IVF treatment and process

What is IVF?

IVF (In Vitro Fertilisation) is a procedure, used to overcome a range of fertility issues, by which an egg and sperm are joined together outside the body, in a specialised laboratory. The fertilised egg (embryo) is allowed to grow in a protected environment for some days before being transferred into the woman's uterus increasing the chance that a pregnancy will occur. 

In Vitro Fertilisation (IVF) can be used to overcome a range of fertility issues and for many couples, gives them the best chance of having a baby.

IVF Treatment

Your treatment will be coordinated by your fertility specialist who is supported by an experienced team of nurses, counsellors and scientists. We understand how important having a family is to you and can assure you that we will provide you with the highest standard of fertility care.

We usually grow embryos in the laboratory until Day 5, known as the Blastocyst stage, because there is strong evidence that these embryos are more likely to implant into the uterus.

Fertilised embryos are transferred to the woman’s uterus in a simple procedure call an embryo transfer (a very similar technique to a pap smear).

If more than two embryos develop, we can freeze those that are surplus for use in subsequent cycles. Find out more about freezing embryos...

If there is any concern about sperm quality, the process of fertilisation is carried out by Intracytoplasmic Sperm Injection (ICSI). This is where one sperm is inserted into each egg.

How much does IVF treatment cost?
IVF cycle paymentIVF estimated out-of-pocket costs (Medicare safety net not reached)IVF estimated out-of-pocket costs (Medicare safety net reached)
$9,828$4,991$4,438

What does the Medicare safety net mean?

In a calendar year, generally during your first cycle, you can expect your out of pocket costs to be approx. $4,991.

If you need more than one cycle in a calendar year and reach the Medicare safety net, your out of pocket costs will be less at $3,946.

Read more about the costs of fertility treatment >>

Complete the form below to find out more about IVF costs. 

Watch a video about the IVF process

Video - How the IVF process works

The IVF process step by step

Each IVF treatment cycle takes around six weeks.

Step 1: Initial Specialist Appointment

At your initial appointment, your fertility specialist will review your medical history and all previous investigations and treatments.

You and your partner should both attend your first appointment with your fertility specialist. They will review your medical history, all previous investigations and treatment, and will provide preliminary advice about your treatment options.

Step 2: Pre-treatment consultation

You’ll meet again with your fertility specialist, confirm your treatment plan, have any questions answered and sign the relevant consent forms. Discuss any complementary medicines you are taking now, as these may interfere with your treatment.

Step 3: Treatment begins

Your fertility nurse gives you the medication you need, explains the treatment cycle timeline, and shows you how to self-administer the Follicle Stimulating Hormone (FSH) injections. We recommend both you and your partner attend this appointment.

Step 4: Hormone stimulation

FSH is administered through a diabetic-style pen, stimulating your ovaries to produce more eggs than usual. We have a higher chance of achieving fertilisation and pregnancy when we can collect more eggs.

Step 5: Treatment monitoring

Throughout your cycle, regular blood tests measure your hormone levels and ultrasounds measure the size and number of your ovarian follicles. This also helps us determine the appropriate time for egg collection. All your blood and ultrasound tests are conducted by our nurses within your chosen IVFAustralia clinic, and are included as part of your treatment costs.

Step 6: Trigger injecton

Once you have the optimum number and size of follicles, we plan your egg collection. You’ll have a trigger injection of hCG (human chorionic gonatrophin) in the evening, and the operation for egg collection will occur 36 to 38 hours later. The hCG injection replaces the natural Luteinising Hormone in the body and 'triggers' or instigates ovulation.

Step 7: Egg collection in day surgery

Egg collection is undertaken in day surgery, usually under ultrasound guidance. Most women prefer a light general anaesthetic, but you can have a local anaesthetic with sedation if you prefer. You will be at the hospital for about 4 hours and will need someone to drive you home afterwards. Make sure you can take the rest of the day off work.

On the morning of your egg collection your partner will need to provide a fresh semen (sperm) sample, so we can immediately fertilise your eggs.

Step 8: Egg fertilisation

Collected eggs are taken to the laboratory and placed in culture medium to prepare them for fertilisation later that day. In IVF, prepared sperm and eggs are placed together in a dish where fertilisation occurs. In ICSI, an individual sperm is selected by a highly experienced embryologist, and, under very delicate microscopic control, the egg is injected with this single sperm.

Step 9: Embryo development

The egg and sperm are then placed in individual incubators at 37 degrees to mimic the temperature of the human body. The next day, scientists will examine the eggs to determine if fertilisation has occurred, and will call you to advise you of the development of the embryos.

Step 10: Embryo transfer

Embryo transfer is a simple day surgery procedure and usually takes place five days after the egg collection. The embryos are transferred into the uterus through a very fine catheter passed through the cervix, a procedure similar to a pap smear. In some cases we may recommend transferring embryos earlier.

Step 11: Embryo freezing

Any extra embryos not used during a treatment cycle that are suitable for freezing can be stored for the future.

Step 12: Pregnancy test

Your nurse will organise an appointment for you to have a blood test two weeks after the embryo transfer. Occasionally, women can still have a period despite being pregnant, so this blood test will occur even if your period has commenced. We do not recommend the use of urinary pregnancy test kits, as the hormone medication given throughout treatment could produce an incorrect reading.

Your pregnancy blood test results are usually available by mid afternoon. If the pregnancy test is positive, we will arrange an ultrasound scan approximately three weeks later.

IVF treatment protocols

IVF treatment is tailored to your specific needs by your fertility specialist. Most patients who undergo IVF will be prescribed one of two main treatment protocols Long Down Regulation and Antagonist treatment cycles.

Long Down Regulation [Agonist] treatment cycle

Long down regulation treatment is the process of suppressing a woman’s natural hormones before fertility medications.

Approximately 3 weeks after your period starts you will have a blood test and begin pre-IVF treatment [GnRH analogue] in the form of a Synarel nasal spray or Lucrin injection to control your natural hormones before the fertility medication starts.

About 12 days later another blood test will be taken to make sure your own hormones are low [or down regulated] and you will be instructed when to begin daily hormone Follicle Stimulating Hormone injections [Gonal-F or Puregon]. You will continue taking the Synarel or Lucrin throughout this time.

5 days after you begin FSH injections you will have a blood test and ultrasound of your ovaries. You will be monitored closely with blood tests and ultrasounds until you have an optimum number and size of developed follicles. Once you are ready will we advise when to have your hCG trigger injection and schedule your egg collection 36 hours later.

After egg collection you will use supplemental progesterone either as a vaginal gel, pessary or subcutaneous injections until your pregnancy test two weeks later.

Antagonist treatment cycle

Antagonist treatment uses injectable drugs called antagonists to prevent premature ovulation. It is the most commonly used treatment protocol because the shorter cycle makes it more convenient for patients and reduces the risk of hyper-stimulation.

Starting on the second day of your period you will have a blood test and providing all your hormone levels are low, you will be advised to begin Follicle Stimulating Hormone (FSH) injections [Gonal-F or Puregon] that day.

After four days of injections you start a second injection [Cetrotide or Orgalutron] to switch off your own hormones and prevent premature release of the eggs. 6-8 days after you begin FSH injections you will have a blood test and ultrasound of your ovaries. You will be monitored closely with blood tests and ultrasounds until you have an optimum number and size of developed follicles.

Once you are ready will we advise when to have your hCG trigger injection and schedule your egg collection 36 hours later After egg collection you will use supplemental progesterone either as a vaginal gel, pessary or subcutaneous injections until your pregnancy test two weeks later.

The IVF protocols, explained

Transcript

Welcome to Fertile Minds.

I'm Professor Michael Chapman, I work with IVFAustralia. Today, we're gonna talk about the protocols we use in an IVF cycle. What we're trying to do is get you pregnant, and this is the way we're gonna be doing it.

The commonest protocol used in Australia and in about 85% of cycles, in fact, is what's called the short protocol, so let's go through that. We start on day two, usually, giving injections of FSH. That's the hormone that normally comes from your brain to tell your ovaries what to do, and what we give you is a synthetic version of that at a much higher dose than your brain normally does so we get lots of eggs.

So we start that on day two and in most cases, that's a daily injection in your tummy, like a diabetic does for their insulin injections, with a little pen which has got a tiny little needle on it, and that happens every day. And then at day five or six, we start a second injection. So the first one was to try and make as many eggs as possible. The second injection, which is on a daily basis, called an antagonist, a GnRH antagonist, cetrotide or orgalutran, that is to stop you ovulating, stop you releasing the eggs before we get to collect them. Obviously, it would be a waste of a cycle if you ovulated yourself before we were able to harvest them. So you're taking two injections a day, usually at the same time, it's recommended they're taken in the evening but the time is not vital, it doesn't need to be on the same hour every day, but in the evenings on a regular basis.

From that point on, you'll probably probably have one or two or three blood tests and ultrasound scans, transvaginal ultrasound scans, to watch the follicles growing and to measure the hormones that are being produced by those follicles. Then the specialist will see those results on a daily basis and make decisions about whether to change the dosage of the drugs that you're using, or to make that final decision of it's time. It's time to collect the eggs.

At that point, time is then set for the egg collection to take place. When the eggs are ready for collection, they need a final maturing injection, an injection that makes the eggs go from 46 chromosomes to 23. It's what happens in nature, just before ovulation, so that your 23 chromosomes can meet up with the 23 chromosomes of the sperm, and that requires a trigger injection, it's called. These days we use a synthetic version of the pregnancy hormone hCG, but we also can use hCG itself. And that is given quite precisely, and you will be told by your nurses to be precise about taking that, 'cause once we give the injection, we know the eggs are gonna be released at about 40 hours after that.

So what we're doing is timing your egg collection to be between 36 and 38 hours after the injection is given. So if we've set a time, say tomorrow morning, eight o'clock in the morning to do the egg collection, you will have had your injection at eight o'clock last night. 10 minutes, either way, is not important, but if you forget it, it is a major problem, because your eggs won't be ready. Once you have had that injection, then as I say, you're gonna be coming to the egg collection room 36 to 38 hours later, eggs are collected, then we begin what is called luteal phase support.

In every IVF cycle, to make sure the lining of the womb is good, we need to keep progesterone levels high, and that's done either with pessaries or tablets in the vagina. That's fairly uniform throughout cycles. You can use hCG injections instead of the progesterone pessaries, but that has a risk of causing hyperstimulation, so we rarely use it.

So that's the short protocol. I'll just run it again. Starts on day two, daily injections, starting on day five, another set of injections, the trigger injection, egg collection, and then luteal phase support. That's the majority. That came to pass about a decade ago in Australia.

The previous regime, and that's what's used by the other 10 or 15% of patients in Australia, is called a long protocol. It's called a long down-reg protocol. That begins in the third week of the cycle before the cycle that we're going to collect the eggs. So 21 days on a normal cycle, we will do a blood test to make sure you've ovulated, and after that, we will be giving you either a nasal spray or an injection to switch off the ovaries, so that when we get to the day of your period, the ovaries are quiet, there's no activity, and then we start the daily injections of the FSH. Again, those injections will continue all the way through until the day of the trigger injection. That's about, usually, an average of 11 days of injections. Could be 10, could be up to 14, but the average is around 11 days.

Same injection as we talked about in the short protocol at that point, but we've already switched off your pituitary gland with a nasal spray or the downregulation agonist injections. Again, there'll be the same monitoring with bloods and ultrasounds, and a decision will be made by your specialists that it's time to collect the eggs and the trigger will be provided. Again, it's the same trigger, 36 hours before the operation, to collect your eggs. The luteal phase support, again, is identical to a short protocol.

Now, the reason why 85% do it that way, it's not because it's any better, it's just that it's easier for you, the cycle is shorter. Studies that I've personally done have shown 99% of patients prefer the short protocol, compared with the long one, just because it's all over in the one month.

There are other protocols. Some people would do natural cycles where you only get one egg and you don't need any medication. In some countries around the world, Japan's one of them, where the drugs aren't covered by Medicare, natural cycles are done a lot, but it means you need to have lots of cycles to get the same cumulative pregnancy rate as we get in Australia, so it's usually not the way to go.

Some people will start the injections later to get one or two eggs only. Again, it's a numbers game. The more eggs you have, the more chance ultimately you have of getting pregnant. In some cases, we even go as far as the long, long downregulation. So we started on day one of a cycle, not in the cycle that you're gonna be having the egg collection, but a month later. Some people do that where there's endometriosis, for instance. It may suppress endometriosis, although in a month, it's unlikely to.

So there are multiple protocols. The majority are pretty straightforward, short protocols that, as I said earlier, are much, much easier and much less burdensome than in the past. So when you sit down in front of your IVF doctor, that's what they'll probably give you, at least as your first cycle. The dosing of those is dependent on your clinical situation, age, weight and previous history. I'm not gonna go into that today but it will vary from patient to patient, so don't necessarily compare my cycle with your cycle . It can lead to confusion.

What you want is a specialist who understands what the best is for you, someone who's experienced, and our doctors at IVF Australia are all in that category. So thanks for watching, I hope that was useful, and if you've got any questions or comments, please make them, and please subscribe to the Fertile Minds.

*All opinions expressed on the Fertile Minds YouTube Channel belong to the individual doctors, scientists and specialists, not the Virtus Health group.
How to prepare for embryo transfer day

How to prepare for embryo transfer day

Transcript

Hi there, welcome to Fertile Minds. I'm Dr. Iris Wang, specialist obstetrician, gynaecologist and fertility specialist with IVFAustralia. Today, I'm going to be explaining how you can prepare yourself for the embryo transfer procedure. As it is a very important day in your IVF treatment.

Now let's get straight into it. So let's talk about how it is done. The embryo transfer procedure is a very straightforward simple procedure. Despite the fact that IVF treatment involves so much technology and is so complicated. So in embryo transfer procedure, we put the embryo back into the uterus using a very fine catheter, trans-vaginally via the cervix, and then into the middle of the uterus. We also use a transabdominal ultrasound to improve the accuracy of the transfer.

That is why we ask you to come with a half filled bladder because that will help us in visualising the uterus on the ultrasound. Of course, before we get to that point, there's a lot of identification process that goes on because we want to make sure the right embryo goes back to the right patient, right? So we ask you to bring a photo ID to help with that process. And then the first step of checking happens at the desk when you first check in with the office staff, and then secondly it will happen in the embryo transfer room with the doctor and the embryologist. And then finally, you will be able to do the ID check on the embryo dish together with your doctor and the scientists via the TV monitor.

On the TV monitor, you will also be able to see your embryo being magnified as seen from the embryologist's perspective using the microscope. So that's a part that the patients all love, it's really cool to be able to see your embryo. And then from there on you will be to see the process happening via the ultrasound.

So you can see that this is a very straightforward procedure and it takes about five minutes. There's no pain and there's no need for anaesthetics. And of course, when you're finished and leave the transfer room, you feel like you were abandoned and you abandoned for the next 10 to 12 days waiting for the pregnancy test result. So I just want to give you some pointers about what to do.

Now firstly, it's very important whenever your doctor and your fertility nurse have advised you to use any medication they ask you to use, keep using them, don't forget. Secondly, keep calm and then the third thing is to help yourself doing that, try and keep yourself busy with projects around the house, keep yourself busy with your work, whatever it is to take your mind off your cycle. So you don't keep thinking it and you don't keep overthinking it.

And then another very important thing is don't do your home pregnancy test because sometimes the medication we give you can give your erroneous readings. So just wait calmly until the scheduled day of the pregnancy test at the clinic.

Now I think I should also talk about a few things that people often ask about and maybe debunking some of the myths that we'll talk about.

So let's start with heating and overheating. Now this advice really comes from pregnancy advice. The idea is that a pregnant woman is working very hard to make sure she provides the baby with a good environment to grow. So as part of this healthy, growing environment, the temperature has been stable, the bluff flow has to be plentiful to provide for the embryo. And when we overheat, we could get a heat stroke and we dehydrate. So when there's dehydration, uterine perfusion goes down, placental profusion goes down and that can potentially affect the pregnancy. So that's where all that pregnancy advice comes from. And of course, people that extend it to people who are trying to get pregnant. So it's not unreasonable.

Now, however, we don't actually have any scientific proof as to how hot is too hot. And we don't have any information as to the kind of damages overheating can do to a pregnancy or implantation. So in the absence of any scientific proof, we'll just give you general advice. And the general advice is don't let your body go over 39 degrees Celsius and always drink plenty of fluids to avoid dehydration.

Another common myth is about heavy lifting. So this really is a myth. There is no proof whatsoever that heavy lifting causes miscarriages or implantation failure. And a very important thing I want to say is once the embryo is inside the uterus, it is in, it does not fall out. So even if the embryo didn't take, it will be cleared by the body's own scavenger system. Even at that point, embryo still does not fall out. So if you use that same principle, you can see that after the embryo transfer, you don't need to lie down for periods of time. You can just get up and go. You don't need to go home and lie down for days. We want you to keep moving, keep active.

As well as using that same principle, you can imagine that after the embryo transfer, it is perfectly okay to go to the bathroom, particularly in view of the fact that we asked you to come with a half full bladder. So after you had the embryo transfer, it is quite important and quite necessary and totally safe to go to the bathroom.

Okay, and I talked a little bit about exercises, We like you to keep active, have some moderate exercises but possibly not extremely strenuous exercises. Again, referring to what I said about overheating.

Now, sometimes after the transfer, there might be a little bit of blood from the instrument and on contact. So this is nothing worry about, don't panic. Now we often give you a pad for that purpose. It doesn't mean a tampon is somehow bad for you, it just means sometimes a lot of times in fact, you're using vagina pessaries and topical medication. So it just makes things a bit messy, so we usually just give you a pad to use and the bleeding will never last for days on end.

Okay, so finally, I think I need to address a very common question about acupuncture. Now, there is no scientific proof acupuncture before or after transfer will improve your pregnancy right after IVF treatment but there's good evidence that acupuncture helps with mental wellbeing and certainly helps reduce stress level and anxiety levels associated with an IVF cycle. So if you find that helps you by all means, go ahead. Because there's no proof that acupuncture is harmful to your IVF cycle.

Okay, just want to recap, we talked a bit about what embryo transfer involves. And we also talked about how to look after yourself after the embryo transfer and we also talked about some of the myths that's surrounding embryo transfer.

I certainly hope that you found this video helpful. Do remember, you all have your own individual circumstances and you should talk to your own doctor who know your full history. Do leave us questions and comments and do subscribe to our channel so you can see other videos on fertility and fertility treatment. For now, it is goodbye until next time.

*All opinions expressed on the Fertile Minds YouTube Channel belong to the individual doctors, scientists and specialists, not the Virtus Health group.

It can be helpful to understand what happens on the day of your embryo transfer as the last step of an IVF cycle. The procedure is very straightforward, as Dr Iris Wang, fertility specialist with IVFAustralia, explains.

Want more information?

To find out more about what’s involved in IVF treatment please come to a free information night or book an appointment with a fertility specialist. Appointments are available within the next couple of weeks and will cost approximately $150 for a couple after the Medicare rebate.

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