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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 donor sperm in an incubator outside the body, and transfer of the embryo back into the uterus.
The sperm can be obtained from either a known or clinic-recruited (unknown) donor. Lesbian women or couples who are considering IVF will have to determine which type of sperm donor is right for them. For more information visit our Donor Program page.
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The IVF treatment cycle generally follows these stages:
In a natural menstrual cycle, hormones from the pituitary gland, 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 given as a surge to mature the developing eggs before collection.
The fertility coordinator will give you detailed information about your specific treatment cycle, medications and a timeline relating to your cycle. You will also be shown how to give your FSH injections and given 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 treating specialist will have selected the right cycle type based on your individual needs.
In step two, daily injections of FSH begin. Everyone responds differently to these medications, but on average the injections continue for between 9 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 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.
About 5 to 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 treating specialist will discuss the reasons for cancelling 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 a very 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 about the exact time to administer your trigger injection. This is an injection of Human Chorionic Gonadotrophin (hCG) to assist with the final maturation of the egg and 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 fine 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 about 20 to 30 minutes, dependent upon the number of follicles that have developed. After the procedure you will rest in recovery 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.
The frozen donor sperm you have selected will be thawed on the day and inseminated with your eggs.
The donor sperm sample is thawed, then added to the eggs about 4 hours after retrieval. The dishes are placed in an incubator overnight and the eggs examined the next day for signs of fertilisation. Usually not all eggs will fertilise. We expect about 60 to 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 of the known sperm donor 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 which is used for the treatment of male infertility. ICSI involves the injection of a single sperm directly into a single mature egg.
Embryo transfer occurs two to five days after egg retrieval. The exact day and number of embryos transferred will depend on a woman’s individual circumstances and embryo quality. 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 with your treating specialist, fertility coordinator, scientist and your partner (if applicable) 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 prior to the transfer. Some of the remaining embryos may be suitable for freezing.
Embryos chosen for transfer are loaded into a transfer 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 all the embryos have been released.
Everyone receiving IVF treatment will be offered the option of cryopreservation (freezing). After your transfer, it may be that you 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 women maintain good health and wellbeing. Smoking and alcohol should be avoided, as should spas and saunas. 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 embryo transfer. Your activity can be gradually increased over the next few days to non-strenuous, non-aerobic types – be guided by your treating specialist if 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, contact 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 starts 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 is due about 14 days after the embryo transfer. It is important to look after yourself in the first two weeks while waiting to have your pregnancy test.
The time between embryo transfer and your pregnancy test is often emotionally charged with expectation and anxiety. We understand this can be a difficult time 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.
Before going ahead with fertility treatment, please consider that each state has different legislation in regard to ART. For example:
Therefore, we encourage you to refer to your own state legislation for more information and see one of our specialists to discuss your individual circumstances and explore your options.
As each treatment cycle is structured to suit individual needs, treatment costs will vary between patients depending on the level of assistance required.
Following your initial consultation with a Rainbow Fertility specialist, you will be given a booking 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 this time. If you have any questions regarding treatment fees, Medicare and private health insurance rebates before this, please do not hesitate to contact our friendly patient services team. Call: 1300 222 623 or email: firstname.lastname@example.org
For general information about treatment fees, please visit our Treatment Costs page.
There are some potential risks and side effects associated with IVF procedures including;
We would like you to take a moment to consider some of the factors that may influence the decisions you make in your journey towards parenthood with ART.
Some of the things you may have to consider are:
We invite you to take your time to consider the above. Try not to feel rushed, and trust your instinct.
At Rainbow Fertility, our specialists have extensive experience in helping create LGBTI families. Feel free to contact our friendly team to learn more about our donor program and the fertility treatment options available to you.
Current as at 15.05.17