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Patients’ Information Presentation
In vitro Fertilisation (IVF) &
Intracytoplasmic Injection (ICSI)
Purpose of this Presentation
• explain the IVF process in a stepwise
fashion
• help you understand the background and
the legal context to this treatment
• outline potential problems and risks and the
things we do to minimize these
Thank you for choosing Leeds
Fertility
Meet the team
Consultants
Doctors
Nurses
Sonographers
Embryologists
Health care assistants
Chaperones
Clerical staff
Counsellors
Welcome to Leeds Fertility
Welcome to Leeds Fertility: Waiting Room
Welcome to Leeds Fertility: Scan Room
Natural conception and fertility
Outpatient Clinic
The IVF Pathway
Outpatient Clinic
COMMON REASONS WHY IVF IS ADVISED
• Blocked or damaged Fallopian tubes
• Ovulation problems
• Irregular monthly cycles
• Reducing ovarian (egg) reserve
• Sperm problems
• Unexplained
• Combination
Aim of IVF is to overcome problems with egg and tubal problems
Aim of ICSI is to overcome problems with sperm problems
The IVF Pathway
Outpatient Clinic
TESTS
Purpose:
1. Identify reasons for not conceiving naturally
2. Plan the most appropriate treatment
Female
HORMONE TESTS
Day 1-3 FSH, LH, Oestradiol
At GP
AMH At Leeds Fertility
SEXUAL HEALTH SCREEN
Vaginal swabs, blood test
At GP
PELVIC ULTRASOUND At Leeds Fertility
Male
SPERM ANALYSIS At Leeds Fertility
SEXUAL HEALTH SCREEN
Urine test At GP
The IVF Pathway
Outpatient Clinic
EXPLAINING THE IVF PROCESS
Once the decision is made for IVF, the next step is a Nurse
Consultation
The IVF Pathway
Outpatient Clinic
LEGAL ASPECTS OF TREATMENT
• Confidentiality of fertility treatment
• Welfare of future children
The IVF Pathway
Waiting for the Nurse Consultation
Maximise your health • Stop smoking completely
• Reduce alcohol intake, ideally stop altogether
• Aim for a normal body weight
• Ensure any existing medical conditions are well-controlled
Make sure all your tests are up to date • Cervical smear test
• Confirmed rubella immunity
Folic acid and Vitamin D supplementation • Folic acid before and during treatment and for first 3 months of pregnancy
• Vitamin D supplements are also recommended
• Over the counter “multivitamins for pregnancy”
The IVF Pathway
Waiting for the Nurse Consultation
CONSENT FORMS
• Consent to fresh IVF treatment
Fate of spare embryos
• Consent to freeze embryos
• Consent to embryo research
• Consent to training of embryology scientists at Leeds Fertility
• Consent to humane discarding of spare embryos
• Consent to use of embryos after death (Posthumous use)
• Implication counselling is available
EngagedMD at Leeds Fertility
EngagedMD at Leeds Fertility
The IVF Pathway
Waiting for the Nurse Consultation
SUPPORT NETWORKS
Leeds Fertility counselling service
•Dealing with social and emotional aspects of fertility problems
•Free service
•Arrange an appointment:
• Directly call 0113 206 3100
• Request a referral from doctor or nurse
Essential counselling
•Donor gametes / surrogacy
The IVF Pathway
The Nurse Consultation
• Lasts about 1 hour
• Both partners need to attend
• Remember to bring with you, PASSPORT PHOTOS, any test results
TASKS
• Consent forms and HFEA Registration
• Prescription and medication injection teach
• Planning your treatment dates
• Settlement of invoice
Important: Please bring your treatment diary to every visit
The IVF Pathway
The Nurse Consultation
PRESCRIPTION Private Patients: Stork dispensary
service
NHS Patients: Stork dispensary
service / hospital pharmacy (NHS
prescription charge payable per top-up
item)
INJECTIONS
Need to consider: • Self /partner injection
• GP / practice nurse
• Daily attendance to: • Leeds Fertility /
• Gynaecology ward at St. James’s Hospital
SETTLING YOUR
INVOICE
Over the telephone prior to
nurse consultation
0113 2063157
Or
In person on the day of
nurse consultation
Leeds Fertility Business
Support Team
The IVF Pathway
The Nurse Consultation
Planning your calendar: TREATMENT PROTOCOLS
Each cycle is personalised to suit the needs of every couple
All types of cycle involve:
• Suppression of natural cycle
• Stimulation of the ovaries to produce multiple eggs
Three Protocols
Long cycle
Short cycle
Flare cycle
The IVF Pathway
Stimulation Phase
Right Ovary Left Ovary
Purpose of producing
multiple follicles
EGGS
FERTILISED EMBRYOS
2 CELL EMBRYOS
FOLLICLES
4 CELL EMBRYOS
8 CELL EMBRYOS
BLASTOCYST EMBRYOS
The IVF Pathway
Stimulation Phase
Right Ovary Left Ovary
Important: Choose a time of day to take your medicines and stick to it.
Ideally 21.00-22.00 is advised as it enables dose adjustments
The IVF Pathway
Ovulation Trigger
Right Ovary Left Ovary
Important: It is important that this injection is given at the correct
time. You may want to set your alarm to remind you!
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Late night injection
Egg Collection
35-37 Hours More than 37 Hours Less than 35 Hours
Insert virtual tour of unit (not my garden)… scan room, theatre, waiting area for OT….?
Welcome to Leeds Fertility: Theatre waiting area
The IVF Pathway
Egg Collection: Preparation
Right Ovary Left Ovary
• Expect to be at Leeds Fertility for 4-6
hours
• Refer to your diary for specific instructions
for both partners
• Men should have produced a back-up
sperm sample for freezing by now (if
necessary)
If you are very anxious, you may request a sedative the night
before the egg collection to help you sleep and remain calm
Welcome to Leeds Fertility: Operating Theatre
The IVF Pathway
Egg Collection
• Eggs are reached through skin
at the top of vagina
• Performed under ultrasound
guidance with a needle attached
to a very gentle suction pump
• Fast acting painkillers and
sedatives given into a vein
• Takes about 30 minutes
• Home within 4 hours
DO NOT DRIVE OR OPERATE MACHINERY x 24h
Welcome to Leeds Fertility: Theatre recovery
The IVF Pathway
After Egg Collection
MEDICATION
• Your personalised treatment plan will be explained before you
leave Leeds Fertility and depends upon the egg collection
results
COMMON SYMPTOMS AFTER THE EGG COLLECTION
• Mild discomfort for 1-3 days
• Slight discharge
Important: Please call the Leeds Fertility emergency phone if you need
advice
The IVF Pathway
Sperm sample
• Abstinence from ejaculation for 3-5 days before
egg collection
• Produced on the unit by masturbation on the
morning of the egg collection
• Sperm washed and prepared
The IVF Pathway
Witnessing Procedures
The IVF Pathway
Laboratory Phase
The IVF Pathway
Laboratory Phase
Finding the eggs
The IVF Pathway
Laboratory Phase
Eggs and sperm mixed together on the
afternoon of the egg collection
INSEMINATION
The IVF Pathway
Laboratory Phase
THE ICSI PROCEDURE
• The need for ICSI (sperm injection)
is usually known beforehand
• Occasionally, sperm sample poorer
than expected
• Only mature eggs can be injected
• Around 10% will be damaged by
the injection
• Pregnancy rates are the same as for IVF
The IVF Pathway
Laboratory Phase
THE ICSI PROCEDURE
The IVF Pathway
Laboratory Phase: Fertilisation
The IVF Pathway
Laboratory Phase
EMBRYO DEVELOPMENT
Early Day 2 Late Day 2 Day 3
Day 4 Day 5-6
2 cells 4 cells 8 cells
Morula Blastocyst
The IVF Pathway
Laboratory Phase
EMBRYO DEVELOPMENT:
Time lapsed imaging incubators: THE EMBRYOSCOPE • Allow embryos to be cultured in a closed system
• Built in cameras take photographs of the embryos every 10 minutes which
generates a video
• Allows continuous monitoring of the
embryos throughout the culture period
• Without this technology, embryos are
removed from the incubator at snap
shot time periods and checked
• Currently not NHS funded but
available to all patients for a fee
The IVF Pathway
Laboratory Phase
EMBRYO DEVELOPMENT:
Time lapsed imaging incubators:
THE EMBRYOSCOPE
IMPORTANT: If you wish to use
Embryoscope you must make
this known at the Nurse
Consultation
The maximum number of
embryo slots available per
couple is 12
If >2 embryos
The IVF Pathway
Laboratory Phase: The fate of the embryos
Selected for embryo transfer
Frozen Humanely discarded
If one or two embryos
The IVF Pathway Laboratory Phase: The fate of the embryos
Selected for embryo transfer
Humanely discarded
The IVF Pathway
The Embryo Transfer
Day of transfer
• Usually 5 days after egg collection
• Can be on day 3 if only 1 or 2 embryos available
Full bladder
No pain relief or sedation
Ultrasound guided
Partners welcome in procedure room
The IVF Pathway
The Embryo Transfer
The IVF Pathway
The Embryo Transfer… afterwards
• Immediately after you may empty your bladder
• There is no need to lie down or rest
• The two week wait:
• Carry on with normal activities
• Low impact activity
• Do not swim
• Urinary pregnancy test 18 days after egg collection
The IVF Pathway
Pregnancy Scan
• The first scan is done
about 5 weeks after
the egg collection
• Would expect to see
the pregnancy sac,
fetal pole (baby) and a
heart beat
<35 35-37 38-39 40-42 43-44 >44
Clinical pregnancy perembryo transfer
47% 46% 43% 32% 12% 0%
Live birth per embryotransfer
43% 38% 36% 23% 12% 0%
0%10%20%30%40%50%60%70%80%90%
100%
Axi
s Ti
tle
2016 – Fresh embryo transfer
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<35 35-37 38-39 40-42 43-44
Clinical pregnancy per embryotransfer
41% 41% 24% 30% 17%
2016 Frozen embryo transfer outcomes
Latest ranking of NHS IVF units in North of England: Based
on HFEA data
0% 5% 10% 15% 20% 25% 30%
James Cook University Hospital, Middlesborough
Jessop Fertility, Sheffield
Gateshead Fertility Unit
Newcastle Fertility Centre at Life
St Mary's Hospital, Manchester
Hewitt Centre, Liverpool
Hull IVF unit
Leeds Fertility
19%
19%
20%
20%
21%
24%
25%
26%
Births per embryo transferred (including all ages - July 2014 to June 2015)
The IVF Pathway
Time Lapse Imaging Incubators
• An optional tool to provide more information about embryo
development and help with embryo selection
• Embryos are in undisturbed culture as they do not need to
be taken out of the incubator to be assessed.
The IVF Pathway Time Lapse Imaging Incubators
• The odds of a live birth was 1.28 times higher when using
the embryoscope
• Lower risk of preterm birth and low birth weight
• Babies were 175 grams (6 oz) heavier at birth
The IVF Pathway
Embryoglue
• Available to all couples undergoing fresh or frozen embryo transfer for a fee
• Has high concentration of hyaluronan (a naturally occurring substance)
which is considered to improve implantation of embryos
37% 46%
0%
20%
40%
60%
80%
100%
Live birth rate
Low/no hyaluronan
High hyaluronan
Cochrane review:
6 studies
1950 participants
Moderate-quality evidence
Fertility and Genetics
• Pre-implantation Genetic Testing • PGT-M (monogenic disorders)
• PGT-SR (structural disorders)
Fertility and Genetics
• Pre-implantation Genetic Testing • PGT-A (aneuploidies) formerly PGS
Fertility and Genetics
Pre-implantation Genetic Testing (PGT-M/SR)
• >400 licensed
conditions
• Funded by NHSE
• Strict criteria
Fertility and Genetics
Pre-implantation Genetic Testing (PGT-A)
Euploid embryo (normal genetics)
CPR 70%
<10% miscarriage
PGT-A does NOT
increase pregnancy rates
per egg collection
PGT-A reduces time to
pregnancy
Who?
• Recurrent miscarriages
• Recurrent implantation failure
• History of pregnancy affected by
chromosomal anomaly
• Older women
But:
• No NHS funding
• Controversial
• Mosaicism
• Single women
• Women in same sex relationship
• Male partner has azoospermia
DONOR SPERM
Spe
rm d
on
atio
n
Known sperm donor
Anonymous sperm donor
Leeds Fertility Sperm Bank
London Sperm Bank
European Sperm Bank
Xytec
Cryos
0%
10%
20%
30%
Live birth per donorinsemination
LeedsFertility
Nationalaverage
The IVF Pathway
Treatment Risks
MULTIPLE PREGNANCY AND THE ONE AT A TIME INITIATIVE
• Our wish is for you to achieve a healthy pregnancy and live birth which is
more likely with a single baby
• Twins and more carry higher risks to mother and babies
• In couples with the highest chance of success, it is not wise to take
unnecessary risks by transferring more than one embryo
Leeds Fertility POLICY IN LINE WITH HFEA CODE OF PRACTICE: Single embryo transfer in women under 38 years, during the first or second cycle of
treatment, where the embryo development has been good overall
The IVF Pathway
Treatment Risks
Ovarian Hyperstimulation
Syndrome (OHSS)
• All patients experience a mild form of
OHSS
• Women at highest risk are those with
polycystic ovaries
• 1% will get significant symptoms
• We take special precautions in women
at high risk
Stimulation may be abandoned We may freeze all embryos
The IVF Pathway
Treatment Risks
Ovarian Hyperstimulatio
Syndrome (OHSS)
OHSS symptoms
• Bloating
• Abdominal discomfort
• Nausea and vomiting
• Diarrhoea
If you suspect you may have symptoms of OHSS, please contact us directly
Risks of Severe OHSS
• Blood clots (thrombosis)
• Dehydration
• Kidney problems
The IVF Pathway
Treatment Risks
Miscarriage •20-30% risk of miscarriage
• <5% risk of miscarriage
once a fetal heart has been
identified
Ectopic pregnancy •If unidentified, it may burst
and cause serious internal
bleeding
•The risk is greater when
tubal problems have been
identified
The IVF Pathway
Treatment Risks
Risks of the egg collection surgical procedure
• Infection
• Bleeding or internal injury
Risks of equipment failure
• Service contracts and safety checks in place
The IVF Pathway
Treatment Risks
RISKS OF INTRACYTOPLASMIC
SPERM INJECTION (ICSI)
• Used worldwide for >20 years
• Potential concerns regarding the risk of passing on a genetic
reproductive problem
• Studies so far are small and do not include effects that may be seen in
older children and future generations
• No clear evidence that ICSI results in more birth defects than
occur with natural conception • No clear evidence giving concerns about the physical and
intellectual development of ICSI children
The IVF Pathway
Treatment Failure
POSSIBLE REASONS • Failure
• to produce enough eggs
• to collect eggs from ovaries
• of eggs to fertilise
• of embryos to divide and develop
• Unexpected illness in either partner
A negative pregnancy test often results with no
clear explanation
These are all UNCOMMON
The IVF Pathway
Research
There is still so much work to do to improve the likelihood of
success, and we urge that you consider participating in our
research projects
• DHEA Trial
• For women with reduced ovarian reserve
Access Fertility offers you all your money back if you don’t have a baby during treatment
- Unlimited Programme* (patients U38)
- Unlimited cycles of IVF over 2 years
- 100% refund if you don’t have baby
- Refund Programme* (patients U40)
- Up to 3 cycles of IVF with unlimited FETs
- Up to 100% refund if you don’t have a baby
- Multi-Cycle Programme (patients U45)
- Up to 2 cycles of IVF with unlimited FETs
- Fixed, discounted fee
- For more information please call 01865 80 1000
- Monday to Thursday – 8am – 6pm, Friday 9am – 4pm
- www.accessfertility.co.uk
*These programmes are subject to a medical review by Access Fertility (zero cost), and there is a 90% acceptance rate
Did you know?
Men and women should ideally prepare for pregnancy for at least 3 months before conceiving What a mother-to-be eats before she conceives has a significant effect on the baby The first 21 days of pregnancy are some of the most important for the future health of your child, before a woman knows she’s pregnant Male factor infertility causes a third of all cases of infertility. Diet and lifestyle could have an effect on sperm health
How can Leeds Fertility help?
Join our free 3-week fertility and
preconception care support group. We will explain natural, dietary and
lifestyle factors that can boost fertility and prepare you for a
healthy pregnancy
Opening welcome by Professor Adam Balen, Professor of Reproductive
Medicine & Chair of the British Fertility Society Week One: Tuesday, 27th Nov, 7-9pm at Leeds Fertility, Seacroft Hospital Week Two: Tuesday, 4th Dec, 7-9pm at Leeds Fertility, Seacroft Hospital Week Three: Tuesday, 11th Dec, 7-9pm at Leeds Fertility, Seacroft Hospital Followed by an optional cookery class (date TBC) at an external venue (there will be a
nominal fee for this)
Places are limited so register soon at
Thank you Follow us on Social Media to keep updated
Leeds Fertility Clinic
@Leedsfertilityclinic
@Leedsfertility
www.leedsfertilityclinic.co.uk
