In vitro fertilisation (IVF)
The IVF process
For many couples and individuals, in vitro fertilisation is the best option for falling pregnant. Today, we use IVF for a range of conditions such as sperm abnormalities, recurrent miscarriages, implantation failures, endometriosis, tubal damage, unsuccessful ovulation induction and unexplained infertility.
The IVF process involves fertilising the eggs in the laboratory, rather than in the woman’s fallopian tubes. During this process the ovaries are stimulated with injections of follicle stimulating hormone (FSH) over a period of 10 to 14 days. This encourages follicles, small sacs that hold your eggs, to grow to maturity.
Some women may have adverse reactions to stimulation, in which is why it is important that the dose is personalised. My aim is to minimise disruption to your everyday life, while giving you the best chance of a successful pregnancy.
I will monitor how your follicles to to determine the best time to collect your eggs. A trigger injection is used to spark the final stage of egg maturation and two days later your eggs will be collected in a day procedure under light general anaesthetic.
Depending on sperm quality, the egg is placed in a glass or plastic dish with many thousands of sperm (IVF), or the eggs are injected with one sperm per egg (ICSI). Once fertilised, the embryo is allowed to grow in the laboratory for a few days and is then transferred through a very fine tube into the uterus. We store additional embryos by freezing them for use in further treatments.
Getting started with IVF
At your first review appointment, I will discuss the results of your fertility tests with you. If IVF is recommended, I will explain the process in full and you will have a chance to ask questions. You may also ask questions at any time in the process, as it is important that you have a good understanding about the proposed treatment.
You will be asked to see a Melbourne IVF Patient Liaison Administrator who will arrange your new IVF patient appointments. Counselling to help you prepare psychologically and emotionally will be arranged and you will also sign the mandatory consent form at this appointment. There will also be an information session with a nurse who will teach you how to administer injections and medication. Finally you will have a meeting with the Accounting Department to discuss the costs of your treatment plan.
All patients undergoing assisted reproductive technology (ART) treatment in Victoria need to have a Criminal Record and Child Protection Order check. The Administrator will help you to arrange this.
Q: How successful is IVF?
A: As part of Melbourne IVF, I have access via my colleagues to more than 35 years of collective expertise. A flexible, minimally disruptive approach is used to achieve the best result for each patient.
There are a range of factors that might affect your chance of conceiving with IVF, such as your age, the cause of your infertility, how long you have been trying to conceive, and any previous pregnancies. Almost half of our patients aged 36 and under will have a pregnancy from their first stimulated cycle of IVF up to 80% will have a pregnancy within three stimulated IVF cycles.
Q: Does IVF lead to premature menopause by using up more eggs in one cycle?
A: No, IVF does not cause premature menopause. The IVF process produces multiple eggs, but these are eggs that would have been wasted in a natural cycle.
Q: Can I make any lifestyle changes to increase my chance of success with IVF?
A: As with anyone trying to conceive, you should stop smoking at least three months before starting IVF treatment. You should also aim to be within a healthy weight range. Women who are overweight or underweight have lower rates of success with IVF. Exercise and healthy eating are as important as ever.
Intracytoplasmic sperm injection (ICSI)
What is ICSI?
Problems with the quality of sperm, a low sperm count or large numbers of abnormally shaped sperm, make it likely that conventional IVF will result in a low fertilisation rate. In this situation IVF with intracytoplasmic sperm injection (ICSI) treatment may be suggested.
For natural fertilisation, the sperm travels to the egg and penetrates the outer layers. In ICSI, instead of letting the sperm fertilise the egg by itself, a single sperm is injected into each egg using sophisticated micromanipulation equipment.
ICSI may sometimes be used if sperm are obtained directly from the testes, such as after vasectomy reversal, in the absence of the vas deferens or if donor sperm is being used.
How does ICSI work?
In natural conception, many millions of sperm cells are needed for fertilisation. In ICSI, just one is often enough.
For couples who decide to go through with ICSI, the female partner is given follicle stimulating hormone (FSH), either with an oral medication or an injection, to encourage several eggs to develop in the ovaries. The eggs are then removed in a short outpatient procedure.
In the laboratory, individual sperm cells are injected into each of the collected eggs. A very powerful microscope and very fine needle are used for this procedure, as the human egg is about one-tenth of a millimetre in diameter and the sperm is about 100 times smaller again.
After about 24 hours in the incubator, most of the eggs will show signs of fertilisation. The cells will divide and multiply to form an embryo and after two or three days an embryo will be made up of about eight cells. It will then be transferred to the uterus with thin, flexible needle to implant the embryo and to form a pregnancy.
ICSI success rates
For men with sperm quality problems, normal fertilisation rates with ICSI are around 50-60%. This means that for every ten eggs combined with sperm, five or six eggs would be expected to fertilise. ICSI will not increase your chance of fertilisation if your sperm assessment is normal.
The chance of ICSI treatment resulting in a pregnancy and a birth depends on your particular fertility issue and your age.
In vitro maturation (IVM)
What is IVM?
In vitro-maturation (IVM) involves collecting a woman’s eggs in an IVF procedure before they have matured, allowing them to mature in the laboratory and then fertilising them with sperm. Because the eggs are collected earlier, the number of ovary-stimulating hormones you need to take is reduced.
Similarly to IVF, once the egg is fertilised, the embryo is allowed to grow in the laboratory for a few days. The embryos are then frozen with some immediately transferred and some stored for use in a future cycle. This is known as a frozen embryo transfer with the embryo transferred through a fine tube into your uterus. This procedure has high success rates. We can then continue to store additional embryos by freezing them for future use to help you complete your family.
Who is IVM suitable for?
IVM is a relatively new method of fertility treament and is the product of reseach from centres around the world including Italy, Belgium, Japan and Canada.
I may recommend IVM to you if you have had an adverse reaction or poor results from standard IVF. During IVM treatment, the dose of stimulation medication administered is very low and gentle on the body. Treatment is usually administered over a three to four day period and the eggs are collected early in the cycle.
IVM has the potential to help women who have had poor outcomes from past stimulation attempts, who are at a high risk of overstimulation with standard IVF or who have ovarian hyperstimulation syndrome (OHSS).