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Invitro Fertilisation (IVF)

Invitro fertilisation is the ultimate procedure in fertility treatment.

Reason for IVF

  1. Unexplained infertility. This means that all the tests done on male and female partner are normal. These are tests for ovulation, tubal patency, pelvic ultrasound and semen analysis. This accounts for about 12-15 % of infertility
  2. Blocked or damaged tubes. This may be due to a previous pelvic infection, ectopic pregnancy, severe endometriosis, previous pelvic surgery and tubal ligation (sterilisation)
  3. Severe endometriosis
  4. Low sperm count, and low sperm (quality)
  5. 4 cycles of failed artificial/intra uterine insemination
  6. Long standing infertility in woman over the age of 35 years.
  7. Reduced ovarian reserve / low Anti-Mullerian hormone
  8. Resistant Polycystic ovarian syndrome
  9. Discordant HIV status

Procedure

The procedure involves 4 steps

Step 1: Stimulation of the ovary

We use the GnRH antagonist protocol. These protocols are more patient friendly and require less injections. The ovaries are stimulated on the 2nd or 3rd day of the period with fertility injections e.g. Gonal F or Menopur injections. These injections are self-injected into the skin around the navel for 10 to 12 days. The aim of the injections are to stimulate the ovary to produce a reasonable number of eggs. The number of eggs is dependent on the age of the woman and her ovarian reserve. The ovarian response is monitored by transvaginal ultrasound. The first ultrasound is done on day 7/8 of your cycle to measure the number and size of growing follicles (eggs). Cetrotide injections are started on this day, to stop ovulation before egg retrieval. These injections are given for 4-6 days. The 2nd ultrasound is usually done 2-3 days later to check the number of mature follicles. A mature follicle is 18-20mm. Once the follicles are mature, you will inject Ovitrelle / Pregnyl that evening in preparation for egg retrieval 36 hours later.

Step 2: Egg Retrievel

The Egg retrieval is done between cycle day 13 to day 16. It is done in theatre under conscious sedation. The follicles are aspirated through the vagina with a thin needle attached to the ultrasound probe. The embryologist looks for the eggs in the aspirated follicular fluid. The procedure takes 10-15 minutes to do. You won’t feel any pain during the procedure, but slight discomfort afterwards. An antibiotic is given during the procedure. You will be disharged 2 hours later .You may not drive.

STEP 3: Fertilisation

Fertilisation is done on the day of the egg retrieval. On the morning of the egg retrieval, a sperm sample is delivered to the laboratory. The sperm sample is washed and prepared in a special culture medium. Some men may have had sperms frozen previously.

The washed sperm is mixed with the eggs in a petri dish. We check for fertilisation 24 hours later.

ICSI

ICSI stands for Intracytoplasmic sperm injection. This procedure is done to manipulate fertilisation for men with extremely low sperm count. A single sperm is injected into the nucleus of the egg to induce fertilisation. We do ICSI for all of our IVF cycles.

The embryos are cultured in the lab for 3-5 days. New laboratory techniques and culture medium allows embryos to be cultured to the blastocyst stage. Blastocyst are embryos with the highest implantation and pregnancy rates. This also allows us to select the best quality embryos for transfer.

STEP 4: Embryo Transfer

Embryo transfer is done on the 3rd or 5th day after egg retrieval. It is done in a procedure room next to the laboratory. You are awake for this procedure. It is similar to doing a Pap smear. The embryos are loaded into a catheter, this is inserted through the mouth of the womb (cervix) under ultrasound guidance. The procedure takes 3-5 minutes to do. A maximum of 2 blastocyst are transferred. Excess embryos are frozen. Pregnancy test is done 10 days later.

Success Rate:

This depends on age, quality of embryos, thickness of the lining of the womb and ease of embryo transfer. Woman under 34 years (normal AMH) – 35% to 40%.

DR RAZAK DHANSAY

Fertility Specialist registered with the Health Professions Council of South Africa. Over 20 years of experience in all aspects of fertility management.

Patient focused fertility care. All treatments individualised and personalised. Holistic approach to fertility management.

CONTACT

Room 101 Library Square, 1 Wilderness Road, Claremont 7708,
Cape Town, South Africa

021 683-7036

086 620-7937