Guide to In Vitro Fertilisation
I want IVF, what’s the first step?
The first step is for you to come in for an advance scan and a consultation. These both occur in one hour-long appointment. The first half of the appointment is the scan; this is an internal scan with an advanced 3D Doppler scanner and will help us assess the blood flow in the ovaries, follicles and womb as well as checking ovarian reserve. We perform a 3D scan to assess the cavity of the womb to rule out any problems for implantation. They will also check for obstructions such as cysts and polyps. Following straight on from the scan you will have your appointment where the doctor will go through the results and your medical history and devise a personalised treatment plan for you based on these.
Do I have to come for the scan on a particular day of my cycle?
No, you can come for the scan on any day of the cycle, including during your period if you are comfortable with this- it doesn’t make any difference from the scanning point of view.
Do I have to have the scan done again if I’ve had one elsewhere?
We request that every patient have a scan within 3 months before starting any treatment. It is at the doctor’s discretion whether they will accept a scan from another clinic; however most doctors prefer to have a scan performed at CREATE because our doctors have been highly trained in scanning methods and will be able to assess multiple aspects of your fertility. Our scanners are 3D Doppler scanners and look at the blood flow in the ovaries and womb as well as checking ovarian reserve.
Should I bring anything with me?
If you have medical notes, from previous treatment for example, you can send copies of these to us in advance to be added to your file. Otherwise you do not need to bring anything with you.
What is Natural IVF?
Natural IVF uses fewer drugs than conventional IVF. We think that you can get the same results with fewer stimulating drugs, which is better for the patient because there are fewer side effects. The body is not designed to produce a lot of eggs in one go, so often even if there are a lot of eggs collected in conventional IVF, lots of them aren’t viable so you end up with the same amount of eggs as if you’d taken fewer drugs. Natural IVF doesn’t use any stimulating drugs at all, and Natural Modified IVF uses just a short course of stimulating drugs: about 3-4 days worth instead of the 4-5 weeks of drugs with conventional IVF.
Natural cycle IVF works within a woman’s own natural cycle, so rather than shutting down the cycle and re-starting it with high stimulation drugs. Natural IVF doesn’t use any stimulating drugs at all, and Natural Modified IVF uses just a small dose of drugs as add-back therapy to support the growth of the leading follicle. This approach is based on a focus on quality rather than quantity. Natural IVF is most suitable for women with low ovarian reserve, low AMH or. high FSH
What is Mild IVF?
Mild IVF focusses on quality rather than quantity of eggs, is conducted within a woman's natural cycle and uses fewer stimulating drugs than conventional IVF. Mild IVF uses a short 5-9 day course of stimulating drugs (rather than the 4-5 weeks worth in conventional IVF) to gently encourage the growth of the follicles.
Mild IVF is designed to be easier on the body with fewer side effects. The short protocols with fewer drugs mean that the stress of treatment and potential side effects are reduced. There have been no cases of severe OHSS at this clinic (OHSS is a syndrome where the ovaries are over-stimulated and swell up, causing pain, bloating and sometimes hospitalisation. It is also more affordable because medication accounts for a lot of the cost of IVF, and the patient experience is better because the treatment time is shorter.
For more information, please visit Mild Stimulation IVF.
Should I do Natural or Mild IVF?
This depends on your own set of circumstances, and the doctor will be able to tell you what’s best in the initial scan and consultation. At this appointment the doctor will do an internal scan with a 3D scanner, which will look at your ovaries and ovarian reserve, the womb lining and the blood flow to these. They will then go through your medical history and devise a treatment plan based on your scan and medical history.
Usually older patients or those with a low ovarian reserve will be advised to go for Natural or Natural Modified IVF. This might seem counterintuitive because it seems like the fewer eggs you have, the more stimulation you need. But eggs cannot be created out of nowhere, so stimulating drugs won’t make more appear, and so a focus on collecting the best of your remaining eggs is more beneficial. Mild Stimulation IVF works well for people with a good ovarian reserve, and it has excellent success rates.
Do you have selection criteria (age/BMI/AMH)?
We accept any women up to the age of 50. We do not have any cut-off for AMH levels, and we will try to achieve fertility treatment for a woman with their own eggs if it is possible. We have had patients with AMH levels under 1 have healthy babies with their own eggs. We do not have a strict BMI cut-off, but will take it into account the health and safety of the woman when deciding what treatment is best suited and in some cases whether it is safe to go ahead with treatment.
Is there a waiting list?
No, there is no waiting list. There are usually initial consultations available within a week. Starting the treatment depends on your cycle, as it will begin after your period starts. This means we can usually start at the beginning of your next cycle.
How long does it take?
After the first scan, the treatment takes about 2 weeks.
What is the process?
The first step is to come in for an initial scan and consultation. At this appointment the doctor will assess your situation and devise a personalised treatment plan. After this, you will come in 2 weeks before the start of your period to meet with a nurse. They will talk you through your treatment, give you your medication and teach you how to take it and go through the consent forms with you. You will then call up on the first day of your period (day 1) to book in your first scan. This will probably be on day 5 or 6, but could be earlier or later depending on the advice of the doctor. After the first scan, there will be around 2 or 3 more scans, usually performed every other day. The egg collection is usually performed on around day 12; this is carried out under sedation, and is followed by the embryo transfer a few days later.
What are the success rates?
Our success rates vary depending on the age of the patient and the type of treatment. Our success rates for Mild IVF are excellent. We have the highest success rates in the country for Natural IVF and are usually able to help women with low ovarian reserve with Natural IVF. We are a long group of fertility clinics with a great track record of providing patients with tailor-made milder treatment. It is very important that you consider other aspects and factors of treatment other than just success rates, which may not reflect patients in your situation. For more details, see our Success page.
Are there any technologies on offer that might improve my chance of success?
We offer a number of technologies that might improve your chances of conceiving successfully with IVF treatment. Please discuss with a consultant to check whether any of these might be beneficial to you.
Embryoscope: One of these is Embryoscope technology. This is time-lapse imaging of embryos while they are in the lab, and offers 2 main advantages. Firstly, the embryology team can examine the division of the embryos and see which ones are dividing as expected. These are likely to be the most healthy embryos, and can then be selected for implantation. Selecting the highest quality embryos means that the chances of success for the cycle are higher. The second advantage is that the embryologists do not have to take the embryos out of the incubator to inspect them, so that favourable conditions are maintained throughout incubation.
ERA: Another technology which can be used to increase the chance of pregnancy is the endometrial receptivity array (ERA). This is used to determine the time at which the uterus is most receptive to implantation. There is a very short window of receptivity and this can vary from woman to woman, so this test takes a biopsy of the womb lining and analyses it to see which genes are switched on and off. This can determine which time in the month is best to perform a personalised embryo transfer.
Endometrial scratch: Another method used to improve the chances of implantation is the endometrial scratch. This is performed in the month before your treatment in the theatre, where the doctor will pass a catheter into the cervix and gently scratch the wall of the uterus. It is believed that this may cause the uterus lining to release certain hormones and chemicals that improve implantation, or that the genes required for implantation are ‘switched on’ by the scratch.
IVM: In-vitro maturation (IVM) is a pioneering technology that can be used in conjunction with Natural IVF to create more embryos. Natural IVF aims to collect one mature egg, but with IVM smaller immature follicles can also be collected and matured in the lab. Around 70-80% of these immature follicles will go on to mature and can then be used for IVF treatment.