The first baby born as a result of in vitro fertilisation dates back to 1978. Since then, IVF has developed into a treatment accepted for infertility worldwide. It is estimated that five million IVF babies have been born.
In short, IVF is the process of fertilisation that takes place in a laboratory instead of in the fallopian tube. Laboratory techniques play a central role in the success of the fertilisation and embryo development. The body conditions are mimicked, as far as possible, with new scientific developments in the field every year to improve these conditions.
In contrast to popular belief, the fertilisation process itself in IVF is not artificial or ‘conducted via man’. IVF is only the process of bringing the sperm and eggs together. The process must then take its physiological and biological course.
The process for IVF is in fact the same process you would go through for ICSI. The only differences between these two processes is the manner in which the eggs are fertilized, and this difference occurs in the laboratory.
On the day
You will be admitted into the day ward at Wijnland Fertility. The aspiration procedure is very short and makes use of anaesthesia sedation, which means that you need to be prepared prior to the day of the procedure (no eating after midnight). The aspiration procedure is so short (generally), that the process of the anaesthetist putting you ‘to sleep’ takes longer than the actual egg retrieval. Once your procedure is finished, you will be wheeled out of theatre and be placed back into your warm recovery bed where you will be woken up with some tea or coffee and a scone. Thereafter, an embryologist will let you know how many eggs where retrieved. This information is only given to you once you have fully woken up from your drowsy sleep and are relaxed and ready to receive the much awaited information.
Following the egg retrieval
The eggs will be evaluated the next day to see how many have been fertilised (Day 1).
We will call you to inform you of the results. Fertilised eggs are now known as zygotes and can start to develop into embryos.
Not all fertilised eggs develop into embryos, but most do. The quality of the embryo development will be evaluated by a scientific grading system, which will guide us to select the embryos with the greatest implantation potential to place into the uterus. The embryologist will inform you of embryo development.
The Embryo Transfer The embryo transfer procedure will be done on Day 5 (in standard cost option Day 3), depending mainly on how many good-quality embryos have developed. Our clinic’s protocol is to transfer only one embryo per cycle. In exceptional cases, two embryos may be transferred at the discretion of the treating doctor and attending embryologist. It will depend largely on the quality of the embryos. If any surplus high-quality blastocysts remain in culture after the transfer, they can either be frozen and stored for future use, or donated or discarded.
Please talk to the doctor and/or embryologist about the freezing, discarding or donation of surplus embryos before starting fertility treatment to ensure you and your partner have enough time to think about these options and make a well-informed decision. The nursing sister or embryologist will call you to inform you when the transfer procedure is going to take place.
You will be given information about preparing for the transfer procedure. This will also include having a full bladder. You will be conscious, and your husband/partner can be with you in the procedure room. Your uterus will be visualised by doing a trans-abdominal scan and the doctor will use a speculum to visualise the cervix. The embryos will be drawn into a thin catheter and will be placed into the uterus.
The embryos will be released slowly into the uterus – you and your partner will be able to see this on the ultrasound screen! Your bladder will then be emptied by the doctor with the use of a catheter. You may lie down and rest for a short while after the transfer. If you have any surplus embryos in the laboratory, the embryologist will talk to you about your decision and/or instructions on the handling of your surplus embryos. The embryologist will give you the applicable consent forms to be signed by you.
You will also receive forms showing a summary of the number of eggs retrieved, the number fertilised, how many embryos were transferred, how many were left in culture and when pregnancy tests can be done. You can then go home and continue with your daily activities. We advise you to take it easy on the day of the transfer. You may drive a car if needed. The embryologist will phone you a few days after the transfer to give you feedback on the further development and/or freezing of your surplus embryos, where applicable.
EmbryoScope™ is the world’s most used time-lapse system for observation of embryo development, while maintaining stable embryo culture conditions. It has been used in more than 300.000 patient treatments since 2009.
In standard IVF, the embryos are removed from the incubator every second day so embryologists can make sure they’re growing as they should be. The EmbryoScope™ is an IVF incubator with a built-in camera for automated imaging of the oocytes in a closed incubation environment from fertilization until the time of the embryo transfer.
It is a system that is an incubator, a microscope with an integrated camera and advanced software at the same time. The EmbryoScope™ time-lapse system provides superior image quality, thereby allowing the embryologist to visually follow the development of the embryos. In this way, the embryologist can distinguish and choose between normal developing embryos with good implantation potential and development patterns with a risk of implantation failure.
Does my bladder have to be full for the scan?
No. Please empty your bladder every time that you come for a scan during your stimulation treatment, before you see the doctor.
Will I be experiencing any side effects from my medication?
This varies from patient to patient. If you do have any side effects, they will only last for a few days. Weight gain is only fluid retention due to the medication.
How do I dispose of the sharps items (glass, needles)?
Please separate the sharp items (sharps) from the plastic and paper and put them in a small plastic container. All plastic and paper (needle caps, syringes and used alcohol swabs) can be disposed of in your normal waste at home. You can empty the plastic container with the sharps in our special sharps containers when you come in for your scans.
May I carry on with exercise?
Yes, but only do mild exercise (e.g. walking). No strenuous exercise please.
What food/drinks should I avoid while having IVF stimulation?
Please avoid caffeine and alcohol. You may drink 1 to 2 cups of normal coffee per day; thereafter please rather drink decaf coffee or rooibos tea. Try to follow a healthy, balanced diet.
Are we allowed to have intercourse while on the programme and when do we have to abstain? You may have intercourse during the cycle. Please abstain for two days before the follicle aspiration. Please have intercourse on the night of the trigger injection (Ovitrelle/Lucrin) so that we can get new, fresh sperm on the day of the aspiration. Please abstain from intercourse for another 10 days after the day of the aspiration.
How long does the procedure take?
The follicle aspiration takes about 15 minutes in the procedure room and you will need to recover for approximately one and a half hours. You will get sedation for this procedure. The embryo transfer takes about 10 minutes in the procedure room and 30 minutes in recovery. No sedation necessary.
Is the follicle aspiration procedure painful?
You will not be aware of any pain or discomfort while the procedure is being performed. You can expect a menstruation-like pain after the procedure. You may take 2 Pando’s (Paracetamol) every 6 hours for any discomfort. You may also use a warm water bottle.
Is the embryo transfer painful?
It is not painful, but may be a little uncomfortable because your bladder needs to be very full for the transfer. This enables us to visualise the uterus better and helps to push down the uterus to enable unobstructed and easy access for the embryo transfer catheter. The doctor will empty your bladder straight after the embryo transfer has been done. You will be comfortable when you go back to your bed in the recovery room.
Am I allowed to drive after the procedure?
If you are having a follicle aspiration, you may not drive for 24 hours after the sedation. You may drive after an embryo transfer (no sedation).
When does the embryo transfer happen?
The embryo will normally be transferred back five days after the follicle aspiration.
How many embryos do you put back?
Our clinic`s policy is to only transfer one good embryo at a time. By putting back more than one embryo, you will not increase your chances of a pregnancy. You will only increase your chances of a multiple pregnancy, which result in high-risk pregnancies (for you as well as for the babies). We aim to give you one healthy baby and one healthy pregnancy at a time.
Can my embryos fall out?
No. The embryo is placed in the uterus and can`t fall out. Bowel movements will not affect the embryo.
What happens to our excess embryos?
All embryos that are of good quality and that are expected to survive the freezing process will be frozen. You will need to complete a consent form in this regard. Additional fees apply to embryo freezing and storage.
When can I go for a pregnancy test?
You can go for a pregnancy blood test seven days after the embryo transfer (if a Day 5 embryo was transferred). The IVF co-ordinator will provide you with laboratory forms and dates that you can go for the blood test. The results will be sent to us and we will phone you as soon as we have received them from the pathology lab. It can take four to five hours to receive the results. If the first test is positive, you’ll need to repeat it 48 to 72 hours later to make sure that the blood count goes up adequately. You also need to continue with your progesterone (Crinone, Gestone, Prontogest) until the end of your 8th week of pregnancy. If the first test result is negative, you do not have to go for the second test.
When can I come for my first scan if I am pregnant?
The first scan can be done at the end of your 6th or beginning of your 7th week of pregnancy (calculated from the first day of your last menstruation).
When is my Day 1?
Day 1 is the first day of your menstruation (full flow of red blood). If it only happens very late in the afternoon or at night, Day 1 will be the next day. Spotting or a brownish discharge is not considered as Day 1.
Who would I need to contact on Day 1?
Please contact one of the IVF co-ordinators at the fertility clinic on Day 1 to arrange an appointment for your scan on Day 3. The IVF co-ordinator needs to prepare your file for your scan, so please do not make an appointment directly with reception before speaking to an IVF co-ordinator. If Day 1 starts on a weekend, please phone on Monday morning at 8h00 to arrange a time for your scan. Please be prepared to still come in on the morning of Day 3.
What happens on Day 2?
Please go for your hormone blood tests on the morning of Day 2. The IVF co-ordinator will provide you with a laboratory form with all the necessary tests ticked off. The results will automatically be sent to your doctor so that they can interpret them on Day 3 while you are at the clinic for your scan.
Why do I need a scan on Day 3?
The doctor will perform a vaginal scan to check that there are no irregularities in the lining of your uterus (endometrium) and to make sure that there are no ovarian cysts. The doctor will also count how many follicles (Antral Follicles) there are that might respond to the stimulation medication. The doctor will then decide on your stimulation protocol. One of the IVF co-ordinators will explain your medication to you and give you your personalised plan to take home.