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In Vitro Fertilisation (IVF)
Patient Information
This leaflet will give you more information about In Vitro Fertilisation (IVF). Before explaining IVF, it is useful to explain the natural fertilisation process (getting pregnant).
Each month an egg (oocyte) is released from a follicle (a fluid filled sac containing an egg) in the ovary and passes down the fallopian tube towards the womb (uterus). Sperm released into the vagina during intercourse swims towards the egg and one sperm will enter the egg, resulting in fertilisation.
This fertilised egg (an embryo) then begins its journey towards the uterus and approximately 5 days later becomes embedded in the thick lining of the uterus (endometrium). This is called implantation and is the first stage of pregnancy.
What is IVF?
IVF involves the collection of eggs directly from the ovaries using a needle. Washed sperm are added to a dish containing the eggs and the sperm are left to swim to the eggs on their own. The sperm and eggs are left in the dish together overnight and the eggs checked for fertilisation the following morning.
The ‘best’ sperm that reaches the egg first should hopefully enter the egg and fertilise it, resulting in an embryo. For more information see In vitro fertilisation (IVF) | HFEA
Who can have IVF?
Women with blocked or damaged fallopian tubes.
People with unexplained fertility problems, or who have tried other treatments that were unsuccessful.
Women who have difficulty with ovulation and who haven’t been successful with other treatments.
Older women who are less likely to be successful with less invasive treatments.
At a clinic appointment the nurse or doctor will assess if IVF is the right treatment for you.
Assessment and Tests Required
Depending on which type of treatment you’re having, you will need to carry out some Assessments and Tests. ACS staff will advise which ones are appropriate to you.
The Stages of Treatment
The drug protocol you have been given will explain each step of the treatment which has been recommended for you. Treatment will either start with an injection to suppress your own hormones or will start with your own cycle.
Before starting stimulation injections to stimulate the follicles on your ovaries, you will come the ACS and have an internal scan of the uterus and ovaries. The nurse will give you a supply of medication, explain how to do the injections and your drug regime.
Around day 8-10 of injections, you will return to the clinic for scans and blood test every 1-3 days after, until you are ready for egg collection.
Each woman’s response to this treatment is different. Daily hormone injections can be required for 8-17 days. Some people respond much more quickly while others can take up to 17 days. However, average is around 10-14 days. Depending on the results from the scans and blood tests, the dose of drug used in your treatment may be changed.
Possible side effects from drugs used during the ‘down regulation’ phase may cause hot flushes, headaches, mood swings and vaginal dryness. These symptoms should pass. We carefully and regularly monitor you when drugs are used to stimulate your ovaries. However, in a small number of cases there may be side effects. In mild cases, the ovaries become slightly enlarged which might cause some abdominal cramps. In severe cases, the ovaries become much enlarged, and fluid gathers in the abdominal cavity causing discomfort or pain. There can be vomiting, diarrhoea, abdominal swelling and breathlessness. There may be a feeling of weakness and fainting, and you may not pass much urine. These complications require immediate attention, and you should contact ACS. For more information see Ovarian hyperstimulation syndrome (OHSS) | RCOG
Unfortunately, some women may not respond to this treatment. In this case the treatment will be stopped, and we will review your case. You will be given a clinic appointment to discuss your options.
If you do respond, once an adequate number of follicles (fluid filled sacs some of which contain eggs) are present in your ovaries, you will be given one final hormone injection called the ‘booster’. This helps mature the eggs in your follicles. You will usually be given this booster 36 hours before having your egg retrieval.
Please note that the timing of this injection is critical, and it must be done at the exact time specified to you by the ACS staff. 4
The Egg Retrieval
The night before your procedure please fast from midnight (do not eat or drink anything), as you will be given sedation.
When attending the procedure:
Give yourself plenty of time to travel to ACS on the day of your appointment. Allow time for traffic delays and finding a parking place which can be time consuming.
Please bring with you a dressing gown and slippers, we will provide you with a hospital gown to wear.
You should not wear nail varnish, perfume, make-up or body lotion.
Do not bring large sums of money or valuable jewellery with you (except your wedding ring).
On the day Please report to the ACS suite. At the ACS suite, a nurse will help you prepare for the retrieval procedure.
A doctor will:
describe the procedure to you in detail
take a history of your general health
answer any questions you may have
ask you to sign a consent form for the treatment.
An anaesthetist will:
discuss the procedure and will be present throughout to control your sedation and monitor your wellbeing.
The Procedure
The procedure begins with a needle assembly (called a venflon) being inserted into a vein in your hand or your arm. Your sedation will be given through a tube attached to the venflon. You may feel yourself drifting off to sleep but still be aware of noise around about you and remain sensitive to touch.
Your ovaries are viewed on an ultrasound monitor by gently placing an ultrasound probe into your vagina. Within each ovary, there will be a number of follicles. A fine needle is passed down a specialised guide attached to the ultrasound probe and the tip of the needle is directed right into the centre of each follicle. Gentle suction is applied through the needle, removing the contents of the follicle into a specially prepared container, which is then carefully examined to see if an egg is present.
This retrieval procedure ends when all the follicles have been drained and usually takes about 30 minutes to complete. Afterwards, you will go back to the recovery area to rest until you feel ready to go home, which is usually 1-3 hours later. You should plan for someone to collect you from the ACS Suite and go home with you.
For 24 hours after sedation, you should not drive or operate machinery, drink alcohol, take sleeping tablets or
sign legal documents.
Sperm Collection and the Fertilisation of Your Eggs
Sperm sample (for men) On the day that your partner’s eggs are to be retrieved you will need to produce a fresh sperm sample. Do not have sex or ejaculate for 2 days before your appointment. We will show you into a private room in the Embryology Laboratory to produce your sperm sample.
A fresh sperm sample is prepared to maximise the number of healthy sperm available for mixing with your eggs. There is no guarantee that all of your eggs will be fertilised and very occasionally there will be no fertilisation at all. Any fertilised embryos that do form are left to grow for 3-5 days depending on your treatment regime. We will contact you the day after your oocyte retrieval to let you know how many of your eggs were fertilised.
Please note that not all patients will have embryos suitable for freezing.
Embryo Transfer
A few days after the retrieval process, the embryo produced will be transferred into your uterus. Please attend the ACS Suite at your appointed time for the embryo transfer.
It will feel similar to having a cervical smear test performed, and you do not usually have to be sedated or anaesthetised. A specially designed tube (called a catheter) is used to place the embryo(s) into your uterus. It would be helpful if you did not empty your bladder before the procedure. After your embryo(s) have been transferred you will continue vaginal progesterone hormone treatment.
Please note that one embryo will usually be replaced, unless double embryo transfer has been discussed. Please see Decisions to make about your embryos | HFEA for more information on why a single embryo transfer is safest for you and any babies born from fertility treatment.
Test Results (Treatment Outcome)
We will give you a date to carry out a home pregnancy test and you should let us know the result via email.