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In Vitro Fertilisation (IVF) - treatment

The Private Healthcare UK guide to infertility treatment contains articles on infertility and IVF treatment which are aimed at improving your knowledge of treatments for infertility, their benefits and potential risks. 


In this section

Starting the treatment

The nasal spray or daily subcutaneous injections often start on day 21 of your preceding menstrual cycle although occasionally a day 2 start is recommended.


After you've been taking the nasal spray/injections for approximately 14 – 21 days, an ultrasound scan will be performed.  This is usually performed trans-vaginally with a thin ultrasound probe passed into the vagina.  This method is quick and painless providing a clear picture and is preferred by most women, as a full bladder is not required.  Two to four scans are usually performed prior to the egg collection.  The first scan checks that the uterus and ovaries look normal before stimulation starts.  A blood test to measure Oestradiol is sometimes taken on the same day. If the scan is normal and the Oestradiol level is low, HMG or FSH can commence.


Occasionally the scan shows a thick womb lining and/or a small cystic area on the ovary.  This happens in about 5% of cases and usually means that the Oestradiol level is not low enough to start stimulation.  Although a nuisance, the starting day for your injections will be delayed, the Oestradiol level usually falls after a further week's course of nasal spray.  The blood test and scan will then be repeated and injections can usually start at this stage.


Starting stimulation

In most cases HMG or FSH injections can commence after the initial/baseline scan and are given on a daily basis.  A nurse will show you or your partner how to give these injections.  Alternatively you may be able to make arrangements with your local GP or practice nurse to administer these.


A week later you will need a scan and two days later (after 10 days of injections) you might need another blood sample and scan after which you will be given further instructions regarding scans and injections.


When your follicles are large enough, you will have 10,000 IU HCG (Pregnyl). It is important that this injection is given 35-36 hours before your operation.  This will usually mean having it between 9pm and 12 midnight 2 days before the operation.  You will be advised of the exact time by the nurse. Injections can be given at the hospital or you may like to make arrangements to have it done locally.


Reasons for cancelling a treatment cycle

  • If, after being on HMG or FSH for several days there is little or no follicular development, you may be advised to abandon the cycle.  Future management can be discussed either at that time or at a follow up consultation.  The usual recommendation would be to use a higher dose of HMG or FSH on another occasion, or a shorter nasal spray regime

  • If you produce too many follicles, you will see a Consultant to discuss the effects of hyperstimulation and future management would then be decided.


Egg Collection

You should have nothing to eat or drink for at least six hours before the egg collection if you choose a general anaesthetic or sedation.  If you choose sedation, you should have a glass of water on awakening. You will be awake during the procedure and sedation is commonly administered through the vagina.  You are likely to feel a few twinges but should not be in pain.  The procedure takes approximately 30 minutes.


A scan probe has a fine needle attached to it which is passed into the ovary and the fluid from each follicle is aspirated.  Clinics usually expect to obtain an egg from about 80% of follicles.  Therefore the number of follicles seen on scanning does not always correspond to the number of eggs present.  On very rare occasions (usually when the ovarian response has been poor) no eggs are collected.


If your partner's sperm is being used to fertilise the eggs, he will need to produce a sample the morning of the egg collection. It is advisable to have three days sexual abstinence prior to the egg collection.   The sample should be produced at the centre during or just after the egg collection.


After the egg collection you may feel drowsy for the rest of the day.  You should be ready to go home two hours after sedation and four hours after a general anesthetic.   However it is important to have somebody to accompany you.  You should not drive a car for 24 hours. 


After the egg collection

It is common to feel some lower abdominal discomfort, for which you may take paracetamol tablets, two four hourly, maximum 8 in 24 hours.  The discomfort and bloating may last for a couple of days.  If you feel sick, avoid eating substantial meals and drink fluids only for the rest of the day.


A small amount of vaginal bleeding is normal.  It is best to use sanitary towels.


You will be asked to use hormone suppositories (Cyclogest 400 mg twice daily) or injections to support the hormone level in the second half of the cycle.  You should start these on the day of the egg collection and continue for 15 days. If you conceive the consultant will advise you to continue this hormone suppositories until 2 to 3 months of pregnancy.


The embryo transfer:

The procedure itself is simple and usually pain free.  After replacement, it is customary to rest for a short while.  The patient is commonly given hormonal support until the result of a pregnancy test is known some two weeks later. The day after the egg collection you should ring the clinic to find out if your eggs have fertilised. Unfortunately not all eggs will fertilise and once fertilised, not all embryos will be of similar quality. Two embryos will be selected for transfer.


Embryos are usually replaced two to three days after egg collection. Fourteen days after the embryo transfer a pregnancy test should be performed.  This can be done on an early morning urine sample at home or brought into the clinic or on a blood sample.  Very occasionally however, you may experience period like cramps with no bleeding. A pregnancy test will give you an accurate answer.


It is important to realise that the drugs given after embryo transfer may delay your period, even if you are not pregnant, in which case only a pregnancy test will tell you one way or the other.  These are hormones for support and do not make you pregnant on their own. 


In this guide

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