IVF Treatment

Overview

IVF stands for in vitro fertilisation, which means fertilisation "in glass": eggs are taken from the ovaries and joined with sperm in a laboratory. A fertilised egg grows into an embryo over a few days, and a doctor places it in the uterus (the womb), where it may implant and become a pregnancy.

ICSI (intracytoplasmic sperm injection) is a variation. Instead of leaving each egg in a dish with many sperm, an embryologist (a scientist who works with eggs and embryos) injects a single sperm into each mature egg with a very fine needle. Doctors commonly use ICSI when the sperm count or movement is low, when sperm was taken surgically, or when eggs did not fertilise in an earlier cycle. The rest of the cycle is the same.

Fertility treatment is regulated more closely than most medicine, and the law changes from one country to the next. Before any clinic quotes for your case, MediCurage checks the rules of the country you prefer, so the options you compare are ones that are allowed there.

Who needs it

Doctors usually suggest IVF when simpler treatment is unlikely to work, or has already been tried without a pregnancy. Common reasons include:

• Blocked or damaged fallopian tubes, the tubes where egg and sperm normally meet.
• Male factor infertility: a low sperm count, poor movement or unusual shape.
• Endometriosis, where tissue similar to the womb lining grows outside the womb.
• Ovulation problems, such as polycystic ovary syndrome (PCOS), when tablets and simpler treatment have not worked.
• Reduced ovarian reserve, meaning fewer eggs remain, often linked to age.
• Unexplained infertility, when tests find no clear cause.

Age matters, because the number and quality of a woman's eggs fall over time, faster after the mid thirties. Your doctor should talk plainly about what IVF can offer in your situation.

Rules that differ by country

Settle these before you choose a destination:

• Who may be treated. Some countries treat only married couples and ask for the marriage certificate; others also treat single women. Some set age limits.
• Donor eggs and sperm. Allowed with conditions in some countries, not permitted at all in others.
• Freezing and storage. How long embryos may be stored, and whether they may be moved abroad, are set by local law.
• Sex selection for non-medical reasons is not offered through MediCurage in any country.
• Surrogacy. MediCurage does not arrange surrogacy in any country.

How it is done

Tests first

Typical tests before your medicines are planned:

• Blood tests for the woman, including AMH (anti-Müllerian hormone, which gives an idea of how many eggs remain), plus thyroid and prolactin levels.
• A transvaginal ultrasound to count the antral follicles (small fluid-filled sacs in the ovary, each holding an immature egg) and to check the shape of the womb.
• A semen analysis for the man.
• Screening of both partners for infections such as HIV and hepatitis B and C.
• Sometimes a hysteroscopy (a thin camera passed through the cervix to look inside the womb).

Many of these can be done at home and sent ahead.

Stimulation

Treatment usually starts on day 2 or 3 of your period. For about 8 to 14 days you give yourself daily hormone injections under the skin of the abdomen, after a nurse shows you how. The aim is to grow several follicles at once instead of the usual one, while a second medicine stops the eggs being released too early.

Every two or three days you have a scan, often with a blood test. When the follicles are ready you take a "trigger" injection, and egg collection is booked about 34 to 36 hours later.

Egg collection

Under sedation, the doctor passes a thin needle through the vaginal wall into each ovary, guided by ultrasound, and draws the fluid from each follicle. There is no cut on the skin. It takes 15 to 30 minutes, and you rest for a few hours before going back to your hotel. Cramping and light spotting are common. The same morning, the man gives a semen sample, or a frozen sample is thawed.

Fertilisation and embryo transfer

The eggs are fertilised by IVF or ICSI within hours, and the next morning the embryologist tells you how many fertilised. Embryos grow in an incubator for 3 to 5 days; by day 5 a healthy one is a blastocyst.

The transfer feels much like a smear test. A soft, thin tube is passed through the cervix, usually under ultrasound, and the embryo is released into the womb. No anaesthetic is needed and it takes a few minutes. Many doctors now advise transferring one embryo at a time, because twin pregnancies carry higher risks for mother and babies.

Frozen embryo transfers

Spare embryos are frozen by vitrification (very rapid freezing). Sometimes the doctor freezes every embryo and transfers one in a later month, for example when the ovaries have reacted strongly. The womb lining is then prepared with oestrogen and progesterone, often at home with local scans, so a second visit may be only a few days.

Recovery and how long you stay

Egg collection and embryo transfer are both day care procedures. You do not stay overnight in hospital.

For a full cycle with a fresh transfer, plan on 2 to 3 weeks near the clinic: the stimulation days, the collection, then 3 to 5 days until transfer. Some clinics let you start the injections at home with scans at a local clinic, which shortens the stay. Ask about this early.

Most women feel ready for normal activity the day after egg collection. The main risk is OHSS (ovarian hyperstimulation syndrome), where the ovaries over-respond to the hormones. Mild bloating is common and settles. Severe pain, breathlessness, vomiting or passing very little urine need a call to the clinic at once, which is one reason doctors like you to stay close by after collection.

Then comes the two-week wait. You take progesterone (as pessaries, gel or injections) to support the womb lining, and a blood pregnancy test is done about 9 to 14 days after transfer. You can have that test at a laboratory at home and send the result to the clinic. Doctors usually advise ordinary daily activity; bed rest is not needed.

Cycle dates move with your body's response, so MediCurage books flexible return flights where possible and a room close enough to the clinic for early morning scans; the clinic does all of the medical work.

Questions to ask your doctor

1. From our tests, do you suggest IVF or ICSI, and why?
2. Which stimulation plan will you use, and can I start the injections at home?
3. On which days do I need to be at the clinic in person?
4. How many embryos would you transfer, and on which day?
5. How long can spare embryos be stored here, and can they be moved to another country later?
6. What is my risk of OHSS, and what will you do to lower it?
7. Which medicines will I carry home, and do I need a letter for airport security?
8. If this cycle does not lead to a pregnancy, what would you change next time?
9. Whom do I contact during the two-week wait if I have bleeding or pain?

If one of you cannot travel for the first consultation, ask whether they can join by video call. Fertility treatment involves both partners, and most clinics want to meet you both at the start.