What is in vitro fertilisation (IVF) ?

What is in vitro fertilisation (IVF) ? 2020-03-05T21:54:16+00:00

IVF stands for in vitro fertilisation which means “to fertilise in glass,” hence the familiar name of “test tube baby”. The eggs are removed from the ovaries using light sedation to make you sleepy and relaxed, and you will be given pain relief medicine to make you comfortable during the procedure. When you are sleepy and comfortable, the eggs are collected using an ultrasound-guided needle. The needle goes through the back wall of the vagina (up to the ovaries), where the eggs are gently sucked in through the needle.

The woman’s eggs are then mixed with the sperm of her partner in a small dish in the laboratory to allow fertilisation to occur. If the eggs are fertilised, they are left in the laboratory incubator to develop into embryos. If the embryos develop, they are checked for quality and one or two embryos are placed into the woman’s womb through the cervix using a small plastic tube.

When is IVF used?

IVF may be recommended if:

• You have damage to or blockage of the fallopian tubes.
• Your partner has mild sperm problems. More severe sperm problems can be treated using a technique called intracytoplasmic sperm injection (ICSI).
• You have been diagnosed with unexplained infertility.
• Other techniques, such as fertility drugs and intrauterine insemination (IUI) have not been successful.

You will be seen in the clinic by the doctor who will discuss IVF with you to help you to decide if this treatment is suitable for you.

What is intra-cytoplasmic sperm injection (ICSI)?

ICSI involves injecting a single sperm directly into an egg in order to fertilise it.

Is ICSI for us?

ICSI is often recommended if:
• the male partner has a very low sperm count
• other problems with the sperm have been identified, such as poor morphology (abnormally shaped) and/or poor motility (poor swimmers)
• at previous attempts at in vitro fertilisation (IVF) there was either failure of fertilisation or an unexpectedly low fertilisation rate
• the male partner has had a vasectomy and sperm have been collected from the testicles or epididymis (sperm reservoir)
• the male partner does not ejaculate any sperm but sperm have been collected from the testicles
• the male partner has had problems obtaining an erection and ejaculating.

How does ICSI work?

An embryologist will examine your sperm under a microscope and decide whether ICSI could increase your chances of fathering a baby. The major development of ICSI means that as long as some sperm can be obtained (even in very low numbers), fertilisation is possible.
If you can, you produce a fresh sperm sample on the same day as your partner’s eggs are collected.
The procedure for ICSI is similar to that for IVF, but instead of fertilisation taking place in a dish, the embryologist selects sperm from the sample and a single sperm is injected directly into each egg in order to fertilise it.

This does not mean that the egg is fertilised, but ICSI now gives an opportunity for that complex process to commence. ICSI is not a guarantee that fertilisation will take place.

Can we have ICSI if I am not producing sperm?

If the embryologist can’t find any sperm in your sample, it may be possible to retrieve some sperm by performing an operation.
If you have a zero sperm count (other than caused by vasectomy) the chances of retrieving sperm may be very low or at least uncertain. If your doctor feels that you would benefit from an operation to try to obtain sperm the risks and benefits will be discussed with you.
It is sometimes possible to collect sperm directly from the epididymis (a narrow tube inside the scrotum, where sperm are stored and matured) using a type of fine syringe. This is known as ‘percutaneous epididymal sperm aspiration’ or PESA.
Sperm can sometimes also be retrieved from the testicles, a process known as ‘testicular sperm aspiration’ or TESA.
It may also be possible to remove tiny quantities of testicular tissue from which sperm can be extracted. This procedure is called ‘testicular sperm extraction’ or TESE.
The sperm taken from these procedures is frozen, and thawed for use at the time of your treatment.
If no sperm are retrieved the options of having Donor insemination (DI) or In vitro fertilisation (IVF) with donor sperm can be considered instead.

What are the risks of ICSI?

Because ICSI is a fairly new treatment (it was introduced in 1992), it is not yet known whether there is any risk that injecting the sperm into an egg could damage it, with possible long-term consequences for the child. The risks that have so far been associated with ICSI are:
• Certain genetic and developmental defects in a very small number of children born using this treatment. However, problems that have been linked with ICSI may have been caused by the underlying infertility, rather than the technique itself.
• The possibility that a boy conceived as a result of ICSI may inherit his father’s infertility. It is too early to know if this is the case, as the oldest boys born from ICSI are still in their early teens.
• An increased risk of miscarriage because the technique uses sperm that would not otherwise have been able to fertilise an egg.
• A low sperm count caused by genetic problems could be passed on to a male child, so you may want to undergo genetic tests before going ahead with ICSI. Infertile men with low sperm count or no sperm in their ejaculate may be tested for cystic fibrosis genes and for chromosome abnormalities. You may want to discuss the full implications of taking these tests with your clinician or the clinic’s counsellor before going ahead.
• It is unlikely that all the eggs collected will be suitable for ICSI, as only mature eggs can be injected. Typically about 70 or 80 out of 100 (70%-80%) of eggs collected are mature. On average about 70 out of 100 (70%) of the eggs will fertilize.
• As ICSI involves using a needle to inject the sperm into the egg it is possible that some eggs will be damaged by the procedure and will not fertilize.

Do any factors affect the success rate of ICSI?

Female factors – in order to withstand the injection process, eggs need to be fairly robust (tough) and of good quality. It is known that the egg quality is reduced in older women and in women who smoke. The success rates of ICSI and IVF are lower in older women (older than 38 years) and women who smoke.

Male factors – if there are no moving sperm present in the sperm sample, it is difficult to identify live sperm. Under these circumstances it may be necessary to select a non-moving sperm for injection. A large number of these sperm will be dead and therefore fertilisation rates will be poor under these circumstances. There is also some evidence that injecting sperm with abnormal head shapes may be associated with poor results.

What are the chances of success with IVF/ICSI?

A woman’s ability to conceive a child reduces with age. If you are using your own eggs, on average, the younger you are the higher your chances of success.  Only a few women over the age of 40 conceive with IVF.  IVF cannot overcome the reduction in the number and quality of eggs as women get older. Success rates for our clinic and national success rates can be found on the HFEA website (www.hfea.gov.uk) .These figures are regularly updated.