Patients undergoing IVF / ICSI with GnRH Antagonists
How long will my treatment take?
Approximately fifteen days from the start of your period. You will need injections for about ten days. This is followed by the egg collection procedure two days later and the embryo transfer is another three days later.
Ovarian stimulation phase
Once the period starts, daily injections of Follicle-Stimulating Hormones (FSH) are commenced to make your ovaries develop the eggs. We need to do a blood test and an ultrasound scan first and this is usually done on day 2 or 3. If these are satisfactory, the injections are commenced. The exact number of days of daily injections depends on how you respond. The usual is about ten days. During this time you will need to come to the clinic to have ultrasound scans to assess the development of the eggs and make adjustments to the injection dosage. The first scan is after five days of FSH and further scans are performed at two to three day intervals. Approx four clinic visits are needed before you are ready for the eggs to be collected.
When the follicles are nearing maturity, a second injection called a GnRH antagonist is commenced to prevent the ovary from ovulating (releasing) the eggs.
An ultrasound procedure is necessary to collect the mature eggs from your ovaries.
You will be given a painkilling injection as well as a sedative and the procedure is then performed using a vaginal ultrasound scan (similar to your scans in the clinic).
A needle is passed through the vaginal skin and into the ovaries under the guidance of the ultrasound scan. The fluid from the follicles is removed and the eggs identified one by one under the microscope. The whole process takes approximately 30 minutes.
Once the procedure is over, you will recover in the ward until the effects of the sedation have worn off and you can then return home.
Usually you will be admitted early in the morning (approximately 7a.m) and will be home by lunchtime.
This is the day that we will require your husband’s sperm to fertilize your eggs.
Over the next three to five days, the eggs and sperm are incubated in our IVF laboratory and the embryos developed.
Three to five days after the egg collection, the embryos are ready to be transferred into your uterus. This is not a painful procedure as it only involves the insertion of a very soft tube containing the embryos into the uterus via the cervix. It is similar to having your annual pap smear done except that you need a full bladder so that we can monitor the transfer procedure with an ultrasound scan.
The number of embryos transferred back into you will be decided on the day. We will discuss this together and a joint decision will be made before the transfer. Our practice is to advise replacement of a maximum two (2) good embryos each time to avoid triplet gestations which carry a high risk.
Any extra good quality embryos can then be frozen for potential future use.
What is the chance of having a baby?
Once you get pregnant, the chance of having a baby is approximately 80%. A pregnancy conceived from fertility treatment behaves like any other normally conceived pregnancy, and there is therefore a risk of miscarriages or ectopic pregnancy (pregnancy outside the uterus).
If the pregnancy progresses safely past the first three months, the chance of having a baby goes up to over 97% as most of the miscarriages etc. occur in the first twelve weeks.
What is my chance of having a multiple birth?
In order to increase the chance of pregnancy, more than one embryo is transferred and even when this is done, you will know that only approximately one half get pregnant. When a patient gets pregnant, one or more of these embryos may have implanted and this is the cause of the multiple pregnancies. On average, our experience is that 65 % are a single pregnancy, 32% are twin and approx. 3% are triplet. We normally replace a maximum of two (2) embryos so that the risk of triplets is reduced. Triplet pregnancies have very high risk to both mother and babies.
Are there any long term risks to fertility treatment?
IVF has been practiced for many years now and the oldest children are over twenty five years old. Over one million IVF babies have been born worldwide and almost 200,000 cycles of IVF are performed worldwide yearly. So far no harmful consequences have emerged.
The short term risks during the cycle are related to Ovarian Hyperstimulation Syndrome, which occurs if a large number of follicles develop. It is our policy to tailor the dose to suit your profile and this, we believe, contributes to our high pregnancy rates and very low incidence of this syndrome. In the last four years, we have not had any patient with this condition.
How many treatments will I require to conceive?
The treatments for conceiving are only about 50% effective each time. Ten years ago this was 15-25% so you can see that great progress has been made. Even though pregnancy rates continue to increase worldwide, it is still not possible to get everyone pregnant the first time around and therefore more than one treatment cycle may have to be undertaken.
Are children conceived by IVF normal?
This has been a focus of scientific investigation for the past 30 years ever since the birth of the first IVF baby. The abnormality rate worldwide for naturally conceived babies is 3% and this includes all known birth defects. With IVF, it is increased by 1%. (ie it is 4%).
Can I exercise during the treatment cycle?
You can do so during the initial part of the cycle. However this should not cause pain and should you find discomfort, it is best to avoid altogether. As the ovaries become bigger from growing follicles, the discomfort increases. The same advice applies to intercourse.
After the egg collection and embryo transfer, it is best to avoid both exercise and intercourse altogether.
You can continue to work normally until the day of the egg collection.