FERTILITY CLINIC MANCHESTER

It is important to understand that IVF is a complex process of up to 7 weeks from start to finish. It may take longer to know whether it is successful. The more prepared you are going in, the better you can cope with the demands of the treatment. During your initial consultation for IVF in Manchester, our expert team of fertility specialists would be more than happy to answer any questions you may have.

INITIAL ASSESSMENT

An initial assessment includes a full interview and examination of the female and/or male partner. Blood tests like Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), Oestradiol, Anti-Mullerian Hormone and blood count are performed to establish the woman’s hormone profile. Couples undergo a virology screen for HIV, hepatitis B, hepatitis C and syphilis. The male partner’s sperm sample is assessed for count, movement, proportion of normal forms of sperm and presence of antibodies. Urine is obtained from both partners to exclude genital tract infections.

COUNSELLING

Counselling is not mandatory, but can be of immense help in preparing yourself with some of the difficulties you may encounter. We would encourage you to take advantage of our on-site counselling services.

OVARIAN STIMULATION

The mainstay of IVF is controlled stimulation of the ovaries to generate growth of many eggs. Two different types of injections are used, which are typically started at the early and late stages in the menstrual cycle. Pelvic ultrasound scans and blood tests are used to monitor the response to stimulation. This continues until the eggs are mature enough to be collected.

EGG COLLECTION

Mature eggs are collected from the ovaries in theatre usually under sedation but sometimes under full general anaesthesia. Usually, this is done by gently guiding a needle into the ovaries through the vagina under ultrasound control. On occasion, the eggs are collected by laparoscopy (keyhole surgery). Women typically spend half the day in hospital and are able to return home about lunchtime that day. We usually commence a five-day course of antibiotics from the egg collection.

MIXING EGGS WITH SPERM

The male partner produces a semen sample on the day of egg collection after two to four day abstinence from ejaculation, to ensure good-quality sperm. Tests determine the highest quality semen, which is inseminated into the eggs, which is left overnight in an incubator. The inseminated eggs are checked the next morning to see how many have been fertilised.

EMBRYO TRANSFER

The embryos are cultured in a special lab incubator and one or two of the best quality embryos are transferred into the womb two to five days later. The procedure does not usually require any anaesthetic or sedation. We discuss and agree the number of embryos to be transferred beforehand but generally encourage most women to have single embryo transfer. Any good quality embryos that have not been utilised can be frozen for the couple’s future use.

AFTERCARE

We advise women to continue with their normal schedule following embryo transfer. Hormone pessaries are given afterwards to help the developing embryos. If treatment is unsuccessful, a period will begin one to two weeks after the transfer. Women who have not had a period by this time are offered a pregnancy test and if positive, a pelvic examination follows.

Three out of four women will complete the treatment without any difficulties or problems. Common problems encountered include:

Poor response to stimulation – although the ovarian reserve test gives us an indication of how you will likely react to treatment, we sometimes encounter poor stimulation response. There is the option to use a higher dose of stimulation drugs in a subsequent cycle.

Excessive response to stimulation – this can result in a condition called ‘ovarian hyperstimulation syndrome’ that affects one in ten women. It can cause abdominal pain and bloating, vomiting, shortness of breath and fatigue. Severe cases may require hospitalisation or even become life-threatening, but this is fortunately very rare.

Injuries during egg recovery – the needle used for the egg recovery may cause injury to the organs in the pelvis (such as the bladder, intestines, and blood vessels) but this is rare.

Pelvic infections – there is a small risk of infection following the egg collection and severe cases may result in pelvic pus collection. We prescribe antibiotics after egg collection as a preventative measure.

Multiple pregnancies – there is a risk of multiple pregnancies, particularly with replacement of more than one embryo, which is why we encourage women to have single embryo replacement.

Abnormalities in babies – babies born following IVF treatment have slightly greater risks of structural and genetic/chromosomal abnormalities.

Donated Sperm, Eggs and Embryos

IVF can be undertaken with donated sperm and eggs, also called gametes. The HFEA has strict regulations governing treatment with donated gametes and these will be discussed with any couple to whom they apply. Some women cannot produce their own eggs due to premature menopause, so need donated eggs or embryos. Women with abnormal eggs and those with a genetic abnormality can also use donated eggs or embryos. Men who cannot produce their own sperm can utilise donated sperm.

Any healthy man, woman or couple that is free of genetic or transmittable diseases can potentially donate their gametes after undergoing a screening process. Factors considered include detailed examination, blood tests for chromosomes and infections like HIV, hepatitis B, hepatitis C, syphilis and cytomegalovirus, and cervical swabs.

Egg Sharing

Egg sharing is a special form of egg donation, whereby two women undergo IVF treatment simultaneously. The recipient effectively pays for the treatment, and eggs are retrieved from another donor which have a better chance of becoming embryos. All previously described processes remain the same.

Ethical Issues with Gamete Donation

There are implications of using donated gametes that all involved parties need to be aware of:

Payment of donors – this is a contentious issue and the legislation concerning it varies from country to country. The current UK legislation holds that sperm, egg and embryo donation should be performed altruistically and not attract any form of payment, except where this is to cover loss of income or reasonable expenses incurred by the donor in the process of the donation.

Egg sharing – couples contemplating egg sharing should agree on all aspects of the treatment thoroughly beforehand and agree a plan of how the eggs are shared and how any future problems are dealt with. These include success in one but not the other couple.

Anonymity – legislation in the UK has recently changed to give offspring of sperm, egg and embryo donation cycles the right to find out the identity of their genetic parents once they reach their eighteenth birthday.

Legal parents – current legislation in the UK holds that a married man and woman receiving treatment are the legal parents of any child that results. For unmarried couples, both partners are not automatically awarded legal parent status and have to apply for this at the time of consenting to treatment or through the courts.

Informing the child – most clinics recognise that children have the right to know about their conception and some arrange a yearly reunion for children born from this and other forms of assisted conception methods to reinforce the normality of such children. Counselling is available at all licensed clinics to discuss the implications of using donated gametes.

Couples with frozen embryos can have these transferred without the need to undergo another stimulation cycle. Frozen embryos have a 60-90% chance of surviving freezing. The embryos can be transferred in natural or hormone-prepared cycles. Natural cycles are suitable for women with regular ovulation while those with irregular periods need preparation of the womb using hormone tablets, pessaries (vaginal tablets) and injections. The artificial hormones used to prepare the womb will need to be continued for some time after the transfer; generally up to 12 weeks if pregnancy ensues. Details of transfer procedures, number of embryos transferred and what happens afterwards will be discussed fully with couples.

In vitro fertilisation has made it possible for many couples to fulfil their dreams of having children, although treatment is not always successful. Factors that improve the chances of success include: young female age (particularly under thirty), previous pregnancies, and short duration of infertility. Success is measured professionally by pregnancy and life-birth rates and current average rates in the UK are detailed in the table below.

Table 1. Live birth rates for assisted conception cycles in the UK; HFEA published results 2014.