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.
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.
Fertility Cost
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