See the following for detail on the IVF Process and ICSI
What is IVF?
In vitro fertilization (IVF) literally means, ‘fertilized in glass’.
Very simply, eggs are removed from the ovary just before ovulation. The eggs and sperm are then placed together outside the body in a specialised laboratory environment in a petri dish. If fertilization and normal embryo development occurs, the best embryo(s) is (are) returned to the uterus (womb) 2-5 days later.
What is ICSI?
Intra-Cytoplasmic Sperm Injection (ICSI) is a method of inseminating eggs.
It involves injecting a single sperm directly into an egg using a fine glass needle (as opposed to standard IVF where the sperm has to penetrate the egg by itself).
Why would couples need IVF or ICSI?
The original indication for IVF was damaged fallopian tubes, but it is now also used for a wide range of disorders such as unexplained infertility, endometriosis and male factor infertility.
How many visits are required for a cycle of IVF and/or ICSI?
Treatment is monitored using a combination of Ultrasound and blood tests. Cycle and individuals vary but 2-5 monitoring visits and 8-12 days of stimulation is usual. To have a reasonable chance of success a number of egg follicles need to develop. Generally over half of eggs collected will fertilise and half of these will grow on as embryos.
What are the stages of IVF and ICSI?
- Ovarian Stimulation
- Ultrasound Monitoring
- Egg and Sperm Collection
- Insemination and Fertilization
- Development of Embryos
- Embryo Transfer
1. Ovarian Stimulation
Stimulation of the ovaries to produce a number of eggs is key to your treatment. The ovaries are stimulated with Follicle Stimulating Hormone (FSH). The ovaries produce a number of follicles within which eggs will hopefully develop. A number of different fertility drugs and protocols are used in the treatment to control the timing of egg release.
2. Ultrasound Monitoring
Eggs are microscopic but they grow in fluid filled structures (follicles) which can be clearly seen on ultrasound scan. The development of the follicles is routinely monitored using vaginal ultrasound scans. After about 7-12 days of the injections, the follicles will almost be mature. Once we anticipate a reasonable number of follicles are mature an ovulation trigger (hCG) is given and egg collection is scheduled.
3. Egg and Sperm Collection
This is a minor surgical procedure, carried out at Merrion Fertility Clinic using ultrasound guidance. A Senior Consultant Anaesthetist is present administering sedation and pain relief intravenously for the procedure. Egg collection is performed 36 hours following the hCG trigger injection. Ultrasound guided follicle drainage is performed and the retrieved fluid checked for eggs. An egg is generally retrieved from most mature follicles, but there are no guarantees. The eggs collected are prepared for insemination or injection with sperm.
Before / during the egg collection procedure, the male partner will provide a semen sample that will be specially prepared and used to inseminate the eggs. Alternatively, if frozen sperm is to be used, this will be thawed out.
MFC has strict protocols in place to double check the identification of samples and the patients to whom they relate at all steps of the clinical and laboratory processes. Every step along the IVF/ICSI process is double witnessed, i.e. 2 members of staff will confirm patient’s details, for more information on our identity check policy please click here.
4. Insemination and Fertilization
Eggs are inseminated in the afternoon following the egg collection (‘day 0’) and are left overnight to fertilize. Usually about 60-70% of the eggs collected fertilize, but this can range from 0% to 100%. Regrettably, some 2-3% of couples will not achieve fertilization of any eggs.
There are 2 ways to inseminate eggs.
IVF (In Vitro Fertilization): This is where a fixed concentration of motile sperm (100,000) are mixed with the eggs overnight. During the night the sperm should fertilize the eggs.
ICSI (Intra-Cytoplasmic Sperm Injection): This is used when there are not enough motile sperm to fertilize the eggs using the standard IVF method. Eggs are first checked to make sure they are mature as only mature eggs can be injected and subsequently fertilize. An individual sperm is then selected by an embryologist and injected directly into each egg.
Eggs are checked the following morning (‘day 1’) for fertilization and patients are phoned with the update.
5. Development of Embryos
Following the fertilization stage, eggs progress on to the embryo stage. Embryos are cultured or grown in the lab for a number of days.
Traditional standard incubators offer an excellent environment for embryos to grow in.
Embryoscope is a highly specialised incubator with a built-in time lapse camera. This provides us with a vast additional bank of information about each embryo without disturbing it. When a number of embryos are available this additional information may help in selecting those embryos with the best potential for pregnancy. The benefit is not as great when only a limited number of embryos are available so we do not routinely recommend it then.
The aim of embryo culture is to learn about the embryos and determine which are best and most likely to implant in the womb. The day of transfer (day 3 or day 5) is largely determined by the number and quality of embryos in that given cycle. Currently over 60% of transfers in Merrion Fertility Clinic occur on day 5 . This is called Blastocyst Culture. In exceptional cases, transfer may be recommended on day 2.
6. Embryo Transfer
The embryo transfer procedure is quite simple and is usually pain free. No anaesthetic is necessary. A very fine tube (catheter) with the embryo(s) is then gently guided into the uterus and embryo(s) transferred. Ultrasound is used to facilitate the process.
The number of embryos to be transferred will depend on several factors such as female age, previous pregnancies and number of cycles etc. and this will be discussed in detail with every couple prior to treatment and again on the day of embryo transfer.
Elective Single Embryo Transfer (eSET) is recommended in circumstances with a high potential for pregnancy. It is well proven worldwide that the safest pregnancy, for both the mother and child, is a singleton pregnancy.
We may transfer two embryos if transferring one only means a significantly lower chance of pregnancy. Thus we maintain a good chance of pregnancy while minimising the risks of multiple pregnancy and all its complications i.e. miscarriage, premature delivery, cerebral palsy, fetal or neonatal death etc.
Rarely a single embryo does split in two following transfer, resulting in identical twins. The chances of this occurring are very low.
Where circumstances are unsafe or unsuitable for transfer we freeze all suitable embryos, for transfer in a later