6.3 IVF

Question 1

How successful is each round of IVF?

Answer 1

25-30% of live birth

Question 2

According to NICE who can get IVF and what criteria?

Answer 2

UNDER 40: 3 cycles if:

• trying UPSI for 2 years
• tried 12 cycles of artificial insemination

BETWEEN 40 - 42: 3 cycles if:

• UPSI 2 years or 12 cycles AI
• no previous IVF
• no low ovarian reserve
• know risks

(or straight away if tests show IVF is only option, like tube problems)

Question 3

What criteria might CCGs add to the NICE guidelines?

Answer 3

• no current children
• healthy BMI
• non smoker
• age eg <35
• some may offer just 1 cycle

Question 4

What is involved in one IVF “cycle”?

Answer 4

• 1 episode of ovarian stimulation and collection of oocytes, gives several embryos.
• Each embryo can be transferred at different times for multiple attempts at pregnancy all during one “cycle”

Question 5

What are the steps in the IVF process?

Answer 5

Suppressing the natural menstrual cycle

Ovarian stimulation

Oocyte collection

Insemination / intracytoplasmic sperm injection (ICSI)

Embryo culture

Embryo transfer

Question 6

What is done in fertility clinic to suppress the menstrual cycle?

Answer 6

• you want to suppress Gonadotropins LH and FSH to stop ovulation

METHOD 1:

• GnRH AGONIST
• injection of goserelin
• in luteal phase eg day 21 (7 before bleed)
• give FSH and LH surge and then suppresses GnRH

METHOD 2:

• GnRH antagonist
• daily SC cetrorelix
• start on 5 or 6
• suppresses LH and ovulation

Question 7

How is ovarian stimulation carried out?

Answer 7

Done to promote development of many follicles.

From day 2 give SC FSH for 10-14 days (many follicles mature)

TVUS to check mature follicles <18mm

• inject HCG and collect eggs 36hrs later
• HCG is similar to LH surge to mature eggs, aka “trigger injection”

Question 8

What is done in oocyte collection?

Answer 8

TVUS and needle aspiration through vagina, aspirate fluid from the follicles which contains oocytes

Question 9

What happens in oocyte insemination?

And in intracytoplasmic sperm injection?

Answer 9

Thousand of sperm added to each egg. Many need to produce enough hyaluronic acid to penetrate corona radiata and zona pellucid.

or ICSI for male factor infertility:
- hight quality sperm are isolated and injected

Question 10

What happens in embryo culture?

Answer 10

• monitor eggs in incubator for 2-5 days to see which grow.

- wait till day 5 “blastocyst” stage

Question 11

What happens in embryo transfer?

Answer 11

after 5 days best embryos are selected for transfer.

Catheter through cervix transfers 1 embryo (2 if over 35)
Remainder are frozen for future transfer.

Question 12

What happens after transfer?

Answer 12

ater 16 days pregnancy test:

POSITIVE:

• implantation has occurred, still risk of ectopic or miscarriage
• progesterone is used to mimic corpus luteum until week 8-10
• US at 7 weeks to confirm fetal heart rate (then standard care)

NEGATIVE:

• implantation failed
• allow normal period (inc bleeding due to hormones)

Question 13

What are the main IVF complications?

Answer 13

Failure
Multiple pregnancy
Ectopic pregnancy
Ovarian hyperstimulation syndrome

Egg collection procedure:
Pain
Bleeding
Pelvic infection
Damage to the bladder or bowel