It may be helpful to have supportive people to speak to, such as friends and family, a clergy member, or one of our counselling team.
- Heavy exercise such as aerobics, jogging, weight lifting etc. are not recommended during ovarian stimulation and until the pregnancy test results are known.
- Acupuncture is permitted prior, during and after your IVF cycle but herbal supplements are not recommended.
What happens if I become pregnant?
If pregnant, you will be asked to return to the clinic for an ultrasound to ensure an ongoing successful pregnancy. After a fetal heartbeat has been confirmed, patients are referred to an obstetrician for the remainder of the pregnancy.
If I am not pregnant, when can we try again?
Usually we ask that patients wait one or two complete menstrual cycles before beginning another Assisted Reproductive Treatment cycle. Sometimes tests are required that may delay subsequent cycles.
Is there a higher miscarriage rate for IVF patients?
The miscarriage rate is about the same for Assisted Reproductive Treatment as the general population. Many times older females undergo IVF and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population.
Am I depleting my store of eggs by undergoing an IVF cycle?
A woman is born with a full complement of eggs. There are far more eggs than will ever be used during a normal lifetime and IVF procedures have no measurable “lowering” effects.
How do we decide how many embryos to transfer?
Your doctor will discuss this with you at the time of consent signing, but we usually follow the recommendations of The Human Fertilisation and Embryology and the British Fertility Society guidelines to limit the chance of you having a triplet pregnancy. We would normally transfer one or two embryos and the number will vary depending on individual diagnosis and clinical circumstance.
Do you have any age or BMI limits to treatment?
For women using their own eggs we treat up to the age of 45 years old, and for women using an egg donor, it is 50 years.
We want to ensure that you have the best possible chance of having a healthy pregnancy, and so we adhere to British Fertility Society Guidelines on an upper body mass index limit of 35 kg/m2.
For those women who need to lose weight, we recommend the Counterweight Plus scheme which has been endorsed by the NHS.
Why is IVF the same cost as ICSI?
We have focused on getting the highest success rates in Scotland, and with that streamlined all processes so that everyone gets ICSI. Should you wish IVF, that would be unusual in our lab and we would need to dedicate personnel to your case.
We are delighted to be able to offer IVF as a treatment package with a single cost from the moment you decide to pursue treatment. Our full price list can be found here for download, but below is a summary of what the IVF package includes. At any time, if you have any questions about the fees, please contact us as soon as possible on 0141 201 8581 to speak to a member of staff.