IVF and ICSI
Medical criteria for IVF or ICSI treatment
The decision as to whether IVF or ICSI treatment is suitable for a couple is based on certain medical criteria and best clinical practice, including the woman’s BMI.
IVF and ICSI are both forms of assisted conception. The treatment for both is the same, with the only difference being the method of fertilisation used in the laboratory.
In-Vitro Fertilisation (IVF)
Literally translated the term ‘In-Vitro Fertilisation’ means ‘in-glass’. This refers to the process whereby a woman’s eggs are removed from her ovary and fertilised outside her body in the laboratory.
The resulting embryos are then transferred back inside her womb a few days later. IVF is suitable for women with damaged fallopian tubes or men with reduced semen quality.
In addition, a large number of couples with unexplained infertility may benefit from treatment with IVF.
IVF can also be used for women who are unable to produce eggs (using egg donation) or who do not have a uterus (using surrogacy).
Intracytoplasmic Sperm Injection (ICSI)
ICSI is similar to conventional IVF in that eggs and sperm are collected from each partner.
ICSI refers to the laboratory procedure in which the embryologist injects a single sperm into each egg. With this technique very few sperm are required and the ability of the sperm to enter the egg itself is bypassed.
However, the ICSI procedure itself does not guarantee fertilisation as the normal cellular events of fertilisation still need to take place once the sperm is placed within the egg. ICSI is specifically suitable in the following circumstances:
- When the man has a very low sperm count
- When the sperm are not moving well or when there is a high proportion of abnormal sperm
- When sperm are surgically retrieved from the testis
- In treatment for couples who have previously had failed fertilisation with conventional IVF
Stages of IVF and ICSI Treatment
In general there are five stages to each cycle of IVF or ICSI treatment.
STAGE 1: Down regulation
Initially, the treatment starts by taking a nasal spray from day 21 of the cycle for 14 days to temporarily switch off the hormonal messages from the brain to the ovaries. After approximately 14 days on the nasal spray daily hormone injections are started for ovarian stimulation. The nasal spray continues to be taken in combination with the injections in order to prevent premature release of eggs (ovulation).
STAGE 2: Ovarian stimulation
Daily injections with hormones (gonadotrophins) should hopefully stimulate the ovaries to produce multiple eggs (follicles). The course of injections is usually for 11–13 days. Stimulation is monitored by ultrasound scans and there are usually at least 2 scans during the treatment. The scans are carried out at the Regional Fertility Centre (RFC), Royal Hospital site. When the follicles reach a mature size a further hormone injection (hCG) is given to ripen the eggs and prepare them for collection approximately 36 hours later.
STAGE 3: Egg Collection
Egg collection is performed in the RFC, Royal Hospital site, using a transvaginal ultrasound probe to which a needle is attached. The fluid within each follicle is gently sucked out into a test tube, via a special pump attached to the needle, and examined by an embryologist who checks for the presence of eggs under the microscope. Intravenous pain relief is given during the egg collection which usually takes around 15-20 minutes. Although some discomfort should be expected, the vast majority of patients tolerate the procedure without difficulty. Once the egg collection is finished, patients are taken to the recovery room and are usually discharged after a couple of hours.
On the morning of egg collection the husband/partner will be asked to provide a semen sample.
STAGE 4: Insemination
In IVF treatment the sperm and eggs are incubated overnight in a special fluid that provides them with all the right nutrients to allow fertilisation to occur. In ICSI treatment the eggs are injected with individual sperm. The following morning, the eggs are checked for signs of fertilisation. At this stage, depending on how many embryos have been formed some may be frozen and stored. The other embryos are allowed to continue to grow and develop for two or three days before transfer back into the womb (uterus). In some cases, the embryos may be allowed to develop further with the aim of reaching a more advanced stage (blastocyst) before transfer.
After the egg collection procedure patients are told when to contact the embryologist to be advised about the fertilisation and when to attend for embryo transfer.
STAGE 5 Embryo transfer
On the day of embryo transfer the embryologist will select the best embryo(s) to transfer. Embryos are usually transferred on the second, third or, occasionally, fifth day after egg collection. Usually one embryo is placed inside the womb (uterus).The embryo transfer is carried out in the RFC, Royal Hospital site. The procedure usually only takes a few minutes to perform and does not require pain relief. The doctor places the embryo into the uterus using a fine catheter, which is inserted through the cervix.
Following the embryo transfer patients are encouraged to resume normal activities. A hormone Gel (Crinone) is inserted into the vagina every evening for two weeks following embryo transfer. After this time, a pregnancy test is performed.
During treatment it may be necessary to alter the dose of the hormone injections depending on the response of the ovaries as monitored on scan.
Unfortunately not all patients respond to the drugs used for ovarian stimulation and sometimes it may be necessary to abandon the treatment cycle before egg collection.
Rarely, all of the eggs that have been collected may fail to fertilize. In these circumstances an appointment will be made with your consultant to discuss your treatment and future options.