Assisted Conception Unit

IVF involves removing eggs from the woman’s ovaries and fertilising them with sperm in a laboratory. One cycle of IVF takes between four to six weeks to complete, and you will need to take fertility drugs to stimulate your ovaries. During your normal menstrual cycle you release one egg per month. By using fertility drugs to release more eggs, you increase your chance of pregnancy. Eggs are collected under ultrasound guidance, in theatre under either general anaesthetic or sedation (your choice). The eggs are then fertilised in the laboratory. The fertilised eggs are balls of cells called embryos. The number of embryos that are transferred will depend on your age and chance of success. If there are extra embryos they may be suitable to be frozen for future use.  You will take a pregnancy test two weeks after egg collection, and your first pregnancy scan will be two weeks later.

Success rates are very much dependant on the age of the woman. Whilst none of us can make ourselves any younger you can improve your chances of success by being a healthy weight before treatment, keeping your alcohol consumption to no more than one unit of alcohol per day and stopping smoking (this includes your partner).

The final step of the IVF process is the embryo transfer; first one of our embryologists checks the embryos to select the healthiest one(s). A speculum (as used in smear tests) is gently placed in the vagina and a small soft plastic tube placed through the cervix into the uterus (there is a cartoon of how IVF works on YouTube).

Intra uterine insemination (IUI) is a fertility treatment that involves directly inserting the sperm into the uterus. It can be performed by using the partner’s sperm or using donor sperm. Couples may decide to use donor sperm if the male partner is not producing any sperm at all or if there is a risk of passing on infection or a genetic condition. Donor insemination allows us to treat single women and same sex couples. It is not always necessary to take fertility drugs to undergo IUI/DI treatment, however fertility drugs are recommended if there are problems with ovulation.

Funding

There are two types of funding available to you: either NHS funding or self-funding.

NHS-funded treatment

The clinical commissioning group (CCG) where your GP is based is responsible for your NHS healthcare costs. Each CCG receives limited funds from central government, which means that each CCG has to set its own priorities.

Some CCGs do fund IVF, but usually to a limited extent. Others do not fund IVF at all. The CCGs set their own criteria for treatment to which Beginnings must adhere. If you live within the Merton, Sutton and Wandsworth area and are registered with a GP, you may be eligible for NHS-funded treatment, provided you meet their eligibility criteria.

Self-funded treatment

You may wish to fund your own treatment if you are not eligible for NHS funding.

We describe the treatment as ‘self-funded’ rather than ‘private’ because the treatment is exactly the same as for patients funded by the NHS. The charges we make are non-profit-making, ie they are at cost price. All income from self-funded patients is put back into the IVF programme.

You can see a full list of our prices for IVF and IUI here: F4a St Helier IVF prices 20-21[pdf] 84KB .

The Human Fertilisation and Embryology Authority 

The Human Fertilisation and Embryology Authority (HFEA) provide clear and impartial information to all affected by fertility treatment.  They are the UK government independent regulator overseeing fertility treatment and research.

HFEA website: www.hfea.gov.uk.

Step 1: egg collection

After a course of Buserelin (a hormone regulator), you will have your first ultrasound scan. If the ovaries show signs of continuing activity, you will be asked to continue the Buserelin for a further week. However, if the scan shows the ovaries to be inactive, you will begin the course of Follicle Stimulating Hormone (FSH) injections.

The FSH injections should cause follicles to grow in the ovaries. A follicle is a little sac of fluid in which an egg develops. In a normal cycle, only one egg is produced, but in an In Vitro Fertilisation (IVF) cycle, we want to obtain a number of eggs in order to increase the chance of pregnancy at the end of your treatment.

A second and third scan are performed on the tenth and twelfth days of treatment with FSH. When the follicles are large enough you can stop the FSH and will be asked to have a human chorionic gonadotropin (HCG) injection (a hormone that supports the normal development of an egg) to prepare the eggs for collection and fertilisation 32-39 hours later.

Before the egg collection, you decide with your doctor whether you opt for a general anaesthetic or if you would prefer sedation only. Egg collection is performed using a needle guided by a vaginal ultrasound probe which punctures and drains all the follicles.

The follicular fluid containing the eggs will be placed in sterile test-tubes, which in turn will be placed into a transport incubator. The incubator keeps the eggs at body temperature while they are taken to the embryology lab. 

Step 2: In Vitro Fertilisation

On the morning of your egg collection, your partner will be asked to produce a sperm sample in the IVF unit. The embryologist will examine the follicular fluid under a microscope to detect the eggs. Each egg is surrounded by approximately 100,000 healthy sperm, and fertilisation should occur 12-18 hours later.

An embryologist will call you to let you know if fertilisation has occurred. If it has, you will be given an appointment for embryo transfer, usually two days later. If fertilisation has not occurred, an appointment will be made for you at St Helier Hospital to discuss the situation.

Step 3: embryo transfer

You will be told about your embryos and given a picture. One, two (or very rarely three) embryos are transferred into the uterus via a catheter. The procedure should only take a few minutes and is usually quick and painless.

Two weeks after egg collection you will have a blood test to determine whether the treatment has been successful. The result will be phoned through to you. If the result is positive, we will arrange a vaginal scan three weeks later in order to confirm that all is well with the pregnancy. In the unfortunate case that the result is negative, one of the fertility nurses at St Helier Hospital will make an appointment for you to see one of our consultants to discuss your treatment cycle with you.

At any time, whether before, during or after your treatment, we will do our best to help you with any problems or questions you may have. If there is a particular member of staff you feel able to talk to, you are welcome to approach them directly. Alternatively, if you would prefer to speak to a specially trained independent counsellor, we can arrange this for you.

The following information is intended as an introduction to these processes.

Initial medication and first scans

Depending on the regularity of your menstrual cycle, you will be prescribed Clomiphene or Tamoxifen to stimulate the ovaries. Some women may also require injection of a follicle stimulation hormone. Your response will be monitored by ultrasound and a blood test to ensure that ovulation has occurred.

Human chorionic gonadotropin (HCG) injection

When the scan shows one or two follicles greater than 17mm in diameter, you will be ready to have the HCG injection to help ripen the eggs.

Timed intercourse and Intra-Uterine Insemination (IUI)

Although intercourse throughout the cycle will not interfere with your treatment, it is recommended that you have a period of abstinence for 2-3 days prior to the IUI.

At your final scan, you will be advised when the IUI will take place, which is generally two days later. On the day of your IUI appointment, your partner will need to provide a sperm sample, which is then prepared for the IUI over 2-3 hours. The IUI takes place in the IVF unit and involves having an internal examination with a speculum (similar to having a cervical smear).

The prepared sperm is then slowly injected into the womb through a fine plastic catheter, which can feel a little uncomfortable. You are asked to remain lying down for ten minutes after the procedure, but can then get up and continue with normal daily activities.

Pregnancy test

Following the IUI you are asked to do a home pregnancy test about 16 days after you had the HCG injection. If positive, we will book you an early pregnancy scan for 2-3 weeks later.

A negative result means that the cycle has not worked, but you can start your next cycle again as already arranged. If you complete all the cycles recommended by the unit, then an appointment will be arranged with the doctor so that your treatment can be reviewed and future plans discussed.

Unfortunately female fertility declines with age. If you have elected, for whatever reason to postpone child bearing, storing your own eggs may be one option you wish to consider. Women at risk of premature ovarian failure or permanent sterility sometimes as a result of chemotherapy or radiotherapy may elect to freeze eggs.

In the event of an IVF cycle where no sperm were to be available on the day of egg collection, emergency freezing would be one option. Before being able to freeze eggs it is important that you have seen one of our consultant specialists and an independent counsellor to discuss the implications of egg freezing.

At the current time the maximum storage period for eggs is ten years, but in certain exceptional circumstances such as cancer treatment or premature ovarian failure the duration can be extended up to age 55.

To increase the chance of success, and to make management of the treatment cycle easier both for you and the medical team, we use a combination of drugs at St Helier Hospital's assisted conception unit:

• GnRH analogues eg Buserelin - suppresses the female hormones by acting on the pituitary gland. It works by ‘switching off’ the ovaries and allowing the medics control over the menstrual cycle.
• GnRH antagonists eg Cetrorelix - this works by acting on the pituitary gland to prevent early release of eggs.
• Follicle stimulation hormone (FSH) - stimulates the production of a number of eggs in the ovaries.
• Human chorionic gonadotrophin (hCG) or luteinising hormone (LH) - ripens the eggs so that they are capable of being fertilised.

Other medication, such as Clomiphene and Tamoxifen may be used in ovulation induction and sometimes in Intra-uterine insemination (IUI).

Your GP may be willing to give you the injections, but the most convenient arrangement is for either your partner, or a relative, or a friend to do it for you. Our assisted conception nurses are happy to show you how to administer the injections, and we can also supply you with the needles and syringes, as well as a special container for the disposal of used needles.   

Please note that these drugs are not included in the cost of the IVF treatment programme, whether funded by your CCG or by you. If self-funding, you will have to purchase the drugs using a private prescription.

There are two types of funding available to you: either NHS funding or self-funding.

NHS-funded treatment

The clinical commissioning group (CCG) where your GP is based is responsible for your NHS healthcare costs. Each CCG receives limited funds from central government, which means that each CCG has to set its own priorities.

Some CCGs do fund IVF, but usually to a limited extent. Others do not fund IVF at all. The CCGs set their own criteria for treatment to which the assisted conception unit at St Helier Hospital must adhere. If you live within the Merton, Sutton and Wandsworth area and are registered with a GP, you may be eligible for NHS-funded treatment, provided you meet their eligibility criteria.

Self-funded treatment

You may wish to fund your own treatment if your CCG does not fund IVF, or if you are not eligible for NHS funding.

We describe the treatment as ‘self-funded’ rather than ‘private’ because the treatment is exactly the same as for patients funded by the NHS. The charges we make are non-profit-making, ie  they are at cost price. All income from self-funded patients is put back into the IVF programme.

You can see prices for self-funding IVF and IUI here: F4a St Helier IVF prices 20-21[pdf] 84KB