IVF and The IVF Process

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The first official day of your IVF treatment cycle is Day 1 of your period. Everyone’s body is different; your fertility nurse will help you understand how to identify Day 1.

The stimulation phase begins on Day 1. In a natural monthly cycle, your ovaries would normally produce one egg. With an IVF cycle, you’ll take medication for eight to 14 days to encourage the follicles in your ovaries (where the eggs grow) to produce more eggs.

Your specialist will prescribe medication specific to your body and treatment plan. This medication usually takes the form of injections. These injections can vary from one-two for the entire cycle, to one-two per day.

The idea of injecting yourself can feel daunting at first - we completely understand this. That’s why your fertility nurse will take you through the process step-by-step, showing you exactly how and where to give the injections. It’s a great idea to get your partner or a support person involved too. That way you can watch and learn together. Also take comfort knowing we have additional resources online to guide you when at home.

Trust us - what seems daunting at first quickly becomes a habit. You’ll be an expert in no time.

The most common hormones contained in the injections are:

• follicle-stimulating hormone (FSH)
• luteinizing hormone (LH)

Throughout your cycle, your specialist and fertility nursing team keep a close eye on your ovaries and how the follicles are developing with blood tests and ultrasounds. They’ll adjust your medication if needed. It’s common to have some transvaginal ultrasounds, where a probe is inserted internally to view the ovaries and developing follicles to help fine tune your treatment during the stimulation phase. Our team are there to support you and make you as comfortable as we can.

We’ll monitor you more frequently towards the end of the stimulation phase to time the ‘trigger injection’ perfectly.

The trigger injection is a crucial step in the process. It readies the eggs for ovulation - the natural process where your eggs are released. Your fertility nurse will tell you exactly when to give the trigger injection. The timing is critical, as your fertility specialist needs to perform the egg retrieval before you ovulate.

The egg retrieval - also known as the egg ‘pick up’ (EPU) - is a hospital day procedure where your fertility specialist collects the eggs from your ovaries. An anaesthetist will give you a general anaesthetic so that you’re asleep for the procedure, which takes about 20-30 minutes.

Your specialist uses the latest ultrasound technology to guide a needle into each ovary. It’s delicate work where every millimetre counts. Our specialists are experts in the field. Eggs are invisible to the naked eye - they’re contained in the fluid-filled follicles in your ovaries. So your specialist will remove fluid from the follicles that look like they’ve grown enough to have an egg inside.

Your fertility team has been monitoring you closely throughout your cycle, so they’ll have a fair idea of how many eggs they expect to retrieve in your procedure. The average number of eggs collected is eight-15, however this is also dependant on your age and clinical history.

After your procedure, you’ll wake up in recovery, where we’ll keep you warm and comfortable. About 30 minutes later you’ll be able to walk out on your own. It’s a good idea to have a support person with you as you won’t be able to drive after the EPU.

If you’re a couple planning on using fresh sperm, the male will produce a sample the morning of the egg retrieval. If you are using frozen or donor sperm our scientists will have it ready in the lab.

We grade the sperm using four different levels of quality. The laboratory will prepare the samples to collect the most viable sperm from the sample for combining with your eggs, all so our scientists can spot the best sperm under powerful microscopes. We take great care in preparing the sperm prior to introduction to the eggs with multiple methods at our disposals tailored to each patients sample. The ideal sperm is not too fat or too thin, with a tail that’s not too long or too short and is referred to as having normal morphology (shape/structure). Being able to identify morphologically normal sperm is a skill that our scientists develop over many years, with constant fine tuning, to select the ideal sperm for every egg. Once the sample is prepared we have it ready and we have it ready and waiting in the lab for the next step We then introduce the prepared sperm to the eggs collected in your egg pick up.

Your fertility specialist gives our scientists the eggs they’ve retrieved from your ovaries. The eggs are contained in tubes of follicular fluid taken from your ovaries. Our scientists use powerful microscopes to find the eggs in the fluid so that they can remove them.

Once the eggs are removed, we culture the eggs in the ideal environment prior to combining with sperm (inseminating) with either standard insemination or Intracytoplasmic sperm injection (ICSI) or a combination of both. Our scientists will either place the eggs and sperm together in a culture dish to fertilise naturally as they would within your own body. This is known as Standard IVF insemination. Another method of insemination is for our scientists to hand select a single “ideal” sperm to inject directly into each individual egg known as ICSI. The method of fertilisation will be directed by your specialist in discussion with your situation to optimise your fertilisation and pregnancy chances in each cycle.

After the insemination procedure, we place the inseminated egg(s) into our specialised culture incubators to assess for fertilisation approximately 17 hours later the next day. We are looking for signs of normal fertilisation - 2 pronuclear bodies known as ‘pronuclei’. These pronuclei are the genetic nucleus from the egg and sperm, so we need to see only two pronuclei. One from the egg and one from the sperm. If the egg does not present with 2 pronuclei, then the egg has not fertilised and will not produce an embryo.

Ideally, after combining a sperm with the egg, approximately17 hours later it will fertilise and begin forming an embryo. Our scientists will culture the developing embryo(s) in a special incubator, where the conditions for growth and development are optimised to grow the best possible embryos. .

We create these perfect growing conditions using a special mix of amino acids, and nutrients similar to the ones your own body would use to nurture the embryo. Our goal is to mimic the body’s natural processes as closely as possible.

Our scientists keep a close eye on the embryo’s development over the next five-six days. They’re aiming to see:

• a two- to four-cell embryo on day two
• a six- to eight-cell embryo on day three (called the cleavage stage)
• an embryo of roughly 100 cells by day five or six (called the blastocyst stage)

Our goal is to grow all embryos to the blastocyst stage. We know that transferring more robust and developed embryos into the uterus boosts your chances of a successful pregnancy.

Unfortunately, not all eggs will fertilise and reach each embryo stage. The eggs might not be mature, or the sperm mightn’t be strong enough.

We know you’ll be eager for news along the way. Rest assured, we’ll keep you up-to-date on how your eggs, sperm and embryos are developing. In the meantime, if you have any questions—our friendly team are just a phone call away.

If your embryo develops in the lab, the next step is to transfer it into your uterus in a simple procedure known as an ‘embryo transfer’.

Your fertility nurse will contact you with some easy instructions on how to prepare.

The embryo transfer is a very simple process—similar to a pap smear. The procedure itself only takes about five minutes. A scientist prepares your embryo by placing it in a small tube called a catheter. It’s critical this is done by an expert in order to disturb the embryo as little as possible.

Your fertility specialist places the catheter through your cervix and into your uterus.

And that’s it!

You’ll be awake, there’s no anaesthetic, and you can get up straight away. Feel free to continue with your day; the embryo is secure within your uterus and won’t fall out if you stand up or go to the toilet.

Approximately two weeks after your embryo transfer, you’ll have a blood test to measure your levels of the hormone hCG (human chorionic gonadotropin). hCG in your bloodstream usually indicates a positive pregnancy test. Your nurse will let you know exactly when to have your blood test, as it may vary for some patients.

We understand that the lead-up to this final blood test can be an anxious time. That’s why it’s a good idea to distract yourself if possible. You may even like to plan a fun event around the time you’re expecting your result. A weekend away or a special lunch can ease stress and give you something to look forward to.