IVF

In vitro fertilisation takes the meeting of egg and sperm out of the body and into the laboratory. Your ovaries are stimulated so several eggs mature at once instead of one, the eggs are collected through a needle passed under ultrasound guidance, and each mature egg is put together with sperm the same day.

ICSI is the fertilisation step done under a microscope. A single sperm is picked up in a glass needle finer than a hair and injected directly into the egg, which is used when the sperm count or movement is poor, when sperm has been retrieved surgically, or when eggs failed to fertilise conventionally in a previous cycle.

The fertilised eggs are grown in an incubator for two to five days and graded, and one embryo is placed back into the womb. Any suitable embryos left over are frozen, and each of those gives a further chance from the same collection without repeating the stimulation.

The stimulation phase lasts about ten to twelve days of daily injections you give yourself into the skin of the abdomen, with a second injection added partway through to stop the eggs being released early. You come in for three or four scans and blood tests during this time to check how the follicles are growing and adjust the dose. A trigger injection is given at a precise hour once the follicles are ready.

Egg collection is 34 to 36 hours after the trigger. You come in fasting, and it is done under sedation, so you are asleep for it and go home the same day. A needle is passed through the vaginal wall under ultrasound guidance and the fluid is drawn from each follicle; the embryologist finds the eggs in that fluid straight away. It takes 20 to 30 minutes.

Fertilisation is checked the next morning and you are told how many eggs fertilised. Embryo transfer follows on day three or day five, or in a later frozen cycle if your lining or your hormone levels favour that. The transfer itself is like an insemination: a speculum, a fine catheter, a few minutes, and no anaesthetic. A blood pregnancy test is done about two weeks later.

After egg collection you rest in the day ward for two or three hours and need someone to take you home, since sedation rules out driving that day. Expect cramping, bloating and light spotting for two to four days, and most people take one or two days off and return to normal work after that. Avoid heavy exercise, swimming and intercourse until the bleeding settles.

After the transfer, ordinary activity is right. Lying still does not help. Progesterone is continued until the test and, if positive, for some weeks beyond.

Plan in cycles and not in weeks. The chance of a live birth from one egg collection depends most on age, ranging from roughly one in two for women in their early thirties down to well under one in ten past forty, and your clinic should quote you its own figures for your age. Frozen embryos from the same collection raise the cumulative chance, so many people who succeed do so on a second or third transfer. Give yourself a break between cycles if you need one.