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Fertility Treatments

Offering evidence-based, leading-edge treatments that provide potential pathways for you to create your family.

Follicle Tracking

When a woman is ovulating normally, an egg is released from the ovary during each menstrual cycle.

Eggs develop inside fluid-filled sacs, called follicles. Just prior to ovulation, follicles reach a size of around 20mm and are visible on a transvaginal ultrasound scan. Ultrasound scanning can be used quite effectively to monitor follicle growth and predict ovulation.

How is follicle tracking carried out?

As practised in most fertility centres, Merrion Fertility Clinic uses vaginal ultrasound scanning to monitor ovarian follicles. Most women find vaginal scanning quite comfortable.

When is follicle tracking used?

Follicle tracking allows us to monitor the cycle and follicle development so that intercourse can be timed around ovulation. Follicle tracking and TSI (timed sexual intercourse) is only used when:

  • ovaries are producing follicles
  • sperm tests are normal
  • fallopian tubes and pelvis are also normal

Follicle tracking may be useful for women whose cycles are very irregular and unpredictable. However, it is not suitable for most infertility pathologies.

Ovulation Induction (OI)

Ovulation induction (OI) refers to the use of fertility drugs to induce ovulation in a woman who does not ovulate herself. 

Fertility drugs used include tablets such as Clomid, Tamoxifen or Letrozole, or injections of the hormones Follicle Stimulating Hormone (FSH) or Luteinizing Hormone (LH). These may also be used in women who are already ovulating themselves in order to ‘boost’ ovulation, a process that is referred to as superovulation.

Monitoring ovulation

The dose of fertility drug used is critical and varies from woman to woman. Some women may over-respond to a particular dose while others may not respond at all. Close monitoring of developing follicles, which contain the eggs, is critical. This is done with transvaginal ultrasound scanning.

Once the follicles reach the correct size (around 20mm), ovulation is likely to occur within 48 hours. The couple are advised to have intercourse over the following days.

Intra-uterine insemination (IUI)

For IUI treatment, a semen sample is produced by the male partner around the time of ovulation, prepared in the laboratory and then placed in the woman’s uterus.

During sperm preparation, dead and poor quality sperm are removed, leaving a highly purified sample of healthy sperm at the correct concentration for fertilization. The healthy sperm is then placed into the uterine cavity using very soft thin tubing, in a procedure quite similar to having a smear test.

How is IUI timed?

IUI must be performed around the time of ovulation. The woman’s cycle is monitored using vaginal ultrasound scanning. IUI may be performed during a ‘natural’ cycle or in combination with fertility drugs.

When is IUI recommended?

IUI is recommended as a fertility treatment for mild sperm abnormalities, cervical problems or psycho-sexual problems in couples where the woman is usually 37 years or younger. It may also be used for unexplained infertility.

IUI is not recommended if there is significant endometriosis (grades III – IV), tubal disease (e.g. following tubal infection), significant sperm abnormalities or in older women.

In Vitro Fertilization (IVF) & Intracytoplasmic Sperm Injection (ICSI)

IVF

In vitro fertilization literally means ‘fertilized in glass’. In IVF, eggs are removed from the ovary just before ovulation. The eggs and sperm are then placed together in a specialised laboratory environment.

If fertilization and normal embryo development occurs, the best embryo(s) is/are returned to the uterus 3 to 5 days later.

When is IVF used?

IVF was originally developed to treat blocked and damaged fallopian tubes. Now, IVF is used for a wide range of disorders including endometriosis and unexplained infertility.

EmbryoGlue®

This is a fluid or media that an embryo can be placed in before being transferred. It can support the process of the embryo implanting into the lining of the uterus, the next developmental step after transfer.

ICSI

ICSI is a specialised form of IVF. In contrast to standard IVF, where the sperm has to penetrate the egg by itself, ICSI involves injecting a single sperm directly into an egg using a fine glass needle. All other stages of the treatment cycle are identical to IVF.

ICSI is recommended in cases where there are not enough motile sperm to fertilize an egg using normal IVF. It is particularly useful in cases where sperm parameters are severely reduced. 

Steps generally involved in a cycle of IVF or ICSI

  • 2 to 5 monitoring visits, which are a combination of ultrasound scanning and blood tests
  • 8 to 12 days of stimulation medication
  • Trigger injection 36 hours before the egg retrieval
  • Egg retrieval is carried out with sedation given by a Consultant Anaesthetist.
  • Fertilisation of the egg and sperm to create embryos
  • Transfer of a suitable embryo to the uterus, 3 to 5 days after the egg collection

Embryo Freezing

Following embryo transfer, there may be additional embryos that are of good quality.

These embryos can then be frozen or  ‘cryopreserved’, stored and thawed for use at a later date during a Frozen Embryo Transfer (FET) treatment cycle.

Not all embryos are suitable for freezing. Embryos must be of adequate quality to endure the freezing and thawing process. 

Single Embryo Transfer Policy

Merrion Fertility Clinic has an elective single embryo transfer policy. For patients deemed to have a very good prognosis, a single high quality embryo is transferred and any other good quality embryos are frozen for subsequent use.

Double embryo transfer may be recommended in certain situations. This option will be discussed with the patient(s) in advance of the embryo transfer.

Frozen Embryo Transfer

Some patients will have embryos frozen during their IVF/ICSI treatment cycle, for future use. A FET cycle involves thawing frozen embryos and transferring them back to the womb.

FET cycles are much simpler than fresh cycles, as ovulation induction, egg collection and fertilisation are not required.

Over 98% of vitrified embryos will survive the freezing process and be suitable for transfer when warmed.

Surgical Sperm Retrieval (SSR)

SSR is a procedure used to take sperm directly from the testis or the epididymis.

At Merrion Fertility Clinic, SSR is performed with sedation and pain relief, provided by a Consultant Anaesthetist.

SSR is generally performed for men who have no sperm in their ejaculated semen, or who have had a failed vasectomy reversal. SSR may also be used for men with spinal injuries and where there are problems with normal ejaculation (e.g. MS or Diabetes).

The samples retrieved are processed by our laboratory team and any functional sperm found are prepared and frozen for future use in an ICSI cycle. The number of sperm is generally small and the motility reduced, so ICSI (intracytoplasmic sperm injection) is needed to maximise the chance of fertilisation with your partner’s eggs.

Surrogacy

Surrogacy enables family creation for persons or couples where the intending parent or parents cannot carry a pregnancy. Most surrogacy practised today is gestational or IVF surrogacy where an embryo is created using the intending parents’ sperm and egg (or a donor egg or sperm, if required). The embryo is then transferred to the uterus of the surrogate who has no genetic connection with the child.

Common medical indications for surrogacy are situations where women are born without a uterus and where women sustain damage to or loss of their uterus, for example from cancer or surgery or haemorrhage in pregnancy.

Other women have serious medical conditions where pregnancy could prove fatal to them and their babies. There are also some specific but rare causes of infertility and recurrent miscarriage where surrogacy may be advised.

Same sex male couples, single men and transgender women also require surrogacy, if they wish to have a family.

Surrogacy is extremely complex from a legal point of view and there is currently no legislation regarding this in Ireland. However, it is currently being debated by the Oireachtas.

Merrion Fertility Clinic is licensed to provide domestic surrogacy. However, we have extremely strict requirements. There must be a definite medical indication for surrogacy and patients must also have a suitable family member or close friend who is willing to act as a surrogate.

There are strict requirements also for the surrogate.  All of those involved must be resident in Ireland and all must be willing to receive legal advice and attend counselling.

For those seeking surrogacy, the National Infertility and Support Group (NISIG) have outlined some important advice in their document on International Surrogacy

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