Guest blog by Kristen Jones, an APACE accredited Embryologist and Founder of “I Like My Eggs Fertilised“.
Trying to conceive can be a very stressful journey, especially when things are just not working out or you receive bad news about your diagnoses. Multiple fertility treatments are available such as ovulation induction, intrauterine insemination and hormonal tracking, and these are usually the treatments of choice for people who are starting treatment for the first time. Unfortunately there are patients that will not have success with these treatments or have been told they need to go straight to IVF/ICSI. These may include patients that:
- Have male factor infertility (poor count, morphology or motility)
- Are using sperm with a limited supply such as frozen pre-chemotherapy or pre-hormone therapy
- Are using surgically retrieved sperm
- Have endometriosis or blockages
- Have had multiple miscarriages
- Have uterine abnormalities such as fibroids, malformations
- Are needing to have genetic testing of embryos
IVF/ICSI is the most advanced fertility treatment (aside genetically tested embryos). It involves stimulating your ovaries to mature multiple eggs, collecting them through an egg collection procedure and inseminating them with sperm in the lab. These will hopefully fertilize and grow into an embryo(s) which can be inserted into the uterus in the hopes of implanting and creating a pregnancy, or they may be frozen and stored for future use. Even though an embryo is being placed directly in the uterus, unfortunately a pregnancy is not guaranteed; although, it gives you the best chance of success if you are unable to get pregnant with other methods.
The general steps in an IVF cycle are:
STIMULATION AND MONITORING
During this phase you will take several different medications/injections to stimulate your ovaries to mature multiple follicles, while suppressing ovulation as well. Regular blood tests will check your levels of estrogen, luteinizing hormone and progesterone and regular ultrasound monitoring will track follicle growth. Different labs have different ways of achieving this; some labs may do more blood testing and others more ultrasound monitoring.
As your follicle growth and estrogen levels start to peak you will be given a specific time to take a trigger injection. This is timed to be approximately 36 hours before egg collection.
EGG COLLECTION AND INSEMINATION
The egg collection is a procedure in which you are admitted to the clinic and sedated. The doctor will insert an internal ultrasound to visualize the ovaries, and this has a needle along side it. The needle is guided through the wall of the vagina and into the ovaries where the fluid is taken out and given to the Embryologist. The Embryologist checks the fluid under the microscope and transfers the eggs into special dishes which have been made just for you. Approximately 4-6 hours later, the eggs need to be inseminated with sperm, and this is with either IVF or ICSI.
With IVF, a measured concentration of washed sperm is placed with the eggs. This is the more natural, less invasive way, as the eggs are not manipulated. Your doctor may be happy for you to have IVF done if:
- You have had natural pregnancies before
- You have good sperm quality
- You have not had poor or failed fertilization in the past
ICSI stands for Intracytoplasmic Sperm Injection and is a process in which the mature eggs are injected with a single sperm. Your doctor may suggest ICSI if you fit into some specific criteria such as:
- History of poor fertilization
- Very poor sperm count, morphology or motility
- High DNA fragmentation
- You are having genetic testing done on the embryos (Some labs are now able to test on IVF embryos, but not all)
The day following your egg collection and IVF/ICSI is Day 1, and it is time for fertilization check. The embryos are observed to see whether 2 pronuclei are visible – a nucleus from the sperm and one from the egg. This is successful fertilization.
A very general embryo development range we like to see (different labs slightly vary and will differ as to when you get checks or updates)
- Day 2: 2-6 cells
- Day 3: 6-10 cells
- Day 4: compacting to cavitating
- Day 5: early blastocyst to expanding blastocyst
- Day 6: fully expanded, or hatching, hatched
It’s important to know that not all embryos are expected to be suitable for transfer or freeze. Embryos are usually graded on quality to allow embryologists to choose the best ones for transfer or freeze, but not all labs give this information to patients.
The embryo transfer is a procedure similar to a Pap smear or an IUI if you’ve had one of those. You lay down and a speculum is inserted to visualize the cervix. The Embryologist brings in the catheter loaded with the embryo, which is then placed through the cervix and gently displaced into the uterus. It is mostly a quick and comfortable procedure, although some patients do report some discomfort.
THE TWO WEEK WAIT (TWW)
The TWW ends on day 14 after your egg collection (or ovulation if you have a frozen embryo cycle), so if you had a day 3 embryo put in you will wait 11 days for your test, and if you had a day 5 embryo put in you will wait 9 days, although some labs do have different timing for this. This is the time in which the embryo should be further developing and hatching out, and hopefully implanting into the endometrium (commonly from 7-10 days after ovulation/egg collection). Unfortunately, the side effects of progesterone do mimic pregnancy symptoms so it can be a stressful time of symptom spotting and impatiently waiting. When the time is up you will find out if you are pregnant or not through either a beta blood test or your clinic may have you perform a urine test before getting a blood test. It can be a roller coaster for sure; so much time, effort, money and emotion have gone into getting this far. You may find out you are pregnant, or you may find out your cycle was unsuccessful. Either way, looking after yourself the best you can, can be helpful to get you through this stressful time.
Kristen is an APACE accredited Embryologist with a Masters degree in Reproductive Medicine. After going through her own struggles to conceive she founded I Like My Eggs Fertilised to help educate about all things fertility to help make the experience more positive and less stressful.