In vitro fertilization (IVF) is a procedure made famous with the 1978 birth of Louise Brown, the world’s first “test tube baby.” Monash IVF reported the world’s first IVF pregnancy. Dr Cook provides IVF services through Monash IVF Bondi.
IVF involves collecting eggs from the ovary, fertilising the eggs in the laboratory and then transferring the fertilised eggs (embryos) back into the uterus to achieve a pregnancy. Most of the cycles at Monash IVF Bondi are short cycles - known as Antagonist cycles. The time from phoning the clinic on day 1 of the cycle until the pregnancy test is about four weeks.
Indications for IVF
The most common reasons for which IVF is performed include:
Damaged or blocked fallopian tubes
Severe Endometriosis (presence of endometrial tissue outside the uterus)
Male factor infertility, including low sperm count and low sperm motility
Presence of a genetic disorder
To preserve fertility for patients with cancer or other health conditions
IVF Procedure Stages
The stages involved in IVF treatment are:
Controlled Ovarian Stimulation
Injections of FSH are taken every night to stimulate the ovaries to mature a group eggs (oocytes). The ideal number is 5-10 eggs. Each egg will develop in a follicle. This is a fluid filled area in each ovary.
This process will be monitored by Monash IVF Bondi. This involves a visit 3-4 times in the first 10-12 days of the cycle. Blood tests and an ultrasound of your ovaries is performed.
The final injection is called an ovulation trigger and achieves the final maturation of the eggs.
This is a minor surgical procedure to remove the eggs from your ovaries. That can be done under local or general anaesthesia. The procedure takes about 5 minutes to perform
A probe is inserted through the vagina and a needle will pierce each follicle in the ovaries under ultrasound guidance.
The fluid in each follicle is drained and collected by a scientist
The scientist examines the fluid under a microscope and collects the eggs
Semen is collected
Semen is collected from your partner at the clinic.
The sperm sample is washed to select only the best sperm that look normal and highly active.
The mature eggs are placed in a culture dish with the sperm. This is IVF standard insemination.
The eggs are mixed with the sperm in an environmentally controlled chamber to facilitate the process of insemination.
After about 40 hours, the eggs are examined to see if they have become fertilised by the sperm. The fertilised egg is called an embryo.
The egg is fertilised within 24 hours following insemination.
If the chance of fertilisation is low, intracytoplasmic sperm injection (ICSI) may be used where the sperm is directly injected into the egg. ICSI is used when conventional IVF has failed to result in fertilisation, when there is a significant abnormality on the sperm, when surgically retrieved sperm is used and in some cases when frozen sperm is used.
The first human pregnancy using ICSI was reported in 1992 and since this time many thousands of babies have been born using this technology.
The embryo continues to grow as the cells divide. Embryos can be grown in the lab up to six days after egg collection
The development of the embryo is monitored and within 5 days, a normal embryo has numerous actively dividing cells. This stage of embryo development is called the blastocyst stage
Embryo transfer is performed 3 to 5 days after egg retrieval and fertilisation.
A day 3 embryo is called a cleavage stage embryo. The timing of this transfer is more beneficial to couples who have low numbers of embryos (one or two)
A blastocyst transfer (transfer on day 5) is more beneficial to couples who have more embryos. It is used to increase the ability of the scientist to select the best embryo for transfer.
A thin tube containing one or 2 embryos is inserted into the vagina through the cervix and into the uterus. This procedure takes about 3 minutes and is similar to a pap smear. You will be given a picture of the one or two embryos being transferred. The procedure can be performed under ultrasound guidance.
After transfer, if an embryo attaches or sticks to the womb lining a positive pregnancy test is seen. A pregnancy test is performed at Monash IVF Bondi 9-12 days after embryo transfer.
The remaining viable embryos can be cryo-stored for transfer to the uterus in a natural cycle (called frozen embryo transfer cycle)
Success of IVF:
These figures are very standard around the world.
The age of the woman is the only factor consistently significantly associated with IVF outcomes.
Woman in her 20s - term pregnancy rate about 50% per egg collection
Woman in her 30s - term pregnancy rate about 30% per egg collection
Woman in her early 40s - term pregnancy rate about 10-12% per egg collection
Woman older than 43years - term pregnancy rate about 5% (not dependent on number of cycles)
Woman older than 44 years - term pregnancy rate about 1% (not dependent on number of cycles)
Other IVF statistics
90% of term pregnancies are seen within 3 egg collections (any age)
91-92% of term pregnancies are seen within 4-5 egg collections (any age)
Risks of IVF
IVF is a very safe procedure and complications are very rare. Complications may include:
Ovarian Hyperstimulation - where the ovaries are stimulated to produce 20-30 eggs (instead of ideally 5-10 eggs). Women will experience significant bloating due to fluid collecting in their abdomen.
The risk of ovarian hyperstimulation is very low and realistically only seen in women who have polycystic ovaries. If a woman is at risk of ovarian hyperstimulation, the dose of the medication is reduced and she is closely monitored.
There is a risk of pelvic infection or damage to pelvic organs. This is very rare and can occur at the time of the egg collection
There is a risk of multiple pregnancy if two embryos are transferred. There is <1% risk of twins if one embryo is transferred and splits into two.
There are the usual risks of pregnancy - including miscarriage, stillbirth, complications during pregnancy and childbirth.