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18.06.2014


IUI involves the injection of a sample of prepared sperm from the husband or partner(IUI-H) into the woman's uterine cavity around the time of ovulation.
IUI is recommended only if the woman has healthy fallopian tubes, preferably confirmed laparoscopically, and if the man's semen analysis is normal.
The chance of success with IUI is enhanced if insemination is combined with ovulation induction using small doses of fertility drugs.
IUI is also sometimes carried out using the sperm of an anonymous donor (IUI-D) in couples where there is a significant male factor involved. Yes, for some couples, IUI is a very effective form of treatment provided that the man's sperm and the woman's tubes are healthy. The term In Vitro Fertilisation (IVF) literally means fertilisation 'in glass' and it refers to the process where a woman's eggs are fertilised outside of her body in the laboratory. Under the care of a consultant gynaecologist, the woman is given fertlity medications to stimulate her ovaries to prodice many follicles. The number and size of the developing follicles is measured by trans-vaginal ultrasound scans. Egg retrieval is a minor theatre procedure which is carried out on an outpatient basis under anaesthesia.
In some couples an alternative form of insemination is required called ICSI, which involves injecting a single sperm into each egg using a very fine neddle, rather than mixing the eggs and sperm in a dish. Irrespective of the method of insemination used, on the moring after egg retrieval, the eggs are examined to see which have fertilised. Fertilised eggs (zygotes) are then routinely cultured in the IVF laboratory until day 3, at which time the best 1-3 embryos are selected and transferred back into the woman's uterus.
ICSI is very similar to conventional IVF in that gamete (eggs and soerm) are collected from each partner.
In conventional IVF, the eggs and pserm are mixed together in a dish and the sperm fertilises the egg 'naturally'. ICSI refers to the laboratory procedure where a single sperm is picked up with a fine glass needle and is injected directly into each egg.
From a patient perspecrive, undergoing an ICSI treatment cycle is exactly the same as a conventional IVF cycle, and the same steps are involved.
From a patient perspective, undergoing an ICSI treatment cycle is exactly the same as a conventional IVF cycle. IMSI is a new technique that allows a better selection of the sperm that is going to be micro-injected during an IVF or during egg donation. TESE is a surgical sperm retrieval produce used in fertility treatment for men who have no sperm in their ejaculate. Under the care of a consultant urologist, TESE is a minor theatre procedure carried out on an outpatient basis under local anaesthesia. Sperm are retrieved from the testes and can be used to achieve fertilisation of eggs in the laboratory. In consultation with the urologist, the doctor may advise that TESE is carried out in advance of any fertility treatment to confirm that sperm production is occurring. Again, providing that there are suitable numbers of sperm present, the sample can sometimes be frozen for use in future treament cycles. After insemination by IVF or ICSI, fertilised eggs are then routinely cultured in the laboratory for 3 days before being transferred back into the woman's uterus.
Before embryo transfer, the embryos are graded by a specially trained embryologist in order to select the embryos with the best chance of implanting in the uterus and forming a healthy baby.
The egg is fertilised following ovulation from the ovary and the embryo goes on to divide (cleave) as it travles along the fallopian tube.
Standard practice in IVF involves the replacement of embryos into the uterus after 3 days when the embryos are at the cleavage stage of development.Blastocyst transfer however involves extending the period that the embryos are cultured in the laboratory to 5 or 6 days.
It is known that a lot of embros are destined to arrest at early stages so extended culture allows the embryologist to identify which (if any) of a group of embryos have the best potential for implantation by identifying those which form a normal blastocyst in culture. Transferring embryos at the blastocyst stage also provides a better co-ordination between the embryo back in the right place (the uterus) at the right time(blastocyst stage). Overall, if you have a normal blastocyst for transfer on day 5, the chances of pregnancy are higher (in our hands) than if you have embryos transferred on day 3.However, the chances of having no embryos for transfer at all are also higher. Semen freezing is useful for the man who finds it difficult to ejaculate on demand and where it may result in an inability to produce a sample on the day of egg collection.However, the quality of the semen is reduced after freezing, so if possible fresh samples are preferred on the day required.
In a typical IVF or ICSI treament cycle, the woman's ovaries are stimulated to produce many eggs.
Embryo freezing (cryopreservation) is a method of preserving the viability of embryos by carefully cooling them to very low temperatures (-196. The main benefit of embryo freezing is the option to have frozen embryos thawed and transferred to the woman's uterus in the future without having to undergo stimulation of the ovaries or egg retrieval. The decision regarding the most appropriate treatment will be made in consultation with the clinician.


Women who do not produce eggs or those with poor quality eggs may be advised to seek treatment with donated eggs.
Egg donation has become an increasingly popular option because it has higher success rates than IVF cycles using the woman's own eggs.
As with natural conception the chances of success following any fertility treatment decline with the age of the woman. The number of healthy eggs collected and the number of normally fertilised eggs also affect the outcome. In a woman with normal menstrual periods, apart from her age the second most important element that affects IVF outcome is the ovarian reserve – the number of potential eggs available in the ovary – which is usually measured by checking the AMH. One of the complications of assisted reproduction is the increased incidence of multiple pregnancy. Problems are more commonly seen in triplet or higher order multiple pregnancies but may also occur with twin pregnancies. The maximum number of embryos transferred is generally three and therefore high order multiple pregnancies are not common.
When 3 embryos are transferred in this younger group of patients, the overall chances of success are not significantly increased but the chances of multiple pregnancy are greater. In women over 37 the implantation rate is lower which accounts for the reduced pregnancy rate. An ectopic pregnancy is a pregnancy that occurs somewhere other than in the uterus, most commonly in the fallopian tubes. If you would like to use a Clearblue Ovulation Test and are wondering when you should start testing, this tool can help you.
If you don`t know your cycle length, we suggest you wait for your next cycle and note the day your period starts (Day 1) and the length of this cycle before using this online tool*.
How long are your cycles on average?To measure the length of your menstrual cycle, count from the day your period starts to the day before your next period starts. If you don`t know your menstrual cycle length, wait until you`ve had at least one cycle, then come back to use this calculator. Due to the variability in women’s menstrual cycles, it can be difficult to know when YOUR fertile days are. If you're eating well before you get pregnant, you'll have all the right nutrients to support your baby from the day of conception onwards.
It may be useful for women who have cervical mucus hostility and in some cases of unexplained infertility.
These are taken by the woman, and the development of the follicles on the ovary is monitored with ultrasound. A concentrated preparation of motile sperm is extracted from the semen sample in the laboratory. It is also often used in cases of unexplained infertility and can be used in combination with ICSI (intracytoplasmic sperm injection) in cases of severe male factor infertility. Follicles are the small fluid filled structures which develop on the ovaries, each of which hopefully contain eggs.
The exact number of follicles which develop varies between patients, but the average is about 10. The trans-vaginal ultrasound probe is used to visualise the ovaries and a needle attached to the probe is passed through the vaginal wall into the follicles. A semen sample is provided by the male partner and, in the laboratory, a concentrated preparation of the best motile sperm is extracted from the semen sample.
For some patients, a blastocyst cycle may have been recommended in which case embryo culture is extended to day 5.
However to have a chance that this will occur, large numbers of actively swimming normal sperm are required. This is carried out in the laboratory by experienced embryologist using specialist equipment. These men have no sperm in their ejaculate because either there is a blockage in the route between the site of sperm production (the testes) and ejaculation or because there is a partial or complete failure in sperm production in the testes. However, because the nubers of sperm retrieved is often very low, it is necessary to combine TESE with ICSI. If suitable numbers of sperm are identified on this occasion, it is sometimes possible to freeze the testicular extract and to thaw and use this sample for subsequent treatment.
Embryos with fewer cells may still be good, but they are less likely to continue normal development. A small amount of fragmentation is normal, but excessive fragmentation suggests that the embryo will have a lower chance of continuing normal development. Following fertilisation and embryo culture, the best embryos are selected for embryo transfer. It is also possible that there may be enough frozen embryos for more than one subsequent cycle.


In some cases, the woman's natural cycle will be monitored by ultrasound to assess the development of the lining of the uterus and to determine the timing of ovulation and hence embryo transfer.
This does however vary between patients and it is possible that none of a couple's embryos will survive the freezing and thawing process. This is mainly because in general the best embryos in a group will already have been trasferred on the fresh embryo transfer. Egg donation also allows for strong biological and developmental relationships within the family because donor eggs are fertilised with the male partner's own sperm through ICSI, matured to the embryonic stage and then placed in the partner's uterus, providing her with the same experience of pregnancy as natural conception. There is much documentaion to show a significant drop in the pregnancy rate for women over the age of 40.
The number of embryos available affects the chances of success for transfer and the number transferred. Women with reduced ovarian reserve have a lower, but reasonable chance, of achieving live birth.
Concerns about multiple pregnancy arise because it is associated with a great incidence of complications.
Because of the greater chance of pre-term labour and delivery, there is an increased risk of the babies being born before they are mature enough to survive and a greater risk of complications associated with prematurity if they do. In an attempt to improve the overall chances of a pregnancy most women over 37 are usually advised to have 3 embryos transferred, if they are available on day 3. With assisted reproduction treatment this statistic is not significantly different, although in women over 40 there is an increased risk. The incidence of ectopic pregnancy with assisted conception treatment is approximately 2.5%.
If your cycle length varies by more than three days, choose the shortest cycle you`ve had in the last six months to work out when to start testing. However, without determining your cycle length, it is possible that you may miss your LH surge because you have started testing too late, or you may need to start a new pack to continue testing. In a study of 87 women, 4 or more fertile days were identified in 80% of cycles using actual cycle length. Crocodile dung is actually slightly alkaline, like modern-day spermicides, so it could have worked. The insemination is timed to take place 36-40 hours after administration of another hormone injection which triggers ovulation. ICSI is a variant of IVF and is where single live sperms are injected directly into oocytes (ripe eggs).
The fluid within each follicle is aspirated and then examined in the IVF laboratoryfor the presence of an egg.
This sperm preparation (containing approximately 150,000 sperm) is added to the dishes containing the eggs, and they are incubated together overnight. The correct positioning of the embryos is confirmed by abdominal ultrasound, so the woman is required to have a full bladder for the procedure.
For many couples, the number of suitable sperm available may be very limited or there may be other factors preventing fertilisation, so conventional IVF is not an option. Very few sperm are required and the ability of the sperm to penetrate the egg is no longer important as this has been assisted by the ICSI technique. More commonly however, once it has been confirmed that sperm production is occurring, the TESE procedure is repeated on the day of the egg retrieval and the fresh sample used for ICSI.
For about 50% of couples, there will also be good embryos which are surplus to those required for embryo transfer. This is carried out in the laboratory using specialised freezing equipment and the embryos can then be safely stored in liquid nitrogen for extended periods.
In other cases, depending on the woman's history a more hormonally controlled cycle may be warranted. Unfortunately the risk of miscarriage in this group is higher; therefore the percentage of women having a live birth decreases.
We would not generally recommend this to women of all ages if the embryos are grown to blastocyst stage.If a woman conceives with multiple pregnancy, careful antenatal management is advised. It is potentially a serious condition but will often be detected very early in the pregnancy by ultrasound scan. After identification, the eggs are washed and transferred into special culture medium in Petri dishes in an incubator. ICSI does not guarantee that fertilisation will occur as the normal cellular events of fertlisation still need to occur once the sperm has been placed in the egg. It is recommended that a detailed vaginal ultrasound scan be carried out 3 weeks after confirmation of pregnancy.



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