In vitro fertilisation (IVF) is a type of assisted reproductive technology (ART) used to treat infertility that has failed to respond to other medical or surgical interventions. IVF literally means “fertilisation in glass” and involves the fertilisation of the egg by the sperm in an incubator outside the body, followed by transfer of the embryo back into the uterus.
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The female IVF treatment cycle generally follows these stages:
In a natural menstrual cycle, the pituitary gland’s luteinising hormone (LH) and follicle-stimulating hormone (FSH) cause the growth of an egg in a fluid-filled follicle within the ovary. Although several follicles start to grow each month, only one will become mature enough to ovulate. Ovulation (release of the egg from the ovary) is triggered by a surge of LH at mid-cycle, about two weeks before menstruation starts. In contrast, during an IVF cycle it is desirable for several eggs to mature simultaneously with FSH injections, and a trigger injection is given as a surge to mature the developing eggs before collection.
The fertility coordinator will give you detailed information about your specific treatment cycle, its timeline and medications. You will also be shown how to give yourself FSH injections and handed instructions for any other medications you may require for your treatment cycle.
*If you are undergoing what is called an antagonist cycle, there is usually no need for pituitary suppression. Your fertility specialist will have selected the right cycle type based on your individual needs.
Daily injections of FSH begin. Everyone responds differently to these medications, but on average the injections continue for between nine and 14 days. The dose of FSH used is somewhat higher than you would produce on your own and this is what stimulates the growth of several follicles instead of just one. The response of the ovaries is monitored with ultrasounds and blood tests. The dose and combination of medications are adjusted to suit your individual response, so do not be surprised if you are on a slightly different protocol or FSH dose from other women. Most women learn to give their own injections, reducing the number of clinic visits.
Between 5% and 10% of women do not proceed successfully through the ovarian stimulation phase. If the ovaries do not respond well enough, with too few follicles developing, the treatment cycle may be cancelled. In this situation, your specialist will discuss the reasons for calling off the cycle, along with options for further treatment.
In about 1% of cases, ovarian hyperstimulation syndrome (OHSS) develops. The ovaries become extremely enlarged and extra fluid accumulates in the abdomen. This complication requires rest, close monitoring, intravenous fluids or even drainage of the abdominal fluid. In rare cases, if we feel you are at high risk of developing OHSS, the cycle may be cancelled before egg collection, or the embryos may be frozen rather than replaced.
Once ultrasounds indicate follicles are of an adequate size and number, the stimulation phase ends. The FSH injections and the GnRH agonist are stopped. Once your fertility coordinator has confirmed your procedure time with theatre, he or she will liaise with you on the exact time to administer your trigger injection. This is an injection of human chorionic gonadotrophin (hCG) to aid the final maturation of the egg and its loosening from the follicle wall. The egg retrieval occurs on the second morning after this final injection (34-36 hours later). Your trigger injection timing is extremely important, so be sure to write it down carefully with your instructions.
The egg retrieval is performed under ultrasound guidance using a probe with a fine needle attached to the side, and takes place while you are sedated (general anaesthetic or light sedation). The needle is passed through the vaginal wall and into each follicle on the ovary. The fluid in the follicle is aspirated into a test tube and is then examined under a microscope to look for eggs. It is not unusual for some follicles not to contain eggs.
The procedure will take 20 to 30 minutes, depending on the number of follicles that have developed. After the procedure, you will rest in the recovery area for about one hour. Some cramping and discomfort after egg retrieval are common, as is some vaginal spotting or bleeding. If this continues, a heat pack, hot-water bottle or analgesic may be helpful at home.
After egg retrieval, you will be issued with medication (progesterone) that will support development of the endometrium (lining of the uterus) in preparation for embryo transfer.
Your partner will be asked to produce his semen sample on the day of your procedure. A men’s room is available at each of our clinics. Understandably, some men have concerns about this part of the process. It may be possible to produce the sample at home and take it to the clinic – this can be discussed with CFC staff at the start of your cycle. If you have any concerns about collecting the sample, please discuss them with staff before starting your cycle as it may be possible to freeze one of your partner’s semen samples as a back-up.
The sperm sample is washed and concentrated, then added to the eggs about four hours after retrieval. The dishes are placed in an incubator overnight and the eggs are examined the next day for signs of fertilisation. Usually not all eggs will fertilise. We expect between 60% and 70% of eggs to fertilise if the sperm sample appears normal. An embryologist will contact you to discuss fertilisation results and answer any questions you may have. The fertilised eggs are then kept in the incubator for an additional 48 hours.
If the sperm quality is low (sperm count or motility), your specialist may suggest Intracytoplasmic Sperm Injection (ICSI) as part of your treatment plan. ICSI is a specialised form of insemination that is used for the treatment of male infertility. It involves the injection of a single sperm directly into a single mature egg.
Embryo transfer occurs two to five days after egg retrieval. A woman’s individual circumstances and embryo quality will determine the exact day of transfer and the number of embryos involved. Generally one embryo, occasionally two, will be transferred into the uterus. In exceptional cases, two embryos may be transferred but this would be after discussion with your treating specialist so risks of multiple pregnancy are clearly understood.
It is important to note that the chance of multiple pregnancy increases with the number of good-quality embryos transferred. Please ensure that all options are thoroughly discussed as you will be asked at the beginning of your cycle to sign a consent form indicating the maximum number of embryos for transfer.
This embryo transfer itself takes only a few minutes and is usually not painful. An embryologist will discuss and confirm the number and quality of embryos with you before the transfer. Some of the remaining embryos may be suitable for freezing.
Embryos chosen for transfer are loaded into a catheter, which is passed through the cervix, into the uterus and gently released. The catheter is then slowly removed and checked under the microscope to ensure that no embryos remain.
Everyone receiving IVF treatment will be offered the option of cryopreservation (freezing). After your transfer, you might have remaining embryos suitable for freezing. To be selected for freezing, embryos must not show any signs of fragmentation (cell breakdown) or abnormal/slow development.
After embryo transfer, it is important that you maintain good health and wellbeing. Smoking, alcohol, spas and saunas should all be avoided. Be guided by your treating specialist about continuing any regular exercise you like to do.
The luteal phase is the two-week period between embryo transfer and the pregnancy test. You will be encouraged to limit your activity for 24 hours after the transfer. Your activity can be increased gradually over the next few days to non-strenuous, non-aerobic pursuits – be guided by your treating specialist if you’re unsure. Many women return to work the following day if their job is not strenuous.
The progesterone medication you start taking after egg retrieval can sometimes cause cramping, nausea, bloating and tiredness. An analgesic may be taken to relieve any discomfort you may experience. If you are concerned about any symptoms, speak to a fertility coordinator at your fertility centre.
Vaginal spotting or bleeding may occur before you are due for your pregnancy test. This does not always mean that treatment was unsuccessful. You should continue using any medications until a full period begins and/or the blood test results are known. Progesterone itself may delay your period, and this does not necessarily mean that you are pregnant.
Your pregnancy blood test will be carried out about 14 days after embryo transfer.
Your pregnancy blood test is due about 14 days after the embryo transfer. It is important to look after yourself in that time, which is often emotionally charged with expectation and anxiety. We understand this can be difficult and encourage you to call your fertility centre for support if you are finding it especially hard to deal with the stress of waiting. Assistance from professional counsellors is also available as part of your IVF treatment cycle.
IVF was developed to treat infertility caused by tubal damage, endometriosis, sperm disorders and unexplained factors. Whether you need IVF will depend on the diagnosis of your infertility and the treatment plan required to address your condition.
Potential risks and side effects associated with IVF procedures include:
IVF babies are the same as babies born through natural conception. However, because of the older age of many women undergoing IVF, we encourage patients to undergo Pre-Implantation Genetic Diagnosis (PGD) to identify any genetic abnormalities.
The world’s first IVF baby, Louise Brown, was born in 1978 in England. Since then, about 5 million babies have been born as a result of IVF.
We understand that each patient’s fertility needs are different. This is reflected in our fee schedule, which is structured around your individual plan and means costs can vary between patients according to the different levels of treatment required. The exact structure of these costs can be discussed fully with you once a treatment plan has been established by your specialist. Please visit the Cost section for detailed information about treatment fees and Medicare rebates.
The first step to access fertility treatment is to obtain a referral, from your GP, to one of our accredited fertility experts – you can download a referral form by following this link: Download Referral Form.
Your initial consultation with a City Fertility specialist will allow him or her to gather all the relevant information regarding your circumstances, medical condition and previous care to provide the direction for your treatment.
Your specialist will devise a treatment plan based on your needs as a couple. Some couples may need further investigations. Once these investigations are carried out, your specialist will ask that you make an appointment for a complimentary pre-treatment information session with one of our experienced fertility coordinators and patient services administrators. All aspects of your fertility treatment, including the cost structure, will be discussed with you at that time.
For more information about IVF, please read our fact sheets: In Vitro Fertilisation (IVF), IVF FAQ, Risks and Complications of IVF Treatment, Fertility Medications and Their Side Effects and Ovarian Hyperstimulation Syndrome (OHSS)
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