Bringing eggs and sperm together in a carefully controlled environment to generate high-quality embryos, also known as in vitro fertilisation.
In natural conception, sperm and eggs meet in the fallopian tube and begin the complex process of fertilisation, embryo formation and growth. Introducing the sperm to the eggs in a carefully controlled environment can overcome the physical, endocrine and immune problems that may be preventing you conceiving.
First, you need to make some eggs. To help, we use fertility drugs to stimulate your ovaries to produce a number of eggs. Then, we harvest them using a minor surgical procedure and place them in a culture dish.
Next, we take the semen – usually produced by masturbation – and, using a variety of techniques, wash it and select the best sperm. These are put in culture with the egg, and fertilisation occurs naturally over the next 18 hours or so.
After a period of growth in culture our skilled embryologists assess the delicate embryos’ developing cell structure under a microscope. One or two are then transferred into your uterus. If suitable, remaining embryos can be frozen for future use (see Frozen Embryo Transfer below).
IVF may be appropriate in cases of male factor , or unexplained infertility, if you have blocked fallopian tubes, or have experienced a lack of success with other fertility treatments, such as ovulation induction or IUI.
If you are a female aged up to 43 you can usually have treatment using your own eggs, depending on your individual circumstances. If you are a women aged 44 or more we will advise you that you may need donated eggs or embryos. In every case we will assess you individually and agree a personalised treatment plan with you.
Following an initial consultation with one of our fertility specialists, you’ll start your agreed treatment plan. This involves taking IVF drugs for several weeks both to stimulate egg production and prepare your uterus to receive the embryos. Since your treatment plan is individual, the drug dosage and number of visits will depend on how your body responds.
You’ll need to visit one of our clinics in the East of England, for scans and blood tests during this time – usually up to four times – and we’ll monitor you closely to assess your response to the medication, suggest any potential modifications to your treatment, and decide when to proceed to egg collection.
Egg collection is a minor surgical procedure, carried out by one of our specialists. It involves an ultrasound-guided vaginal egg collection. We immediately pass the collected eggs to our on-site embryology laboratories.
Following the fertilisation of your eggs with sperm, we transfer either one or two of the resulting embryos to your uterus using a narrow catheter passed through your cervix. Then, 18 days after egg collection, you’ll be able to take a pregnancy test. If that is positive, you should attend the clinic about 20 days later for a pregnancy scan.
Sometimes conventional IVF – leaving the sperm and egg to do their thing in our laboratory – needs a helping hand.
Intracytoplasmic Sperm Injection (ICSI) is a lab technique that may be appropriate for you if your sperm need a bit of extra help to achieve successful fertilisation. Your embryos, created using the ICSI technique, are then transferred in exactly the same way as in standard IVF.
Your eggs are collected in the same way as IVF, and a single sperm is injected into the centre of each mature egg to assist fertilisation in the laboratory. We use ICSI in conjunction with an IVF cycle when we believe that fertilisation is unlikely to occur using conventional IVF.
In the same way as a conventional IVF cycle, one or two of the resulting embryos can then be transferred to your uterus, and any additional suitable embryos can be frozen for your future use.
Bourn Hall’s fertility experts have performed ICSI since 1993, making us one of the most experienced centres for this type of technique in the UK.
We might recommend ICSI when:
- Your sperm count is low
- Your sperm motility – movement – is poor
- You have a high number of abnormal sperm
- Your sperm has been collected surgically
- Your semen contains levels of antibodies
- You have previous, unexplained, unsuccessful conventional IVF treatments, or when very few eggs have fertilised following IVF
- Tests of your sperm function have shown that the sperm would be unlikely to achieve fertilisation, or embryo quality and implantation may be compromised
- You have chosen to use donated eggs and sperm
Your ICSI treatment cycle is exactly the same as for conventional IVF. The only difference is that our embryologists use micromanipulation techniques in the laboratory to fertilise your eggs, instead of placing sperm and eggs together in a tissue culture dish.
Human embryos are delicate, and cultivating them in our laboratory for a longer period of time allows us to pick the best ones to return to your uterus more reliably.
Blastocyst culture is a scientific term for when your embryos are kept in our laboratory incubators for longer. This ensures they undergo critical developmental changes before being returned to the uterus.
This period of extended culture – growth – helps our fertility experts select the best possible embryo(s) for transfer to your uterus.
By the time an embryo has reached the blastocyst stage, it’s already undergone several cell divisions and achieved its first cell differentiation into two distinct cell types.
We have impressive success rates that show this extended culture maximises the chance of you achieving a viable pregnancy.
Our fertility experts will guide you if blastocyst culture is right for you, depending on your individual circumstances. Although this period of extended culture doesn’t necessarily improve the quality of your embryos, or guarantee that they will reach the blastocyst stage, we have been researching and refining this process at our Cambridge, Colchester, Norwich and Wickford clinics for many years.
Our results indicate that with five or more embryos on day one after egg collection, there’s an improved pregnancy rate using extended culture, compared with day two or three transfers.
Your treatment cycle is exactly the same as for IVF, except that your embryos will be cultured for longer in our embryology laboratory. This means that the day of your embryo transfer will be five days after egg collection.
This process enhances our embryologists’ ability to select the embryo(s) most likely to result in pregnancy.
If you had embryos frozen during a previous cycle, they can be thawed and placed in your uterus, avoiding the need to go through another IVF cycle.
We strongly recommend that good quality embryos surplus to the requirements of a fresh IVF cycle are frozen and stored for your future use. This laboratory technique is highly successful both in post-thaw survival and pregnancy outcome. As they are stored at -197°C – in theory – they can be preserved forever. However, in the UK storage is limited by regulation to 10 years and, only in exceptional circumstances, to 55 years.
Thawed embryos can be replaced in a natural menstrual cycle or in a hormone replacement cycle (HRT). We tend to recommend the latter, as it gives us more opportunity to examine the growth and development of your uterus before thawing the precious embryo(s).
The HRT treatment involves damping down your own hormones and substituting the necessary hormones to create the best environment in your uterus for the embryo(s). We’ll monitor your progress to assess the right time for the transfer, maximising your chances of achieving a pregnancy.
Frozen Embryo Transfer is appropriate if you have already got frozen embryos and wish to return for further treatment without going through a full cycle of IVF.
FET is considerably less invasive and less expensive than a fresh IVF cycle and may be the best choice if you’re considering treatment sometime after the embryos were created. For example, you may have chosen to freeze your embryos before receiving cancer treatment, because of other health factors that could potentially affect fertility, or because you wanted to postpone pregnancy for other reasons.
Of course, it could be that you have been successful in an earlier cycle(s) and simply wish to return to add further children to your family.
We’ll agree an individualised treatment plan with you and then you’ll attend some monitoring appointments – for example, ultrasound scans – to decide the optimal timing for your embryo transfer.
Following the thawing of your frozen embryos, one or two can be transferred to your uterus through a narrow catheter passed through your cervix – this is the same method that’s used in a fresh IVF cycle.
You’ll be able to take a pregnancy test 18 days after embryo transfer. If this is positive, you can attend one of our East of England clinics including Cambridge, Colchester, Norwich or Wickford, for a pregnancy scan about 20 days later.
If your embryos are frozen and stored by us, we’ll contact you each year and ask you to confirm your wishes for the next 12 months. If you wish to continue storage with us there will be an annual storage fee.
In some cases, potential parents need the help of another person to carry and deliver their baby for them – a process known as surrogacy.
We were the first clinic to offer IVF treatment with surrogacy to both heterosexual and same-sex couples; the first IVF surrogacy baby was born in 1989. Our experienced team will guide and support you throughout the surrogacy process.
You will have IVF treatment to create your own embryos, which will be transferred to the uterus of your chosen surrogate host. She then carries the pregnancy and gives birth. Donor sperm or donor eggs can also be used in surrogacy treatment. One of the commissioning parents must be genetically related to the baby so donor embryos cannot be used.
You may already have a friend or relative who has agreed to be a host. If this is not the case, please bear in mind that it is illegal in the UK to advertise for surrogates, and fertility clinics are not allowed to find a host for you. However, you may be able to find help through the agencies that work in this field.
Surrogacy may be appropriate if you have a medical condition that makes it impossible or dangerous to get pregnant and give birth. For example, you may have had a hysterectomy or you have a medical condition where pregnancy would be detrimental to your own health. In the case of male, same-sex couples, it’s clear that a surrogate host is needed.
Following a panel of medical investigations you will have a cycle of IVF treatment – with or without ICSI – to create your embryos. They will be frozen and stored ‘in quarantine’ for an appropriate period. You and the surrogate host will attend medical consultations and independent counselling where all aspects of IVF surrogacy will be discussed in detail.
Ideally, surrogates should be aged under 36 and already have their own family, or have decided they do not want to become parents themselves. The surrogate will be medically screened, including HIV testing.
Your embryo(s) will be transferred to your host using a standard hormone replacement cycle.
We appreciate that surrogacy is a big step that needs careful consideration by everyone involved. Before undertaking treatment, we strongly recommend that all parties involved take advice, including legal advice, from one of the surrogacy support organisations and from a solicitor with a specialism in surrogacy law. We can give you contact information for both.