Pelvic Organ Prolapse Treatment

What is IVF?

In vitro fertilisation (IVF) literally means ‘fertilisation in glass’ giving us the familiar term ‘test tube baby’. During the IVF process, eggs are removed from the ovaries and fertilised with sperm in the laboratory. The fertilised egg (embryo) is later placed in the woman’s womb.

Is IVF for me?

A clinic may recommend IVF as your best treatment option if:

1. You have been diagnosed with unexplained infertility
2. Your fallopian tubes are blocked
3. You have been unsuccessful with other techniques like using fertility drugs or intrauterine insemination (IUI)
4. There is a minor degree of male subfertility - more severe problems are treated with intra-cytoplasmic sperm injection (ICSI).

How does IVF work?

IVF techniques can differ from clinic to clinic, often depending on your individual circumstances.

A typical treatment may involve:

For Women:

  

Step 1: Suppressing the natural monthly hormone cycle

As a first step you may be given a drug to suppress your natural cycle. Treatment is given as a daily injection. This continues for about two weeks.

Step 2: Boosting the egg supply

After the natural cycle is suppressed you are given a fertility hormone called FSH (or Follicle Stimulating Hormone). This is usually taken as a daily injection for around 12 days. This hormone will increase the number of eggs you produce - meaning that more eggs can be fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.

Step 3: Checking on progress

Throughout the drug treatment, the clinic will monitor your progress. This is done by vaginal ultrasound scans and, possibly, blood tests. 34–38 hours before your eggs are due to be collected you have a hormone injection to help your eggs mature.

Step 4: Collecting the eggs

Eggs are usually collected by ultrasound guidance under sedation. This involves a needle being inserted into the scanning probe and into each ovary. The eggs are, in turn, collected through the needle. Cramping and a small amount of vaginal bleeding can occur after the procedure.

Step 5: Fertilising the eggs

Your eggs are mixed with your partner’s or the donor’s sperm and cultured in the laboratory for 16–20 hours. They are then checked to see if any have fertilised. Those that have been fertilised (now called embryos) are grown in the laboratory incubator for another one to two days before being checked again. The best one or two embryos will then be chosen for transfer. After egg collection, you are given medication to help prepare the lining of the womb for embryo transfer. This is given as pessaries, injection or gel.

Step 6: Embryo transfer

For women under the age of 40, one or two embryos can be transferred. If you are 40, or over, a maximum of three can be used. The number of embryos is restricted because of the risks associated with multiple births. Remaining embryos may be frozen for future IVF attempts, if they are suitable.

Step 7: Other treatments

Some clinics may also offer blastocyst transfer, where the fertilised eggs are left to mature for five to six days and then transferred.

Step 8: Collecting sperm

Around the time your partner’s eggs are collected, you are asked to produce a fresh sample of sperm. This is stored for a short time before the sperm are washed and spun at a high speed. This is so the healthiest and most active sperm can be selected.

Intra-cytoplasmic sperm injection (ICSI)

What is intra-cytoplasmic sperm injection and how does it work?

Intra-cytoplasmic sperm injection (ICSI) involves injecting a single sperm directly into an egg in order to fertilise it. It is a process sometimes used during in vitro fertilisation treatment (see IVF patient information leaflet).The fertilised egg (embryo) is then transferred to the woman’s womb.

ICSI is often recommended if:

• The male partner has a very low sperm count.
• Other problems with the sperm have been identified, such as poor morphology (abnormally shaped) and/or poor motility (poor swimmers).
• At previous attempts at in vitro fertilisation (IVF) there was either failure of fertilisation or an unexpectedly low fertilisation rate.
• The male partner has had a vasectomy and sperm have been collected from the testicles or epididymis (sperm reservoir).
• Other situations where the sperm count is zero and donor insemination is not wanted.
• The male partner does not ejaculate any sperm but sperm have been collected from the testicles.
• The male partner has had problems obtaining an erection and ejaculating. This includes men with spinal cord injuries, diabetes and other disorders.

How does ICSI work?

The procedure for ICSI is similar to that for IVF, but instead of fertilisation taking place in a dish, the embryologist selects sperm from the sample and a single sperm is injected directly into each egg. After two to three days in the laboratory, those that are fertilised are transferred to your womb in the same way as for conventional IVF.

The major development of ICSI means that as long as some sperm can be obtained (even in very low numbers), fertilisation is possible.

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