Services We Offer . . .
In-Vitro Fertilization
Ovulation Induction
Artificial Insemination
In Vitro Fertilization
Embryo Transfer (IVF / ICSI -ET)

In Vitro Fertilization is commonly referred to as IVF. IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish. When the IVF procedure is successful, the process is combined with a procedure known as embryo transfer , which involves physically placing the embryo in the uterus.

What is involved with in vitro fertilization? ​

There are five basic steps in the IVF and embryo transfer process which include the following:

  1. 1. Monitor and stimulate the development of healthy egg(s) in the ovaries.
  2. 2. Collect the eggs.
  3. 3. Secure the sperm.
  4. 4. Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
  5. 5. Transfer embryos into the uterus.​

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Step 1

Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman's cycles. This is often referred to as controlled ovarian hyperstimulation and involves using a number of protocols which would have been chosen for the patient. At BART the majority of our patients use the Short Protocol. The stimulating injections are usual given for a period of of 8 to 10days.  Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries, and blood test are done to check hormone levels. When 3 or more eggs are larger then 18mm, a tigger is given to induce ovulation (Medication: Ovidrel).


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Step 2

Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity. Sedation and local anaesthesia are provided to reduce and remove potential discomfort. The eggs are removed from the ovaries in a procedure called follicular aspiration or oocyte pickup. Some women may experience cramping on the day of retrieval, which usually subsides the following day; however, a feeling of fullness or pressure may continue for several days following the procedure.


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Step 3

Sperm, usually obtained by ejaculation is prepared for combining with the eggs.

Step 4

In a process called insemination, the sperm and eggs are placed next to each other in an incubator located in the laboratory. The incubators enable fertilization to occur.


In some cases where there is a lower probability of fertilization, Intracytoplasmic Sperm Injection  (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. At BART we prefer to do ICSI on most of our cases. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered to be embryos. The woman has to start using her drugs for luteal phase support from the day of the retrieval

Step 5

The embryos are usually transferred into the woman's uterus from three to five days later, but in most cases the transfer occurs between three to five days following egg retrieval. At this stage, the fertilized egg has developed into a six-to-eight cell embryo (for a Day 3 transfer) or a blastocyst (for a Day 5 transfer). The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos (generally between 2 - 3 embryos) are loaded into a catheter. This catheter is then inserted into the womb and the embryos are released. This process is often guided by ultrasound. The procedure is usually painless, but some women experience mild cramping. These steps are followed by rest and specific post embryo transfer medications for 12 days. That is Gestone, Cyclogest, Meticortin, Proganova, Ecotrin and Folic acid. 12 days after the embryo transfer, a pregnancy test is performed via a blood test.

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DAY 2

DAY 3

DAY 5

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Ovulation

Induction

Many women do not ovulate and therefore need medical treatment to stimulate ovulation. The main clinical symptom will be an irregular or absent periods.  The most common cause of this is Polycystic Ovary Syndrome (PCOS) 

Medications are given to stimulate the growth of eggs (oocytes). These include tablets containing clomiphene citrate eg. Clomid, Serophene, Fertimed, Clomihexal, aromatase inhibitors like Letrozole or fertility injections containing FSH (Follicle stimulating hormone) e.g. Gonal F, Pergonal, Menogon. The treatment is carefully monitored using both ultrasound scans and blood tests. The follicles containing eggs can be easily seen on ultrasound scan and the maturity and number of eggs is assessed during this scan.

When eggs are mature the doctor will give the days to time the intercourse.When ovulation induction is used for IUI you will receive a trigger injection and told when to come for the insemination, Ovulation is triggered by using an injection called HCG (Human Chorionic Gonadotrophin) e.g. Ovidrel, Profasi, Choragon. In PCOS high insulin levels in the blood inhibit ovulation, and recent research has shown that insulin sensitizing medications such as Metformin can be used to improve ovulation rates. These medications are usually used in the treatment of diabetes. Part of the standard investigations for PCOS now include a fasting blood test for glucose (sugar) and insulin levels. 

The most common side effects of Clomid tablets are headaches, and hot flushes. Multiple follicles may develop during clomiphene citrate treatment which can result in multiple pregnancies. One of the options that may be offered if too many follicles develop during treatment is to convert the timed intercourse cycle to IVF (in-vitro fertilitzation) to avoid multiple pregnancies.

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Intrauterine

insemination
(IUI)
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Artificial Insemination is usually combined with super-ovulation (stimulating multiple eggs to grow). This type of treatment is useful in cases where there is mild endometriosis, failure to ovulate, mild abnormalities in the semen analysis, sexual dysfunction (premature ejaculation of inability to ejaculate into the vagina), HIV discordant couples and unexplained infertility. Frozen thawed sperm can be used for artificial insemination when the male partner is away during the time of ovulation.

The treatment is started in the first 3 days of the period and medications are given to cause eggs to grow. These medications include tablets containing clomiphene citrate e.g. Clomid, Serophene, Fertimed, Clomihexal or fertility injections containing FSH (Follicle stimulating hormone) eg Gonal F, Pergonal, Menogon. These are all used to stimulate the growth of eggs (oocytes). The follicles containing eggs can be seen on ultrasound scan. Monitoring of the treatment cycles using blood tests and ultrasound scans is usually starting on day 8 – 9 of the cycle. IUI can also be done in Natural cycles without ovulation induction.

The procedure of artificial insemination is performed in the doctors’ rooms. This procedure is similar to a routine gynaecological examination for a PAP smear. A speculum is inserted to visualize the cervix and a tiny flexible plastic tube (catheter) is inserted into the uterine cavity in order to insert the prepared semen sample.

The semen sample is prepared by performing a sperm wash procedure and then a swim up procedure in order to optimize the fertility potential of the sperm. The semen sample should be dropped off at the IVF lab approximately 2 hours prior to the time of the insemination and no later then 1 hour after the semen is produced. Alternately the semen can be produced at the laboratory.

A pregnancy test can be performed 12 days after the procedure to check whether it has been successful.

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