In Vitro Fertilisation (IVF)

• Chicken pox immunity
• Rubella (German measles) immunity
• Syphilis serology
• HIV
• Hepatitis B and C
• Blood group and antibody status
• Full blood count
• Current breast check and pap smear (within the past two years)

During a basic fertility assessment a pelvic ultrasound and ovulation testing is performed. Hormone levels are also measured. In some cases other gynaecological investigations may be necessary. This is usually the case for women with medical conditions such as PCOS or endometriosis, or of advanced maternal age. Specialist blood test may be requested to determine egg reserves, or special ultrasounds to assess tubal patency.

• HIV
• Hepatitis B and C

A standard semen analysis will also be preformed. This will investigate sperm count, concentration, motility and morphology. In some cases, a physical examination and blood tests will also be requested.

* It’s very important not to underestimate the male role in IVF. Prior to undertaking IVF treatment, men can take important steps to improve their chances of starting a family. Ensuring that your sperm is as healthy as it can possibly be can significantly improve conception rates. Sperm takes three months to fully mature and during this time you can influence sperm health through positive lifestyle changes. Exercising, not smoking, avoiding stress, and drinking alcohol in moderation can support healthy sperm development. Nutrition is particularly important.

Learn more about the importance of diet for male fertility

Step 1: Ovarian Stimulation

The first stage of IVF involves fertility medications. These are taken to help increase the number of follicles that form within the ovaries by regulating hormones^[1]“Macklon, N. et.al. (2006). The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocrine Review. Volume 27, Issue 2, (pp. 170).”. This medication also helps to control ovulation timing.

There are a range of fertility medications available. The most popular include clomiphenes citrate, metformin hydrochloride, and gonadotrophins. The medication selected will depend on the physician’s preference and the woman’s individual diagnosis.

Often fertility medications are given as injections rather than orally. Women are shown how to inject the medication daily under the skin so that they can take the medication at home without having to attend a clinic.

After several days of injections, blood tests are taken to determine hormone levels and a pelvic ultrasound is often required to assess follicle growth. Depending on the results, fertility medication does may be increased or decreased. Often these tests are preformed several times throughout a cycle.

The aim of fertility medication is to produce a least two healthy follicles that are around 15-18 mm in length. In many cases, much more than two follicles develop. Once healthy follicles have been identified as ‘ready’, human chorionic gonadotropin (hCG) is injected to stimulate ovulation. Approximately 36 hours later, the follicles will be prepared for the egg retrieval process.

In some cases, it is possible to perform unstimulated IVF without the use of fertility medications. However, this is a rare practice and the majority of IVF procedures worldwide use from form of ovarian stimulation.

Step 2: Egg Retrieval 

Following a hCG injection a specialised procedure is performed for oocyte removal. This usually occurs between 32 and 36 hours after the hCG injection. The physician uses an ultrasound probe inserted into the vagina to remove eggs from the follicles using a specialised needle. Sedation is often used during the procedure and it can take up to 30 minutes depending on the number of eggs retrieved.

Women can usually go home the same day after several hours in recovery. However, due to the use of anaesthesia driving is not advised.

Step 3: Embryo Transfer

Between two and five days after the eggs have been retrieved and fertilised, one of more embryos are inserted into the uterus. This process is done using a flexible, thin catheter inserted through the woman’s cervix. This process is done as gently as possible to reduce uterine cramping. Generally, anaesthesia isn’t necessary for embryo transfers.

Following the procedure, the patient is encouraged to rest for several hours. Progesterone medication may be prescribed to improve the probability of embryo implantation in the uterus. Often this medication is taken on the retrieval day or transfer day. It may be administered as a suppository, vaginal gel, or an injection into a muscle.

Providing a Semen Sample

Although the majority of IVF processes involve laboratory processes and focus on successful egg retrieval and embryo transfer, the male role in this ART is also critical. The provision of healthy, viable sperm is essential for fertilisation.

There are three main ways sperm is provided for IVF:

Ejaculation

This is the most common way to obtain semen for IVF. It is usually done by masturbation and collection of the day of egg retrieval. To ensure an optimum quality sample, there are a few measures men can take including:

• Abstain from ejaculation for a minimum of two days but no longer than five days prior to collecting a semen sample.
• Semen must be collected in a non-toxic, sterile, plastic container provided by the fertility clinic
• Lubricants should be avoided unless stated otherwise by your physician
• Generally clinics prefer that a specimen is collected on site in a private collection room. Hands should be washed and dried before collecting semen to prevent contamination.
• Some clinics will allow a semen sample to be collected at home, although the specimen container must be kept at body temperature and delivered to the IVF clinic within two hours of providing the sample.
• Always follow the clinics instructions for transporting and labelling the specimen.
• If you have any difficulties collecting a sample, this should be discussed with your physician to determine if an alternative method could be used.

In some instances, fertility specialists will recommend cryopreservation of a semen sample several days before the egg retrieval procedure. This frozen sample can be used as a ‘back-up’ in case there are problems with the semen sample on the day of egg extraction. Also, some fertility specialist will recommend that men take antibiotics before semen collection for IVF.

TESE / TESA

TESE (testicular sperm extraction) and TESA (testicular sperm aspiration) are surgical procedures used to extract sperm directly from the testes. These processes may be necessary when spermatozoa numbers are exceptionally low or there is a sperm transport obstruction that is preventing sperm from entering the ejaculate.

 Learn about sperm transport obstructions

Sperm Donor

Also known as heterologous insemination, a sperm donor can be beneficial in the following situations:

• If the male partner is unable to produce sperm or no sperm can be collected through TESE/TESA.
• If testes have been surgically removed.
• Following radiation or chemotherapy that has resulted in infertility.
• If the man carries a genetic disorder that parents don’t want passed down to their children.
• Lesbian couples seeking to have IVF treatment to start a family.

Step 1: Semen Preparation 

While eggs are being retrieved, semen is being prepared in the laboratory. How semen is prepared will depend on the quality of the sample and the procedures adopted by the specific clinic. The most common procedure is called density gradient preparation. Semen is added to a special media within a test-tube that removes sperm with poor motility. In the case where surgical sperm collection sperm was needed, or sperm count is low, the semen sample may undergo a spinning procedure to concentrate the sperm.

Step 2: Insemination

Insemination techniques may vary. Following egg retrieval, often the oocytes are combined in a laboratory dish with sperm and left overnight to fertilise. Generally, half the oocytes will become fertilised. This is the standard IVF insemination procedure used for patients with normal semen parameters. However, if sperm parameters are abnormal, or previous standard IVF insemination has failed, other methods may be adopted. Usually this involves combining IVF with ICSI, whereby technicians manually fertilise eggs with sperm. Fertilisation rates using ICIS can vary from between 50 and 70%^[2]“van Rumste, M. et.al. (2003). Intra-cytoplasmic sperm injection versus conventional techniques for oocyte insemination during in vitro fertilisation in patients with non-male subfertility. … Continue reading.

Step 3: Fertilisation and Embryo Culture

The next day following insemination, the eggs are checked for signs of fertilisation.

If fertilisation is successful and embryos are evident, they are then grown further in the lab. How long the embryos grow before transfer into the uterus will depend on your fertility specialist and the agreed IVF procedure. Some clinics offer different stages of embryo culture prior to transfer. Depending on the clinic, embryos may be received at the cleavage of blastocyst stage. Embryos two or three days old are at the cleavage stage. This stage is usually offered to couples with a low number of available embryos for transfer. Embryos four or five days old are typically more developed and at the blastocyst stage. This stage may be offered to couples with more embryos available than they want to have transferred. It allows scientists to select the most developed embryo for transfer.