Fembryo Fertility & Gynaecology Clinic
In Vitro Fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro (latin for within the glass).
In Vitro Fertilisation (IVF)
In the presence of severe male and/or female factors your doctor may suggest an IVF treatment programme.
During this procedure, pharmacological doses of medication are used to stimulate numerous egg cells simultaneously. When these egg cells are mature, they will be aspirated in theatre under conscious sedation. Depending on the male factor present, the laboratory will advise on which lab technique needs to be used to fertilise the eggs. Embryo’s are transferred on Day 2 or Day 3 or Day 5.
In-Vitro Fertilisation (IVF)
This is known as the classical test tube fertilisation whereby the ovum from the female and sperm from the male are brought together outside of the body and fertilised in a test tube. They are incubated for a few days and then placed in the uterine cavity of the female either on day 2, 3, or on day 5 (Blastocyst stage) post oocyte aspiration.
IVF is a five-stage procedure:
Drugs that work centrally in the Hypothalamus-Pituitary complex, are responsible for hyper-stimulating the ovary, thus producing more than the normal one follicle in a natural cycle. This process will lead to obtaining several female gametes with which the fertility team can work, in order to improve chances of fertilisation.
This stage involves ultrasound scans after five days of hormone injections to determine the number of follicles and the follicle size. Not all follicles contain eggs, the size of the follicle determines the maturity of the eggs. Usually the follicles are small at the first scan, subsequent scans and hormone injections will continue until the leading follicle reaches 18mm or more in size.
Egg Retrieval Stage
The eggs are retrieved from the ovaries while you are under sedation so that you do not experience pain. In theatre, under ultrasound guidance, a long fine needle is attached to the vaginal probe and gently pushed though the vaginal wall to the follicles on the ovaries. The follicular fluid of each follicle (in which the egg is suspended), is methodically drained into test tubes. The procedure does not take more than 20 to 30 minutes.
An embryologist using a high-powered microscope identifies the eggs immersed in the follicular fluid. The eggs are placed into a dish that contains specialised growth medium. This medium allows the eggs and later embryos to continue developing as they would in the fallopian tubes. The sperm sample is collected, prepared and placed in the medium with the eggs (insemination). Extensive infection tests on both male and female are necessary before the IVF procedure to prevent the growth medium being contaminated. The dish with eggs and sperm are placed in an incubator, fertilization will occur naturally.
After three to five days the laboratory scientists, who have been monitoring embryo development closely, will according to international grading criteria decide which embryos to replace into the uterus. Your doctor will discuss which embryos and the number of embryos (not all the embryo’s will necessarily be used) to be replaced at this stage. A more accurate estimation of the success rate for the treatment will also be covered. The embryo transfer is a minor procedure requiring no sedation.
Extra medication is given to maintain a healthy endometrial lining. Emotionally this is a very taxing time. Hormone levels are high and there is not much that can be or cannot be done to influence the outcome of the treatment. Whether there is a pregnancy has been determined physiologically soon after the embryo transfer. It is recommended to resume normal activities after approximately 2 days in this period. The pregnancy test is done 10 days after the embryo transfer.
Intra-Cytoplasmic Sperm Injection (ICSI)
With this technique, a single sperm cell is injected into the cytoplasm of the egg. The technology used in this method is for the infertile male who has an extremely low or immotile sperm count or when the morphology is low.
The process followed is that a single viable sperm is injected with microscopic equipment directly into the ovum. This brings about assisted fertilisation.
The actual treatment is the same as the five stages of In Vitro Fertilisation. The only difference is that in the laboratory stage sperm is not placed with the egg but a single sperm is injected into every ovum (egg) demonstrated above.
A blastocyst is a day 5 human embryo that has divided many times and is comprised of hundreds of cells. The human embryo, just like a chicken egg, needs to hatch from its shell (the zona pellucida) and that is what is depicted in the photo below. The inner cell mass will become the fetus and the trophectoderm will become the placenta (sac).
A sperm is selected from a Hyaluronan droplet (found on a commercially made dish). Some sperm adhere to the droplet (this enzyme occurs naturally and is a component of the cumulus oophorus complex which surrounds the oocyte) and is then removed and used to inject a mature metaphase II oocyte. Studies have reported that sperm selected in this way are more morphologically normal, have better DNA packaging integrity and normal chromosomes (DNA). This technique offers better results for those patients who have poor quality sperm (genetically) or have had previous failed cycles.
Intracytoplasmic High Magnification Sperm Injection (IMSI)
This is the same as ICSI but the sperm is selected under HIGH magnification. Sperm morphology is a predictor of likely success and thus using this long known fact, scientists have thus developed ICSI at 6000x magnification vs the standard 440x, yielding better results for specific patients.
WHAT IS ‘ICSI’?
ICSI, or Intracytoplasmic Sperm Injection, is where one sperm is injected directly into the oocyte (egg). This technique is used when a male factor is present.
WHAT IS A BLASTOCYST?
A Blastocyst is a day 5-human embryo that has divided many times and is comprised of hundreds of cells.
With IMSI (Intracytoplasmic Morphologically-selected Sperm Injection) treatment, a selected sperm is injected into the ova (female egg) directly, and then incubated before being returned to the uterus.