In vitro fertilization (IVF) is a procedure where eggs are extracted and fertilized in the laboratory. This is also called a “test-tube baby”.

The indications for IVF include damaged or blocked fallopian tubes, severe endometriosis, abnormal semen analysis, advanced age / decreased ovarian function and unexplained infertility.

Treatment is usually started within the first 3 days of the period. A cycle sheet will be drawn up describing exactly how the medications should be taken and when monitoring needs to be done.

Medications are given to stimulate egg growth. These medications may include tablets containing clomiphene citrate eg. Clomid, Serophene, Fertimed, Clomihexal or fertility injections containing FSH (Follicle stimulating hormone) eg Gonal F, Pergonal, Menogon. The most common side effect is enlarged ovaries, which can cause abdominal pain. Ovarian hyperstimulation syndrome (OHSS) is a rare but serious side effect caused by overproduction of eggs.

The follicles containing eggs can be seen on ultrasound scan. Monitoring of the treatment cycles using blood tests and ultrasound scans is usually starting on day 8 of the cycle.

Medications are also given to suppress ovulation. This may be in the form of an injection or nasal spray. These medications suppresses normal pituitary function to prevent ovulation prior to the time of the egg collection. The medications include Cetrotide, Lucrin, Zoladex or Synarel nasal spray. Common side effects of these medications include hot flushes, vaginal dryness, headache, insomnia, mood swings, and reduced libido. However, these side effects generally subside when you begin your FSH injections.

The eggs are triggered approximately 36 hours prior to the egg collection by using an injection called HCG (Human Chorionic Gonadotrophin) eg Ovidrel, Profasi, Choragon.

The egg collection procedure is performed in theatre with sedation. Tablets are given in the ward 2 hours to the procedure and further sedation is given intravenously in theatre. A transvaginal ultrasound is performed and a fine needle which is attached to the ultrasound is used to extract the eggs. The follicular fluid is examined under a microscope in the laboratory adjacent to the theatre to check how many eggs have been collected.

Progesterone hormone is given after the egg collection to prepare the lining of the uterus (womb) prior to embryo transfer. This may be given as a vaginal gel (eg.Crinone), pills inserted vaginally (eg. Uterogestan), vaginal pessaries (Cylogest)or an injection (eg. Gestone).

A sperm sample is given on the same day as the egg collection, and the eggs are fertilized after collection. The embryos are grown in the laboratory for 3-5 days and then replaced into the uterine cavity. New techniques of embryo culture mean that embryos can be grown in the laboratory longer until they reach the blastocyst stage (day 5). This means that embryos that fail to grow can be detected and better quality embryos can be chosen for transfer into the uterine cavity. Fewer embryos (usually two or three) can be transferred with excellent success rates and less chance of multiple pregnancy (ie. Twins and triplets).

Extra embryos are frozen (cryopreserved) and stored in liquid nitrogen. They can be used in future treatment cycles.

Embryo transfer is performed in a special procedure room. This is a painless procedure and no anaesthetic is necessary. The legs are supported by a gynaecological examination bed and a speculum inserted into the vagina to visualize the cervix. A thin plastic tube is used to transfer the embryos directly into the uterine cavity. A ultrasound scan is performed to ensure the embryos are transferred into the correct position in the uterine cavity.