Fertility treatment steps

1. Fertility treatmentsteps In vitro fertilization (IVF) involves the fertilization of eggs with sperm outside thebody. Indications for its useinclude: Conception following a period of expectant management in people with unexplainedinfertility. Treatment for an identified cause of male factor infertility (often in combination with intracytoplasmic sperminjection.. Treatment forendometriosis. IUI using partner or donor sperm. Severe tubaldisease. Severe male factor infertility (IVF with ICSI may be the preferredoption). Failure of spermatogenesis following cancer treatment where cryopreserved semen has been unsuccessful at achieving conception with IUI. Ovarian failure caused by cancer treatment where eggs or embryos have been crypreserved. Where oocyte donation is being used An IVF treatment cycle comprises of the following seven sequentialstages. However, depending on the exact protocol being used, not all the stages areused: Pre-treatment This is believed to have three potential functions: Improving the response to exogenous hormonetherapy Minimizing the risk of ovarian cyst formation, and facilitating the scheduling of stimulated IVF cycles to ensure that the timing of oocyte recovery coincides with availability of clinical and laboratorystaff. Down-regulation This temporarily stops the pituitary gland from functioning which reduces the risk of a cycle being cancelled from early exposure to luteinizing hormone (LH) which could disruptnormal

2. follicle and oocyte development or stimulate premature release of the eggs before they can be retrieved surgically (‘harvested’) prior to insemination in thelaboratory. Controlled ovarianstimulation The aim of this stage is to produce a number of mature eggs which can be retrieved surgically prior to fertilization in thelaboratory. Ovulationtrigger At the end of the stimulation phase of an IVF cycle, a drug (‘ovulation trigger’) is used to mimic the natural endogenous LH surge which initiates the process of ovulation. The mature eggs are collected from the woman (‘harvested’) and fertilised with sperm in alaboratory. Oocyte and spermretrieval After triggering, mature oocytes are aspirated from the woman’s ovaries for fertilisation in the laboratory. In addition, in some cases of male factor infertility the sperm has to be obtained directly from thetestes. Embryoreplacement Once the eggs have been fertilized, one or two of the resultant embryos are then placed back into the woman’s uterus 2–3 days later, at the cleavage phase of embryo development. Longer laboratory culture times can be used with good quality eggs with intra-uterine replacement occurring after 5–6 days, at the blast cyst phase ofdevelopment. Luteal phasesupport After embryo replacement, drugs may be given to help support the early phase of pregnancy development. This is intended to mimic what happens in natural conception, where, once ovulation has occurred, the endometrium prepares to receive a fertilised embryo. This consists of a series of changes within it which are driven by progesterone produced by the corpus luteum in the ovary. An IVF cycle may be stopped (‘cancelled’) at various points within the treatment process. A cycle will most often be cancelled either because the treatment presents a risk to the women (for example ovarian hyperstimulation syndrome [OHSS]) or because the woman has not responded to part of the treatment (for example ovarian stimulation), and this most frequently occurs during ovarian stimulation; that is, before oocyte retrieval. However, in some circumstance oocytes may be collected and frozen for later transfer. This may be construed as interruption of the fresh IVF cycle rather than cancellation as the intention is to transfer embryos at a laterdate.