Female Infertility::

In Vitro Fertilization (I.V.F.)

IVF is the treatment of choice for patients with irreparable Fallopian tube damage (those considered unsuitable for micro or laser surgery ). It is also frequently used as both a diagnostic and a treatment option for patients with other types of fertility problems: suboptimal sperm counts and ovulatory disorders being among the most common.

Preparation for a treatment cycle:

During the initial consultation all aspects of the treatment cycle are discussed and a decision as to the couples suitability for IVF  is reached. Once the preliminary investigations ( including the routine and any specialised blood tests) are complete, the couple may proceed with the treatment cycle with the onset of the  next menses.

Management of an IVF treatment cycle:

In order to obtain the best results it is necessary to stimulate the development of multiple ovarian follicles using a combination of medications tailored to individual requirements. The subsequent growth of the follicles and the developing endometrium are monitored by regular ultrasound scans. Once the follicles are considered mature and the endometrium of optimal development, the arrangements are made for the patient to receive an injection of Pregnyl (human chorionic gonadotrophin - hCG) which completes the maturation and preparation stages. The IVF egg collection procedure is booked to take place 36 hours after the injection of Pregnyl has been given.

The technique of egg collection:

For the IVF procedure the eggs are collected under intravenous sedation (general anaesthesia is rarely required). Eggs are recovered using ultrasound techniques whereby a vaginal transducer enables visualisation of the ovarian follicles. A fine needle is passed through the vaginal wall into each follicle and the contents are aspirated. The eggs lying in the aspirate are selected out and maintained in a specialised culture medium.

Once all the eggs have been collected, the patient is transferred to the day ward for a short rest before discharge home ( 1-2 hours ).

Approximately four hours after the start of the egg collection the selected eggs are inseminated with a prepared sperm sample. 24 hours later they are examined for the first signs of fertilization, and at 48 hours they are observed for the next stage of embryonic  development-" cleavage". Once cleaved embryos are confirmed, the couple can be assured that embryo transfer will take place.

After the IVF procedure:

IVF patients are prescribed vaginal pessaries of the hormone " Progesterone" (Cyclogest) to support the lining of the uterus until the result of the pregnancy blood test  (BhCG - usually taken 12 days later) is known.

The Embryo transfer:

The transfer of the selected cleaved embryos is performed 48 hours after the initial egg collection. A fine catheter is inserted through the cervix, via the vagina to reach high into the uterus. The embryos, resting in a minute amount of culture medium, are then injected through the catheter and pass out into the uterus.  This procedure is of a very short duration and does not usually require any form of sedation.

Suitable embryos not utilised during the transfer may be cryo-preserved  (frozen ) for use in a future treatment cycle is desired.

The success rate:

Success rates for IVF / GIFT are commonly quoted as between 30 and 40%. However, success rates for either procedure varies depending on the different types of problems requiring treatment and the different factors existing in individual patients. Factors predominantly influencing success are (i) the age of the woman producing the eggs (ii) the number of eggs produced (iii) the quality of the sperm (iv) the number of embryos generated and the number  transferred. GIFT is generally more successful than IVF, probably because the Fallopian tube provides a more satisfactory physiological environment for fertilization than the laboratory culture dish.