Common questions about IVF and ICSI
What are the IVF and ICSI steps?
The cycle of treatment includes the following steps and/or procedures:
- Taking hormone medications to grow multiple follicles and to collect multiple eggs.
- Undergoing ultrasound scans, and in some cases blood tests, to assess the ovarian response to stimulation.
- Taking the trigger hormone injection 34-36 hours before egg retrieval.
- Retrieval of eggs from the ovaries under ultrasound guidance and sedation in theatre.
- Fertilisation of eggs with sperm by IVF or ICSI in the laboratory.
- Growing the fertilised eggs to embryos in the laboratory.
- Transfer of one or more embryo(s) into the uterus under ultrasound guidance, usually without sedation.
- Taking hormone medications whilst waiting to have the pregnancy test.
What is ovarian stimulation?
In most cases stimulation of the ovaries is recommended to collect multiple eggs. The stimulation requires hormone injections that contain follicles stimulating hormone (FSH) with or without luteinising hormone (LH), and are usually started at the very beginning of your menstrual cycle or an induced bleed. The dose and type of hormones is patient specific and depends on various factors, including age, body mass index, anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), and the response to previous ovarian stimulation protocols, if applicable.
Injections are be self-administered easily at the same time every day.
The injections are administered for a period of 10 to 14 days, depending on the ovarian response. Once your follicles have reached the optimal size, your consultant will advise to take the ‘trigger’ injection to ensure the eggs within your follicles mature and are ready for harvesting 34-36 hours later.
How is the stimulation cycle monitored?
After 5 or 7 days of you taking the hormone injections, you will have transvaginal ultrasound scans every 2 or 3 days. In some circumstances transabdominal ultrasound scans can be done. This is important to determine the development of the follicles, to alter the dose of the medications in order to ensure adequate response and to decide when to have the ‘trigger’ injection prior to egg retrieval. Blood tests are performed sometimes in conjunction with the ultrasound scans to assess the response to the ovarian stimulation hormones.
How is the egg collection performed?
This procedure is performed in the theatre room, generally adjacent to the laboratory, and you will be given sedation medications via an intravenous line. The anaesthetic consultant and nursing staff will be present in theatre together with the fertility consultant carrying out the procedure. If necessary, you may be given pain relief during the procedure or afterwards.
The egg collection takes 15-30 minutes depending on the number of follicles available and the ease of access to the ovaries. A fine needle, sliding into a guide mounted on the transvaginal ultrasound scan probe, is inserted through the vagina into the ovaries, and the fluid of each follicle is aspirated into a clear tube which is then passed to the embryologist to look for the egg. Occasionally the egg collection can be performed transabdominally under ultrasound guidance and sedation.
Very seldom absorbable stitches may be put inside the vagina at the end of the procedure, if there is a small area of bleeding. You will be able to resume normal activities the following day.
When is the sperm prepared for treatment?
The sperm that will be used to inseminate the harvested eggs is received either from your partner fresh on the morning of your egg collection or if frozen will be thawed and processed. If you are using donor sperm, this will be thawed and processed on the day of your egg retrieval.
What is embryo development and culture to blastocyst?
After checking for fertilisation, the embryologists either directly or by means of time lapse technology inspect the embryos development over the course of few days. Embryos are kept in special culture media solution and in controlled conditions incubators to aid development.
In chronological order, below are the steps from fertilisation to blastocyst formation:
- Day 1: The inseminated or injected eggs are assessed for fertilisation.
- Day 2: The fertilised eggs start to divide into multiple cells and become embryos. Most of the embryos have between 2 to 4 cells at this stage.
- Day 3: The embryos have developed further, and have between 6 to 8 cells at this stage. They can be chosen for transfer or left in culture for further development.
- Day 4: No evaluation of the embryos occurs at the Morula stage, but information can be gained if using time lapse systems.
- Day 5: The embryos have reached the blastocyst stage, and are suitable for transfer if planning a fresh embryo transfer or alternatively can be frozen for future use. Any embryos that may not have yet reached the blastocyst stage are cultured further for possible freezing later on the same day or the following day (day 6).
How is the embryo transfer performed?
This procedure does not require any anaesthesia, unless you prefer so or it has been difficult in the past. The embryologist selects the best embryo(s) for transfer. It is performed in a dedicated procedure room close to the laboratory.
The practitioner inserts the speculum in the vagina (similar to taking a smear test), then cleans the vagina before inserting a catheter through the cervix and into the uterus to place the embryo(s) under transabdominal ultrasound guidance. You will need to have a full bladder when you undergo the embryo transfer.
What happens after the embryo transfer?
After the procedure, you may experience some light cramping, and very occasionally spotting and vaginal discharge. We recommend taking it easy, avoiding exercise, sexual intercourse, hot baths, saunas, steam rooms, swimming, smoking and drinking alcohol. Make sure you are taking your folic acid and other supplements and vitamins as recommended by your consultant. Follow the instructions of your fertility team if you are taking hormones. Your pregnancy test will be done around 12-14 days after your embryo transfer, depending on you having had blastocyst or cleavage stage embryo transfer.
What are the chances of success of IVF and ICSI?
Both IVF and ICSI have been around for over three decades and over 2.5 million treatment cycles are performed every year globally. Published data in the literature show that the chances of success either as clinical pregnancy rate or live birth rate depend on several factors such as female chronological age, number and quality of eggs, quality of sperm, quality of embryos, previous pregnancies and live births as well as lifestyle. The live birth rates in good prognosis patients can be as high as 50-55% per cycle, with no significant difference between fresh and frozen embryo transfers.
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