28 September 2018
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IVF (In Vitro Fertilisation) is a technique involving the fertilisation of eggs by sperm outside the body. Spire Clare Park Hospital offers IVF treatment in conjunction with Guys and St Thomas's Fertility Centre. This combined service is designed to offer patients convenient care locally and with two visits to London for the IVF procedure itself. Patients will have their initial consultations and investigations with Mr Nick Elkington at Spire Clare Park Hospital and attend Guys and St Thomas's assisted conception unit for egg collection and embryo transfer with Mr Khalaf. Ongoing follow-up and pregnancy scan will be provided by Mr Elkington at Spire Clare Park Hospital. A treatment cycle is made up of six stages: 1. The woman’s normal hormone production is temporarily switched off, using medicine, so we have control of egg production and release. 2. The woman’s ovaries are then stimulated with hormone injections to produce eggs. 3. The woman’s eggs are collected from her ovaries. 4. The male produces a semen sample (on the day of egg collection). 5. The eggs and sperm are placed together in a laboratory dish to allow fertilisation and early embryo development. 6. The embryo(s) are placed in the woman’s uterus usually on the third or fifth day after egg collection when the fertilised egg has divided and contains six to eight cells, or is a blastocyst. 7. A pregnancy test should be carried out 14 days after the embryo transfer, and if the result is positive an ultrasound test will take place two weeks later to check the number of embryos, that the embryo is alive and situated in the uterus. What causes IVF to fail? During the IVF treatment cycle, problems can arise which cause the treatment to be unsuccessful: The ovaries may either fail to respond to the simulating drug or over respond. In the latter case, the treatment would be put on hold until it is safe to continue without the risk of ovarian hyper-stimulation. Very rarely, despite ultrasounds indicating the presence of follicles, no eggs are found during the egg collection procedure. The collected eggs fail to fertilise in the laboratory and therefore no embryos are available to transfer. The eggs may fail to divide after fertilisation and cannot be placed into the uterus. The most common reason for IVF failure is embryos failing to develop in the uterus.
For couples where there may be a problem with the sperm, ICSI (Intracytoplasmic Sperm Injection) treatment can be used. This is similar to IVF, however rather than combining the eggs and sperm and allowing the eggs to be fertilised naturally, a single sperm is injected directly into each egg. Fertilised eggs are then monitored and, at the appropriate time (Usually day five at ‘blastocyst’ stage), transferred back into the uterus. ICSI can be used when there is a low sperm count, slow moving sperm and when an IVF fertilisation failed in-spite of good quality sperm. The development of ICSI means fertilisation is possible even with semen samples that have a very low sperm count. The average fertilisation rate per egg injected is about 60-70%.
Intrauterine insemination (IUI) involves a relatively straight-forward laboratory procedure to separate fast-moving sperm from more sluggish or non-moving sperm. The woman will be given a course of drugs to stimulate the production of eggs. The fast-moving sperm from the partner or donor sample are then placed into the woman's womb using a fine catheter close to the time of ovulation when the egg is released from the ovary. As the timing of insemination is crucial, the woman's cycle is monitored using ultrasound scans to assess the development of follicles and occasionally urine tests to check for the time of ovulation. The sperm is inseminated when these tests indicate that ovulation is imminent.
Donor Insemination (DI) uses sperm from a donor to help the woman become pregnant. Single and lesbian patients will need to use sperm from a donor, whether a known or unknown donor. Prospective parents can choose the appropriate physical characteristics from the panel of donors so that skin colour, height, eye and hair colour can be matched. Donor sperm can be used as part of a treatment, such as IVF, or for IUI. Only healthy donors are recruited and all donors are required to undergo a thorough medical examination and screening test. Counselling for donors and recipients is mandatory.
Surgical sperm retrieval can be used to extract sperm from the testes for use in IVF and/or ICSI. It is only necessary when a man is unable to produce sperm in his ejaculate, has had a failed vasectomy reversal or has absent vas deferens - the duct that carries the sperm from the epididymis to the penis. Sperm can be surgically recovered in two ways. Percutaneous Epididymal Sperm Aspiration (PESA) involves a needle being inserted into the epididymis and sperm is withdrawn. However, if sperm cannot be found in the epididymis, Testicular Sperm Aspiration (TESA) is used. This involves extracting sperm from testicular tissue by inserting the needle directly into the testis. Following these procedures patients may experience discomfort or pain and may have some localised swelling. However, patients who undergo PESA typically may return to work the following day.
When an individual or couple decide they want to become pregnant, it is important to consider their personal health and wellbeing. Lifestyle changes often need to be made to improve both a person's fertility and general health in preparation for conceiving and carrying a baby. Stopping smoking, cutting out alcohol and improving diet and overall fitness are some things that can improve your chance of becoming pregnant and carrying a healthy baby. Women trying for a baby are also advised to increase their daily intake of folic acid - a mineral vital to the growth and development of a baby's nervous system during its early stages. Folic acid tablets can be puchased in a chemist or be taken as part of a preconception tablet.
Preimplantation Genetic Diagnosis (PGD) is an early prenatal diagnosis, designed for couples at risk of transmitting inherited disease to their children because of chromosomal abnormalities. The major advantage of PGD is that it allows couples to identify embryos that may be carrying genetic disorders and minimise the risk of a difficult choice of abortion, or possible miscarriage during the pregnancy. Structural chromosomal abnormalities can include a number of different chromosomal defects and usually occur when there is an error in cell division. Patients having PGD will undergo routine IVF to generate multiple embryos to increase the chance of obtaining chromosomally normal embryos. Both partners will have a cytogenetic karyotype test. The laboratory will then analyse your case over a period of two to three months, and both partners will meet with a genetic counsellor before commencing a typical IVF cycle. Once the embryos are created, the laboratory will perform an embryo biopsy procedure using state-of-the-art laser drilling to create access for the removal of single cells from each embryo for testing. Laser drilling allows for higher accuracy cutting when accessing cells from within the delicate embryos. Following a diagnosis period of 48 hours, approved embryos (up to two) are then transferred into the womb.
If you have any questions then please give us a call on 01252 895 490.