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Home > Fertility treatments > IVF/ICSI treatment stages

IVF/ICSI treatment stages

1. Helping you take the first step

The first step is usually the hardest – making that initial call. But remember, you are not alone and at Bridge we are experts at treating people just like you. Simply phone us in the strictest confidence and our friendly team will help guide you through the stages of the IVF procedure or the ICSI procedure and the options open to you.

Whether you have recently become concerned about your fertility or have had treatment elsewhere and want another opinion, we will do our best to help you achieve a successful outcome.

We can generally offer an initial consultation within a few days, and for your convenience we offer appointments Monday to Friday from 8.30am until 4.00pm. Later appointments are available on Wednesday evenings.

2. Your first visit

Initial consultation

You should allow around two hours for your first appointment at the Bridge. This will give you time to meet a member of the nursing team who can introduce you to the clinic.

At the first consultation you will meet with one of our fertility specialists who will complete a detailed review of your medical history. You will also have the opportunity to ask any questions.

3. Pre-treatment

Before starting treatment , you and your partner (where applicable) will have various screening tests.  These may include blood tests, an ultrasound scan and a semen analysis for the male partner. These tests are all straightforward and there is no need for concern.

Once the results are available, you will be asked to make a second appointment with the specialist to review your results and to develop the treatment plan. 

4. Counselling

At Bridge we recognise the importance of providing both physical and emotional care during your fertility treatment. That’s why fertility counselling is included in your initial consultation and is available at any time during the remainder of your treatment.

Patients having treatments with donor gametes (sperm, eggs or embryos) must also have counselling.  

5. Preparation

Prior to treatment

A blood test will be arranged to co-inside with day two or three of your period to measure hormone levels.  It is advisable, if you haven’t done so already, to start a course of folic acid and to continue until you are a minimum of three months pregnant.

Hormone suppression

Depending on your treatment plan, drug treatment will begin on or around day 21 of your menstrual cycle or between days 2-7 of your cycle.  The medication prescribed will suppress the release of your own fertility hormones.   

Stimulation of the ovaries
The next stage is a course of ovarian stimulation with hormone injections. The purpose is to grow several follicles rather than the single follicle that is usually produced each month.

The treatment cycle is then monitored with ultrasound scans to measure the development of the follicles.  This may require an adjustment to your drug dose.  When the follicles have reached an appropriate size, you will have a final injection to ensure the maturity of the follicle (hCG).  This injection is carefully timed to allow egg collection to be performed 36 hours later.

6. Egg collection

Egg collection is usually performed under sedation (a general anaesthetic is rarely required). You will be awake during this 30 minute procedure. A probe is passed through the vagina and into the ovary under the guidance of ultrasound ; the fluid from each follicle, which contains the egg, is extracted. It is usual to obtain an egg from about 80% of the follicles retrieved. You may feel a few twinges but should not be in pain and you will need to rest at the clinic for a short time before going home.

7. Fertilisation

If your partner's sperm is being used to fertilise the eggs, a sample will be required on the day of egg collection. We advise that you don’t have sex for three days before the sperm sample is provided. The sample is prepared so that the sperm cells are separated from the seminal fluid. All the eggs collected are graded according to their development and left in an incubator for a few hours before being mixed with the selected sperm.

In an IVF cycle, the prepared sperm (whether partner or donor) and egg(s) are placed together in assigned dish(es).  In an ICSI treatment cycle, a single sperm is injected into each mature egg, which are then put in an assigned dish. The dishes are left in the incubator overnight to allow fertilisation to take place.  Usually about 60%-70% of the eggs collected will be fertilised. It is rare for a patient not to have any fertilised eggs, although sadly it does happen.

Around 12 hours after fertilisation the egg will start to divide. After 2-3 days, the embryos will usually consist of four to eight cells, and at this stage are ready for transfer to the uterus.  In some cases, the embryos are left for 2-3 further days before transfer as blastocysts.

At each stage of the fertilisation process, our team will keep you informed of how the embryos are developing and when you need to return for embryo transfer.

8. Embryo development

We will contact you the day after egg collection to let you know if fertilisation has taken place and to arrange a time for embryo transfer.

In the meantime, ‘cleavage’ or division of cells is occurring within the fertilised embryos. Although the mass of the embryo remains constant, the cells get smaller and smaller, increasing in number. The quantity of cells is not critical to quality, as each embryo develops at its own rate. Embryos may have up to six cells by the second day. Based on their regularity and appearance, the embryos are graded for quality. Additional good quality embryos can be frozen and stored for future use.

9. Embryo transfer

The embryo transfer procedure is similar to a smear test and it may cause some minimal discomfort. One or two embryos are carefully transferred through the vagina and cervix to the uterus, where implantation begins. 

High quality embryos remaining after the transfer can be frozen for use at a later date.  In accordance with the Human Fertilisation and Embryology Act, a maximum of two embryos can be transferred in any cycle, other than in exceptional circumstances.

10. Pregnancy

If you have not had a period 14 days after embryo transfer, you should take a pregnancy test. If you are pregnant further medication may be prescribed to support the pregnancy.  An ultrasound scan will be performed at six or seven weeks’ gestation to confirm a visible heartbeat and ongoing pregnancy.

If, unfortunately, you do have a normal period, a follow-up consultation will be arranged and support counselling is available.

11. Frozen embryos

Spare embryos from your treatment cycle may have been frozen for future use. Under current guidelines they can be stored for up to 10 years. Embryos are stored by removing the fluid from inside the cells before freezing them in liquid nitrogen. 

There is an initial charge for freezing embryos, which includes storage for one year. Storage is then renewable annually.

1. Helping you take the first step

The first step is usually the hardest – making that initial call. But remember, you are not alone and at Bridge we are experts at treating people just like you. Simply phone us in the strictest confidence and our friendly team will help guide you through the stages of the IVF procedure or the ICSI procedure and the options open to you.

Whether you have recently become concerned about your fertility or have had treatment elsewhere and want another opinion, we will do our best to help you achieve a successful outcome.

We can generally offer an initial consultation within a few days, and for your convenience we offer appointments Monday to Friday from 8.30am until 4.00pm. Later appointments are available on Wednesday evenings.

2. Your first visit

Initial consultation

You should allow around two hours for your first appointment at the Bridge. This will give you time to meet a member of the nursing team who can introduce you to the clinic.

At the first consultation you will meet with one of our fertility specialists who will complete a detailed review of your medical history. You will also have the opportunity to ask any questions.

3. Pre-treatment

Before starting treatment , you and your partner (where applicable) will have various screening tests.  These may include blood tests, an ultrasound scan and a semen analysis for the male partner. These tests are all straightforward and there is no need for concern.

Once the results are available, you will be asked to make a second appointment with the specialist to review your results and to develop the treatment plan. 

4. Counselling

At Bridge we recognise the importance of providing both physical and emotional care during your fertility treatment. That’s why fertility counselling is included in your initial consultation and is available at any time during the remainder of your treatment.

Patients having treatments with donor gametes (sperm, eggs or embryos) must also have counselling.  

5. Preparation

Prior to treatment

A blood test will be arranged to co-inside with day two or three of your period to measure hormone levels.  It is advisable, if you haven’t done so already, to start a course of folic acid and to continue until you are a minimum of three months pregnant.

Hormone suppression

Depending on your treatment plan, drug treatment will begin on or around day 21 of your menstrual cycle or between days 2-7 of your cycle.  The medication prescribed will suppress the release of your own fertility hormones.   

Stimulation of the ovaries
The next stage is a course of ovarian stimulation with hormone injections. The purpose is to grow several follicles rather than the single follicle that is usually produced each month.

The treatment cycle is then monitored with ultrasound scans to measure the development of the follicles.  This may require an adjustment to your drug dose.  When the follicles have reached an appropriate size, you will have a final injection to ensure the maturity of the follicle (hCG).  This injection is carefully timed to allow egg collection to be performed 36 hours later.

6. Egg collection

Egg collection is usually performed under sedation (a general anaesthetic is rarely required). You will be awake during this 30 minute procedure. A probe is passed through the vagina and into the ovary under the guidance of ultrasound ; the fluid from each follicle, which contains the egg, is extracted. It is usual to obtain an egg from about 80% of the follicles retrieved. You may feel a few twinges but should not be in pain and you will need to rest at the clinic for a short time before going home.

7. Fertilisation

If your partner's sperm is being used to fertilise the eggs, a sample will be required on the day of egg collection. We advise that you don’t have sex for three days before the sperm sample is provided. The sample is prepared so that the sperm cells are separated from the seminal fluid. All the eggs collected are graded according to their development and left in an incubator for a few hours before being mixed with the selected sperm.

In an IVF cycle, the prepared sperm (whether partner or donor) and egg(s) are placed together in assigned dish(es).  In an ICSI treatment cycle, a single sperm is injected into each mature egg, which are then put in an assigned dish. The dishes are left in the incubator overnight to allow fertilisation to take place.  Usually about 60%-70% of the eggs collected will be fertilised. It is rare for a patient not to have any fertilised eggs, although sadly it does happen.

Around 12 hours after fertilisation the egg will start to divide. After 2-3 days, the embryos will usually consist of four to eight cells, and at this stage are ready for transfer to the uterus.  In some cases, the embryos are left for 2-3 further days before transfer as blastocysts.

At each stage of the fertilisation process, our team will keep you informed of how the embryos are developing and when you need to return for embryo transfer.

8. Embryo development

We will contact you the day after egg collection to let you know if fertilisation has taken place and to arrange a time for embryo transfer.

In the meantime, ‘cleavage’ or division of cells is occurring within the fertilised embryos. Although the mass of the embryo remains constant, the cells get smaller and smaller, increasing in number. The quantity of cells is not critical to quality, as each embryo develops at its own rate. Embryos may have up to six cells by the second day. Based on their regularity and appearance, the embryos are graded for quality. Additional good quality embryos can be frozen and stored for future use.

9. Embryo transfer

The embryo transfer procedure is similar to a smear test and it may cause some minimal discomfort. One or two embryos are carefully transferred through the vagina and cervix to the uterus, where implantation begins. 

High quality embryos remaining after the transfer can be frozen for use at a later date.  In accordance with the Human Fertilisation and Embryology Act, a maximum of two embryos can be transferred in any cycle, other than in exceptional circumstances.

10. Pregnancy

If you have not had a period 14 days after embryo transfer, you should take a pregnancy test. If you are pregnant further medication may be prescribed to support the pregnancy.  An ultrasound scan will be performed at six or seven weeks’ gestation to confirm a visible heartbeat and ongoing pregnancy.

If, unfortunately, you do have a normal period, a follow-up consultation will be arranged and support counselling is available.

11. Frozen embryos

Spare embryos from your treatment cycle may have been frozen for future use. Under current guidelines they can be stored for up to 10 years. Embryos are stored by removing the fluid from inside the cells before freezing them in liquid nitrogen. 

There is an initial charge for freezing embryos, which includes storage for one year. Storage is then renewable annually.

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