IVF Treatment

In vitro fertilisation (IVF) is a procedure made famous with the 1978 birth of Louise Brown, the world’s first “test-tube baby.” Monash IVF reported the world’s first IVF pregnancy. Dr Turner provides IVF services through Monash IVF Brisbane.

About IVF Process

IVF involves collecting eggs from the ovary, fertilising the eggs in the laboratory and then transferring the fertilised eggs (embryos) back into the uterus to achieve a pregnancy. Most of the cycles at Monash IVFBrisbane are short cycles - known as Antagonist cycles. The time from phoning the clinic on day 1 of the cycle until the pregnancy test is about four weeks.

Indications for IVF

The most common reasons for which IVF is performed include:

• Damaged or blocked fallopian tubes
• Ovulation problems
• Endometriosis (presence of endometrial tissue outside the uterus)
• Male factor infertility, including low sperm count and low sperm motility
• Presence of a genetic disorder
• To preserve fertility for patients with cancer or other health conditions
• Recurrent miscarriages
• Unexplained infertility

IVF Procedure Stages

The stages involved in IVF treatment are:

Controlled Ovarian Stimulation

• Injections of FSH are taken every day to stimulate the ovaries to mature the follicles containing the eggs(oocytes). These follicles appear on the transvaginal scan as fluid-filled spaces. The ideal number is 10-15 eggs.

Dr Turner will monitor this process by transvaginal scanning and occasionally blood tests This involves a visit 3-4 times in the first 10-12 days of the cycle. Once the majority of the follicles are mature -[17-24mm in diameter], the final injection called an OVULATION trigger is given, which achieves the final maturation of the eggs. The egg collection is done in 36 hours.

Egg retrieval

• This is a minor surgical procedure to remove the eggs from your ovaries. That can be done under local or general anaesthesia. The procedure takes about 15 minutes to perform.
• A probe is inserted through the vagina, and a needle will pierce each follicle in the ovaries under ultrasound guidance. 
• The fluid in each follicle is drained and given to a scientist
• The scientist examines the fluid under a microscope and isolates the eggs

Semen is collected

• Semen is collected from your partner at the clinic.
• The sperm sample is washed to select only the best sperm that look normal and highly active.

Egg Fertilisation

• The mature eggs are placed in a culture dish with the sperm. This is IVF standard insemination.
• The eggs are mixed with the sperm in an environmentally controlled chamber to facilitate the insemination process.
• The egg is fertilised within 24 hours following insemination.
• After about 40 hours, the eggs are examined to see if they have become fertilised by the sperm. The fertilised egg is called an embryo.

If the chance of fertilisation is low, intracytoplasmic sperm injection (ICSI) may be used where the sperm is directly injected into the egg.

ICSI is used when

• conventional IVF had failed to result in fertilisation,
• there is a significant abnormality of the sperm,
• surgically retrieved sperm is used, or
• when frozen sperm is used, if doing PGT [genetic testing for monogenetic disorders, sex selection, structural chromosomal rearrangements but not needed if testing for aneuploidy], or
• if using frozen eggs.

The first human pregnancy using ICSI was reported in 1992, and since this time, many thousands of babies have been born using this technology.

Embryo Culture

• The embryo continues to grow as the cells divide. Embryos can be grown in the lab six days after egg collection.
• The embryo's development is monitored, and within five days, a normal embryo has numerous actively dividing cells. This stage of embryo development is called the blastocyst stage.

Embryo Transfer Procedure

Embryo transfer is performed 3 to 5 days after egg retrieval and fertilisation.

• At day three, the embryo is called a cleavage stage embryo. The timing of this transfer is more beneficial to couples who have low numbers of embryos (one or two)
• A blastocyst transfer (transfer on day 5) benefits couples with more embryos. It is used to increase the ability of the scientist to select the best embryo for transfer.
• A thin tube containing one or two embryos is inserted into the vagina through the cervix into the uterine cavity. This procedure takes about 3 minutes and is similar to a Pap smear. You will be given a picture of the embryo transferred.

The procedure can be performed under ultrasound guidance.

• After transfer, if an embryo attaches or sticks to the womb lining a positive pregnancy test is seen. A pregnancy test is performed at Monash IVF Brisbane 9-12 days after embryo transfer.
• The remaining viable embryos can be cryo-stored for transfer to the uterus at a later stage in a natural or hormone replacement cycle (called frozen embryo transfer cycle)

Who Can IVF Help and Success Factors

These figures are very standard around the world. The woman's age is the only factor consistently significantly associated with IVF outcomes.

• Women in their 20s - term pregnancy rate is about 50% per egg collection
• Women in their 30s - term pregnancy rate is about 30% per egg collection
• Women in their early 40s - term pregnancy rate about 10-12% per egg collection
• Woman older than 43years - the term pregnancy rate is about 5% (not dependent on the number of cycles)
• For women older than 44 years - the term pregnancy rate is about 1% (not dependent on the number of cycles)

Other IVF Statistics

90% of term pregnancies are seen within three egg collections (any age)

91-92% of term pregnancies are seen within 4-5 egg collections (any age)

Risks Associated with IVF

IVF is a very safe procedure, and complications are very rare. Complications may include:

Ovarian Hyperstimulation - where the ovaries are overstimulated and produce 20-30 eggs (instead of ideally 5-10 eggs). Women will experience significant bloating due to fluid collecting in their abdomen.

The risk of ovarian hyperstimulation is very low and realistically only seen in women who have polycystic ovaries. If a woman is at risk of ovarian hyperstimulation, the dose of the medication is reduced, and she is closely monitored. If there is concern that OHSS may occur, the ovulation trigger dose is changed to a GNRH agonist instead of ovidrel. If this is not possible, then the cycle may be cancelled.

There is a risk of pelvic infection or damage to pelvic organs. This is very rare and can occur during egg collection time. Also, bleeding requiring reoperation or blood transfusion may rarely occur.

There is a risk of multiple pregnancies if two embryos are transferred. There is a 2-3%risk of twins if one embryo is transferred and split into two.

There are the usual risks of pregnancy - including miscarriage, stillbirth, and complications during pregnancy and childbirth.