IVF stands for In Vitro Fertilisation - which is the fertilisation of an oocyte (egg) by a sperm outside the body; In vitro is latin for ‘in glass’. There are 8 phases in the Affordable IVF process. Each of these is covered in detail below:
1. Down-regulation Phase
Down-regulation is the process of supressing a woman’s natural production of luteinising hormone (LH). LH is the hormone that triggers ovulation and aids the final maturation steps of the oocyte(s). IVF medications allow for the regulation of a woman’s cycle, enabling many follicles on the ovaries to be stimulated and multiple oocytes to be collected at the time of oocyte retrieval. As opposed to collecting one oocyte (as in a natural cycle) IVF procedures increase the likelihood of success by collecting multiple oocytes. At Affordable IVF we use what is known as the oral contraceptive pill (OCP) and the Long Down Regulation approach to treatment.Long Down-regulation. You will be placed on the oral contraceptive pill for a period of time. Approximately 5 days before you take your last tablet, you may commence a nasal spray called Synarel. You will get a period around 4-7 days after taking your last pill and the stimulation injections will then start after you get your period. Both are continued until just prior to the oocyte retrieval
2. Stimulation PhaseIn order to encourage the ovaries to produce multiple oocytes, medications are given to gently stimulate the development of several follicles in the ovaries. At Affordable IVF we use low doses of Follicle Stimulating Hormone (FSH), which reduces the likelihood of over stimulation. As low dose FSH is used we only expect to collect a small number of oocytes and subsequently create a small number of embryos. Due to this treatment method, it is probable that there will be no surplus embryos suitable for freezing. If you do have excess embryos and decide to freeze them, they will be cultured to the blastocyst stage and frozen under the embryo freezing programme of our parent clinic. You will be referred to a Specialist of your choice at the parent clinic for frozen embryos transfer (FET) cycles.
3. Cycle Monitoring Phase
Each woman responds differently to stimulation injections, and even an individual woman can respond differently to stimulation from cycle to cycle. Hence it is important for us to monitor how you are responding to your treatment. We use a combination of blood tests and ultrasound scans to do this. You will be required to have your blood tests at the clinic.The ultrasound scans are done as trans-vaginal procedures; this involves an ultrasound probe being inserted into the vagina. These scans are used to assess the presence of developing follicles within the ovaries, these are represented on ultrasound by the black collections of fluid. The follicle is where the oocyte resides, so generally it is expected that one follicle represents one oocyte; however this is not always the case. Scans will need to be done at the clinic by a trained fertility nurse.
4. Trigger Shot Phase
Once your ultrasound confirms the presence of a number of mature follicles, a final step is required before we collect your oocytes. In order to undergo the final stages of oocyte maturation an ovulation trigger is required. This involves a single injection of human chorionic gonadotrophin (hCG) alpha, which is almost identical to LH and therefore leads to ovulation like in a natural cycle.At Affordable IVF we use Ovidrel.
5. Egg Collection Phase
Your oocyte retrieval/collection procedure will be carried out by an Affordable IVF Specialist as a day procedure in hospital, under a light anaesthesia (some clinics only use sedation and you are awake for this procedure). A trans-vaginal ultrasound probe is used to locate the follicles on the ovaries (just the same as you have had done when having your ultrasounds). A long thin needle runs alongside the vaginal probe and can be seen on the ultrasound. The needle passes through the wall of the vagina and into the follicles within the ovaries. The follicular fluid inside is gently aspirated and transferred into heated test tubes.One of our scientists then examines the follicular fluid under a microscope to identify the oocytes within the aspirate. The egg collection procedure can be performed in a hospital setting under the comfort of a general anaesthetic or you can chose to have this procedure in the clinic itself under conscious sedation (you are awake throughout the procedure). There are specific criteria that needs to be met before a patient can have the egg collection under conscious sedation so if you would like to learn more please call us where a nurse will be able to discuss this in more detail. This procedure generally takes half an hour depending on the number of follicles present. Once the nursing staff are happy with your progress and you feel up to it, you are able to return home.
6. Fertilisation Phase
Back in our laboratory a scientist will prepare your oocytes for fertilisation. A semen sample will need to be delivered to the clinic after the oocyte retrieval procedure. The semen sample will then be prepared via a density centrifugation process, in order to isolate good quality sperm for insemination. Depending on your treatment, sperm are then added to the oocyte culture dish or injected directly into the oocyte in the case of ICSI (Intra-cytoplasmic sperm injection).The following day (16-20 hours post insemination/injection) the scientist will examine the oocytes under a microscope to determine fertilisation rates. It is expected that approximately 60% of oocytes inseminated using IVF will fertilise, whilst roughly 70% of mature oocytes will fertilise using ICSI. If fertilisation has occurred there will be two central discs called pronuclei (PN) identifiable within the oocyte. One pronuclei represents a set of chromosomes from the male, while the other is from the female. The developing embryos are then returned to the incubator. The embryos will remain in the incubator until the time of your embryo transfer, usually 2-3 days after the oocyte collection.
7. Embryo Transfer Phase
Having an embryo transfer is similar to having a pap smear. A speculum is placed in the vagina so that the cervix can be seen. A thin tube is passed through the cervix into the lower part of the uterus. Once this is in place the Scientist will load your embryo into an even smaller tube (a catheter) with a small amount of fluid. This tube is then fed through the one in your cervix, and the embryo is pushed out of the transfer catheter into the uterus.The tube through your cervix and the transfer catheter are then removed. The Scientist inspects the transfer catheter under a microscope to be sure that the embryo has been expelled. The speculum is then removed and you are free to get dressed and go. Embryo transfers are performed by one of our experience fertility nurses and occur 2-3 days after your egg collection.
8. Extended Embryo Culture and Vitrification
Any embryos that are suitable will be cultured on in the laboratory to the blastocyst stage and then vitirified on day 5 or 6 and then stored at our parent company Fertility Solutions. This is known as blastocyst culturing and freezing.Vitrification is a cutting edge technology for the freezing of embryos which is now available. Cryopreservation is a term used to describe thee freezing of biological material for future use. Unfortunately not eveyone will have embryos frozen. The process of IVF is described in easy to follow steps: ABC Science Animated IVF Model