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IVF Treatment (In Vitro Fertilisation)
An Introduction to IVF
IVF refers to the mixing of sperm and egg in an environment where fertilisation can occur outside the body. Originally the receptacle used was a small test tube, hence the phase 'test tube babies'. Nowadays, we use both test tubes and flat dishes in an incubator.
The technique was pioneered through the 1970's by Patrick Steptoe and Professor Robert Edwards, initially in Oldham and then continued at Bourn Hall. In 1978 the first baby was born, Louise Brown. The technique was developed originally to treat patients who have blocked or damaged fallopian tubes (so that the sperm and egg cannot meet), but as it has become more successful it has been used to treat a much wider spectrum of infertility disorders (including sperm problems, endometriosis, ovarian problems and unexplained infertility). To obtain a reasonable success rate with IVF, more than one egg needs to be collected during the treatment cycle. This is achieved by using fertility drugs.
An egg collection procedure
Principles in IVF Treatment
The first principle of the treatment is to stop the body's normal control mechanisms for ovulation. To do this we use a type of medication known as a gonadotrophin releasing hormone agonist (GnRH agonist). There are different forms of this drug, which can be administered as a nasal spray (eg. Nafarelin), by daily subcutaneous injection (Buserelin), or by a subcutaneous injection that lasts for 4 weeks (Prostap). The two drugs that we use most commonly in this clinic are Nafarelin and Buserelin. This step in the treatment is important as it makes the process a lot simpler, it allows us to plan the cycle more readily and finally, it does appear to increase the success of the treatment substantially. Having stopped the body producing its own hormones, we can then administer the hormone you require to produce a group of mature eggs. The hormone that we use to stimulate the ovaries is called follicle-stimulating hormone (FSH) which is available in a number of preparations, which are either given a daily subcutaneous or sometimes intramuscular injection.
The common brand names are Menogon, Menopur, Gonal F, and Puregon. For the purposes of IVF all these medications act in a similar fashion and are interchangeable.
Visual of an ultrasound The development of the follicles containing the eggs is monitored indirectly using blood tests and directly by visualising the ovary, using a vaginal ultrasound probe. The eggs, when mature, are collected using the vaginal ultrasound probe with an attached guided needle under sedation/local anaesthetic.
The eggs are placed in test-tubes in culture fluid. On the morning of the egg-collection, the man produces a sperm sample by masturbation. The best sperm are then selected using a sperm wash technique and after 6 hours are added to the test-tubes containing the eggs. The morning after the eggs are inspected for signs of fertilisation.
If fertilization has occurred the embryos are transferred to the uterus 48 hours after the eggs were collected. It is usual to transfer two embryos through the cervix into the uterus using a soft catheter although in some circumstances it may be more advisable to transfer three embryos. About 30% of couples have sufficient spare embryos after the transfer to freeze for use at a later stage.
One cycle of IVF therefore takes around 6 weeks, from stopping the body's control mechanisms to having the result of the pregnancy test.
Example Of A Cycle
The diagram below shows how long an IVF or ICSI cycle takes. The cycle breaks into three stages:
- Down-regulation (stopping the body's own control mechanisms for ovulation).
- Ovarian stimulation (to stimulate the growth of a group of mature eggs)
- Egg-collection/embryo transfer and waiting for the pregnancy test.
