In Vitro Fertilisation

In Vitro Fertilisation (IVF/ICSI) is the process of retrieving eggs and sperm and manually fertilising them, in a laboratory dish outside the womb, by means of Intra Cytoplasmic Sperm Injection (ICSI). Healthy embryos are then transferred back into the uterus, with the goals of implantation and further embryo development. IVF/ICSI is performed by physicians who specialise in reproductive medicine and have received additional education and training in the evaluation and treatment of male factor and female factor infertility.

What is IVF?

IVF was originally developed in the early 1970s to treat infertility caused by blocked or damaged fallopian tubes. Louise Brown, born in the United Kingdom in 1978, was the first baby conceived with the help of IVF. She made headlines again in 2006, when she went on to naturally conceive a healthy baby of her own. The technology of IVF and advanced reproductive technologies has improved markedly since then, with over three million babies  born, with the help of IVF, since Brown’s birth.

What is ICSI?

Intra Cytoplasmic Sperm Injection (ICSI) is a cutting-edge technology used primarily for the treatment of severe cases of male factor infertility.

ICSI involves the injection of a single sperm directly into a mature egg.

IVF Steps

In order to maximise the patient’s chances for successful fertilisation, a patient undergoing IVF usually takes hormones, in the form of injections, to increase the number of eggs produced in a given month. Frequent monitoring is performed to continuously follow a woman’s ovarian response, enabling the physician to adjust and time medication dosage appropriately.

Under sedation, the reproductive specialist extracts mature eggs via ultrasound guidance. Egg retrieval is a minimally invasive procedure that normally takes about 40 minutes. Patients typically can resume normal activity the next day.

Embryologists use high-power microscopes and steady precision to fertilise the eggs with sperm in the embryology laboratory. At times, 100 000 sperms are released with each oocyte egg in the hope that one sperm will fertilise the egg. In most other cases, especially when there are less than one million living sperm, intracytoplasmic sperm injection (ICSI) is used where a single sperm is microinjected directly into the cytoplasm of the ovum. The fertilised oocyte is then cultured in the incubator for three to five days.

Day one

The oocytes are scored for proof that the sperm did its work inside the egg. Proof of fertilisation is expected 16 to 18 hours after the ICSI procedure. It is visible as the formation of two pronuclei inside the cytoplasm. 

The 2 pronuclei as can be seen in this picture is postive signs of fertilisation seen on Day one.

Day two

On day two, the fertilised oocyte is expected to develop into a two to four cell embryo.

The fertilised egg now starts to develop into a two to four cell embryo. The individual cells are called blastomeres.

Day three

The developing embryo is now at the six to eight cell stage.

Depending on the number of developing embryos, the embryo transfer can take place either on day three or on day five of embryo culture. This decision is made by the fertility expert gynaecologist.

Day four

Embryos are now at the monulae stage, with many cells developing.

Embryos are not scored on day four as they are very sensitive and best left untouched inside the incubator. The cells typically form a berry-shaped cluster of 16 or more cells.

Day five

In this picture, important structures indicating a good quality blastocyst can be seen as: compacted inner cell mass (top left); continuous cell lining inside embryo form a 'flower pattern'; blastocoel, which is the clear fluid-filled space inside the embryo (middle to right side); and a thinned outer membrane (zona pellucida).

On day five, the embryo is expected to reach the blastocyst stage. This is the final stage of development before the embryo implants into the uterine lining of the womb.

Day one

The 2 pronuclei as can be seen in this picture is postive signs of fertilisation as seen on Day one.

The oocytes are scored for proof that the sperm did its work inside the egg. Proof of fertilisation is expected 16 to 18 hours after the ICSI procedure. It is visible the formation of two pronuclei inside the cytoplasm.

Day two

The fertilised egg now starts to develop into a two to four cell embryo. The individual cells are called blastomeres.

On day two, the fertilised oocyte is expected to develop into a two to four cell embryo.

Day three

Depending on the number of developing embryos, the embryo transfer can take place either on day three or on day five of embryo culture. This decision is made by the fertility expert gynaecologist.

The developing embryo is now at the six to eight cell stage.

Day four

Embryos are not scored on day four as they are very sensitive and best left untouched inside the incubator. The cells typically form a berry-shaped cluster of 16 or more cells.

Embryos are now at the monulae stage, with many cells developing.

Day five

On day five, the embryo is expected to reach the blastocyst stage. This is the final stage of development before the embryo implants into the uterine lining of the womb.

In this picture, important structures indicating a good quality blastocyst can be seen as: compacted inner cell mass (top left); continuous cell lining inside embryo form a ‘flower pattern’; blastocoel, which is the clear fluid-filled space inside the embryo (middle to right side); and a thinned outer membrane (zona pellucida).

The embryo transfer procedure can be scheduled either on day three or day five of embryo development. The two most viable embryos are selected. Where necessary, laser assisted hatching is performed, to create a weak spot on the outer membrane of the embryo, to enhance implantation to the womb.

 

Illustration of laser assisted hatching.

A fertility specialist will transfer a maximum of two healthy and mature embryo(s) back into the uterus, with the goal of implantation in the uterine wall. This procedure usually does not involve any sedation. The physician will use ultrasound to guide a small catheter through the cervix and deposit the embryo(s) in the uterus. The embryo transfer procedure takes only a few minutes and recovery time is less than a day. It is advised that patients rest for at least 48 hours afterwards. The remaining viable embryos can be cryopreserved and used for subsequent transfer in the natural cycle. A pregnancy test is performed 14 days after the egg retrieval takes place, to evaluate whether implantation occurred successfully.

Explore more fertility treatments

Artificial Insemination (AI/IUI)

Artificial insemination brings healthier sperm closer to the egg by placing washed sperm directly inside the uterus.

Egg & Sperm Freezing

Egg and sperm freezing (cryopreservation) is the process of freezing for future use.

Embryo Freezing

Embryo freezing is when excess embryos are frozen and then stored at the laboratory for a later transfer during the natural cycle.

Every journey begins with a first step

Take the first step towards your future. Speak to a specialist or schedule a consultation today.

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Your IVF Fertility Journey

Scheduling a fertility consultation with one of our fertility expert gynaecologists:

  • Dr Richard Joubert 013 7457605
  • Dr Pieter Steyn 013 7552106
  • Dr Wilhelm Combrink 013 7457988
  • Dr Jean Nel 013 7458054

*Your fertility journey timescale might differ from the one described here.

  • 1

    The fertility specialist will do all necessary tests and evaluations on you as a couple in order to make a fertility treatment diagnosis.

  • 2

    To start the treatment program you will call the fertility specialists rooms on the first day of your next menstruation

  • 3

    You will see the fertility specialist on day 2 or day3 of your cycle for a sonar examination to determine the state of the ovaries and uterus before you start taking the medication. The specialist will explain how the stimmulation drugs are used henceforth on your own or with the help of your partner.

  • 4

    Your next appointment will be on day 8 or 9 of your cycle. Doctor will again do a sonar to see how your ovaries have responded to the stimmulation and he will start monitoring them in terms of count as well as diameter. You will also be send for bloodtests to correlate the hormonal value increase with the number of developing follicles on the ovaries.

  • 5

    Once the biggest follicle measures more than 20mm in diameter doctor will determine the day of aspirating the mature eggs and a trigger drug will be administered to mature the eggs.

  • 6

    In the mean time you will be referred to Surgiclinic Fertility to open your file and hospital admission. Your eggs will be harvested 36 hours after taking the trigger drug. This is usually scheduled for 9pm at night so we can do the harvest around 8am 36hours later. You need to be fasting from the previous night and report to Surgiclinic Private Hospital at 7am sharp to be ready for the aspiration procedure scheduled for 8am

  • 7

    The aneasthetist will give you consious sedation in order to not feel any pain or discomfort while the oocytes are harvested. This process is ecxatly the same as when doctor monitored your follicles in the rooms with the only difference that the aspiration needle is now attached to the sonar probe.

  • 8

    In the mean time your partner needs to be available on the day of aspiration to give a very much needed sperm sample. He is usually expected to have 3 to 5 days of sexual abstinance in order to give a good sample by means of masterbation. There is a special private faccility close to the IVF lab where he will find all that is needed to do his very important part in this procedure.

  • 9

    Once all the follicles are aspirated doctor will put a small armband around your wrist with the exact number of eggs retrieved written on it. You will be served some tea and toast once you wake up.

  • 10

    You should be ready to go home at around 10am. Try to rest at home and not to plan any other activities as you might not feel ready for that. There might be some lower abdominal discomfort as well as bleeding.

  • 11

    The embryologist will continue the preparation of both eggs and sperm sample to be able to do the fertilisation on the very same day the aspiration has taken place

  • 12

    Each morning the embryologist will evaluate the development of the eggs starting with fertilisation to embryo development. You will each day receive a Whatsapp picture to explain what they look like at that time.

  • 13

    The fertility specialist will decide when the embryo transfer will be, either day 3 or day 5 of development.

  • 14

    You and your partner will be expected to report to Surgiclinic Fertility an hour prior to embryo transfer.

  • 15

    Your partner will sit next to you while the embryos are transferred by sonar guidance. Doctor will give you a note then to do the pregnancy test, usually 14 days after the oocyte harvest took place. This is a bloodtest and all values above 25 are considered positive and repeated within 48hours to ensure an ongoing value

  • 16

    When your test is positive Doctors rooms will give you an appointment for the first scans at 7weeks pregnancy. Celebrate and rest a lot.