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31 July 2019

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IVF Step by Step

dr shadi khashaba

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Dr Shadi Khashaba

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What is IVF treatment?

IVF is part of what we call ART (Assisted Reproductive Technologies) which allows fertility doctors to help people become pregnant if they cannot do so naturally. IVF stands for In Vitro Fertilisation, in vitro meaning ‘in the dish’ and fertilisation, which takes place outside of the body.

In short, IVF is the process of stimulating the ovaries for around two weeks to create more eggs. Once the ovaries have been stimulated to produce these eggs, a fertility doctor surgically removes the eggs, adds them to a dish with the male’s sperm, in hopes that the eggs will fertilise and, over a five day period, develop into embryos.

So where do I begin?

The first step is to get a referral from a GP for yourself and your partner (if present) to see your desired fertility doctor or clinic. When you attend your initial consultation, your fertility doctor will take a full history of your journey so far, how long you’ve been trying and what has happened up until this point. He or she will also consider your medical history, surgical history, gynaecological history and take detailed information of your menstrual cycle. Your doctor will ask lifestyle related questions such as whether you smoke, how much alcohol you consume and many others to gain insight into your current fertility status.

After your doctor has obtained this information, bearing in mind every scenario is different, he or she will recommend certain investigations. Usually these infertility tests are completed early on in order to diagnose and treat any conditions that may have been unknown and potentially interfering with conception.

What kind of tests are involved?

The very first fertility test is a simple blood test for yourself and your partner. This includes antenatal testing, Anti Mullerian Hormone (AMH), hormonal profile (pituitary, ovaries and thyroid) and Karyotype (checking chromosome - genetic material) to make sure the number of Chromosomes is correct and that they are in in the right order. In addition, your doctor will do a pelvic ultrasound to get an idea of the structure of the pelvis, the uterus and what it looks like, the ovaries and their positioning and if there are any problems that require further investigation. None of these tests are painful, but you may experience some discomfort.

If your male partner is present, he will undergo a semen analysis just to make sure there’s enough good looking swimmers. They specifically look at shape, size, count and movement.

Follow up consultation

Two weeks from the initial consult, once all testing has been completed, you will return to your fertility doctor for a follow up consultation where you will receive your results. Based on these results, your doctor will formulate and propose a treatment plan that is most appropriate for your situation.

Depending on your individual circumstances, treatment begins on the first day of your period. Whether you’re going ahead with ovulation tracking, IVF or IUI  this is the first day of your cycle and a sign to commence treatment.

IVF process step by step

If you are going through IVF, when you get your period you’ll need to call the nurses who will ask you to come into the clinic for an orientation. Here you will learn about the medication involved, how to administer an injection, how to dispose of that injection and any other information relevant to your treatment. Your nurse will also take a blood test to ensure all levels are optimal for beginning the cycle, and on that night you will receive the test result and advise if you can commence treatment.

The first injection is an FSH injection, which stands for Follicle Stimulating Hormone and it does exactly that, stimulates the ovaries to create follicles. Follicles are fluid filled sacs which house eggs. Naturally there’s only one produced every month, but during IVF, the growth is stimulated to produce more than one, hence administering the FSH injection. You administer these injections yourself for the next five days, then return to your clinic to understand how your body responded to the injections (to avoid under or over stimulating the ovaries). The nurses will then recommend either increasing or decreasing your dosage depending on how your body has responded to it.

If you are on track with your FSH injections, you will undergo a follow up ultrasound scan and blood test to confirm your body is heading in the right direction (stimulation) for your IVF cycle. Your doctor will count your eggs to make sure they are growing at a good rate and size, once they are confident in the progression, you will then receive what’s called a ‘trigger’ injection that makes the eggs mature and become ready to be collected.

Two days later you will attend the day surgery to undergo an egg collection (this is the only day you will need to take off work during your IVF cycle). This process takes around 5-10 minutes; you will be completely asleep whilst your fertility doctor uses a small needle, to drain the follicles guided by an internal scan. These follicles are immediately transported to an embryologist who counts the number of eggs in the fluid and prepares them for fertilisation with your partner or donor’s sperm in a dish. If your partner is supplying the semen sample, he will do so earlier that day so it is prepared and ready for the fertilisation process.

The next day, the embryologist will look at the eggs to understand which have fertilised. The fertilised eggs develop in an incubator over a five day period where they will hopefully divide and grow into Blastocysts. A Blastocyst is the optimal stage of development for an embryo; ‘blast’, meaning ‘making’, and cyst, meaning ‘a pool’, which essentially mimics a visual of this stage of development.

Around five days after egg collection, the best looking embryo will be transferred into your uterus through a very fine catheter through the cervix. At this point you will be at approximately day 19 of your IVF cycle, and you would ideally have a few embryos to choose from for transfer. This decision would be guided by a scientist and your fertility doctor. This procedure is very much like a pap smear, it takes about five minutes and you can return to work afterwards.

The two week wait?

The time between transfer and pregnancy test is almost always known as the two week wait, but in fact, the waiting time is 10 days.

Once a week nurses will give you certain instructions about your lifestyle activity and dietary requirements. This usually includes eating a balanced diet and avoiding alcohol for the next 10 days. After this time, you will be called back into the clinic – this may be at the point you would be due for a period. If you have missed this period it’s a distinct sign of pregnancy, nevertheless you will always undergo a pregnancy blood test for confirmation.

What’s next?

If during this cycle you were unsuccessful, the next step is to schedule an appointment with your fertility doctor to sit down and talk comprehensively about the previous cycle and why it may not have worked. For example, how your medication worked, how well the sperm performed and the quality of your remaining embryos. All of this information is taken into consideration for the next cycle to be undertaken.

If you or someone you know would like to know more about IVF treatment or to book an appointment, you can speak to our Public Liaison Coordinators on 1800 111 483.

Process may vary depending on the site and State of treatment and your individual needs – indicative guide only.

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