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  1. Boosting your egg production

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    Boosting your egg production1, 2

    After your natural hormone cycle has been suppressed, you’ll need to take an IVF treatment that encourages your ovaries to produce more eggs than normal

    These treatments are called gonadotrophins. They contain a hormone called follicle-stimulating hormone (FSH), and possibly luteinising hormone (LH) too.

    You’ll usually need to take them as daily injections you give yourself for around two weeks (treatment duration can vary). Giving injections like this can be a little daunting at first, but you’ll be given plenty of support and guidance to learn how to do this.

    References:

    1. National Institute of Health and Care Excellence. Fertility problems: Assessment and treatment [CG156].

    Available: https://www.nice.org.uk/guidance/cg156 (last accessed on April 2021).

    2. National Health Service (NHS). What happens – IVF (Page last reviewed: 01 August 2019).

    Available: https://www.nhs.uk/conditions/ivf/what-happens/ (last accessed on April 2021).

    UK-RMMH-2100028 | Date of preparation: June 2021

  2. Collecting and fertilising your eggs

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    Collecting and fertilising your eggs1, 2

    When mature, your eggs will be collected ready for fertilisation

    Egg collection

    Egg collection usually takes place while you are under sedation. Egg collection is a relatively quick and painless procedure, and usually takes place while you are under sedation. A general anaesthetic is not normally required. A trained doctor will insert a hollow needle attached to an ultrasound probe into your vagina.

    The ultrasound probe is used to help guide the needle through the wall of your vagina and into each of your ovaries to collect your eggs – it does not go through your fallopian tubes.

    This procedure usually only takes 15-20 minutes, but it can make you feel a little sore and bruised – for a short while afterwards you may experience some cramping and experience a small amount of bleeding from the vagina. If necessary, you may want to book a couple of days off from work in order to rest, and you will also need someone to accompany you (such as your partner) to and from the procedure.

    Fertilisation

    Your partner will be asked to provide a sample of sperm at the same time as your eggs are collected. If preferred this sample can be provided in advance and frozen before use, or you may be using a sample of frozen donor sperm.

    The sperm sample is washed, and the highest quality sperm selected. These are then mixed with your eggs and stored in a temperature-controlled environment for 16-20 hours. Sometimes, a single sperm may be selected and directly injected into an egg, this process is known as intra-cytoplasmic sperm injection (ICSI).

    Three to five days after egg collection, the eggs are then checked by a trained professional to see if they have fertilised successfully. The best quality fertilised eggs, now called embryos, are selected and maintained in a stable environment until they mature ready for transfer back into your womb or for freezing to be used in a future IVF treatment cycle.

    Embryo transfer

    After fertilisation, a single or multiple embryo(s) (depending on what the clinic decides is best for you) can be transferred into the womb.

    This procedure uses a small thin tube that passed up the vagina and through the cervix into the uterine cavity. It’s similar to a cervical screening test and is simpler than the egg collection procedure, so you won’t need to go under general anaesthetic.

    References:

    1. National Institute of Health and Care Excellence. Fertility problems: Assessment and treatment [CG156].

    Available: https://www.nice.org.uk/guidance/cg156 (last accessed on April 2021).

    2. National Health Service (NHS). What happens – IVF (Page last reviewed: 01 August 2019).

    Available: https://www.nhs.uk/conditions/ivf/what-happens/ (last accessed on April 2021).

    UK-RMMH-2100027 | Date of preparation: June 2021

  3. Coping with emotions during IVF

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    Coping with emotions during IVF1,2

    It’s important to keep in touch with your feelings and ask for help

    Fertility treatment can be an extremely stressful time. You’re taking daily treatments and having quite invasive procedures, your hormones are all over the place, and you might be juggling other commitments at the same time. It’s vital that you keep in touch with how this is making you feel, and to seek help if you need it. Below are a few useful tips for doing this.

    Remember – you’re not alone. There’s a wealth of advice and support to be found. Your clinic will be able to help and may offer a counselling service, and you can also find useful advice and local support groups via the Fertility Network UK and the HFEA .


    It can take more mental energy to pretend that nothing’s wrong. Be realistic with yourself and know your limits.


    Of course, men and women cope with emotions in different ways. But it can really help to let each other know how you’re feeling.


    It’s good to have a positive outlook, and doing so will help you feel less stressed. At the same time, make sure you’re well informed about your chances of success so that you’re able to cope if your treatment doesn’t go to plan.


    Don’t let infertility or your treatments take over your life. Try new things with your friends and family to help keep your mind off it.


    Try activities that help you relax – yoga, acupuncture or anything else that helps you feel physically or emotionally calm.


    You might not want to tell everyone about your fertility treatment. But it definitely helps to be able to chat with someone about how you’re feeling. This could be a friend, family member, an online fertility forum, or a professional counsellor.

    If you’re considering professional help, try to find a counsellor experienced in dealing with fertility issues. Your clinic should be able to help you with this, and you can also find private counsellors on the British Infertility Counselling Association website.

    References:

    1. Fertility Network UK.


    https://fertilitynetworkuk.org/access-support/support-groups/ (last accessed October 2021).

    2. Human Fertilisation & Embrology Authority.


    https://www.hfea.gov.uk/about-us/our-blog/how-to-thrive-and-not-simply-survive-during-fertility-treatment/ (last accessed October 2021).

    UK-RMMH-2100026 | Date of preparation: June 2021

  4. Embryo transfer

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    Embryo transfer1, 2

    After your fertilised eggs have spent two to five days in a temperature-controlled environment, they will be selected ready for transfer back into your womb

    The best quality embryos are selected for transfer back into your womb. This transfer is a bit like having a cervical smear test.

    During the procedure, a trained doctor will insert a device into your vagina that will help hold it open. This is so that the cervix (the opening to the womb) is visible.

    A fine tube is then passed through the cervix, normally using an ultrasound scan to guide it into the right place.

    The embryo or embryos are then transferred down the tube and into your womb.

    This is normally a pain-free process and unlike egg collection no sedation is usually necessary. You may experience a little discomfort because you need a full bladder if ultrasound is used.

    If you have any remaining high-quality embryos these can be frozen and stored for use in a future cycle, should you wish.

    References:

    1. National Institute of Health and Care Excellence. Fertility problems: Assessment and treatment [CG156].

    Available: https://www.nice.org.uk/guidance/cg156 (last accessed on April 2021).

    2. National Health Service (NHS). What happens – IVF (Page last reviewed: 01 August 2019).

    Available: https://www.nhs.uk/conditions/ivf/what-happens/ (last accessed on April 2021).

    UK-RMMH-2100025 | Date of preparation: June 2021

  5. Fertility checks and tests

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    Fertility checks and tests1, 2

    Before you start IVF, it’s important to check if it’s physically the right course of action for both you and your partner. This usually starts with a visit to your GP

    At the GP

    Your GP will ask you a series of questions about your medical, sexual and social history. You may be uncomfortable or embarrassed by these types of questions, but it’s important to answer openly and honestly. The answers you give will help determine your next course of action, and if further tests may be necessary. Ideally, it is good to have your partner with you at this meeting.

    You can find a more detailed guide to the sorts of questions and examinations your GP might do on the NHS Choices website.

    Initial fertility tests for women

    Some of these can by done at your GP, while others may require a trip to your local hospital or fertility clinic. These can include:

    • – A cervical smear test if you haven’t had one recently
    • – A urine test for chlamydia, a common, treatable infection which could be blocking your fallopian tubes and thereby stopping you from becoming pregnant
    • – Blood tests to:
      • Check if you are ovulating (these are usually taken seven days before your period is due)
      • Measure any hormone imbalances and check for early menopause
      • Check for German measles (Rubella) which could harm an unborn baby
    • – An ultrasound scan to look at your womb and ovaries
    • – Hysterosalpingo-contrast sonography (HyCoSy), a more detailed ultrasound scan involving a vaginal ultrasound probe to check the fallopian tubes for blockages or follow the development of a follicle to see if an egg is developing
    • – Hysterosalpingogram – an x-ray to check your fallopian tubes
    • – Laparoscopy – an operation to check for any blockages in the fallopian tubes or other problems with your reproductive organs
    • – Hysteroscopy – a procedure which involves using a telescope with a camera attached to view your uterine cavity to check for conditions such as fibroids or polyps
    • – Very occasionally, a small tissue sample (biopsy) may be taken to assess the lining of your womb

    What happens next?

    If results are normal for both partners, some lifestyle changes may be recommended to help you conceive naturally. If not, or if you fit other criteria for IVF treatment such as length of time trying to conceive, you may be referred to a fertility clinic.

    Choosing a clinic

    The HFEA (Human Fertilisation & Embryology Authority) has this handy guide to help you choose a fertility clinic, if this is applicable to you.

    Preparing for IVF

    Once you’ve had an appointment with a fertility specialist and they’ve recommended in vitro fertilisation (IVF) for you and your partner, you’ll be introduced to a whole new world of appointments, scans, treatments. For a heads up on what to expect, check out some FAQs.

    References:

    1. National Institute of Health and Care Excellence. Fertility problems: Assessment and treatment [CG156].

    Available: https://www.nice.org.uk/guidance/cg156 (last accessed on April 2021).

    2. National Health Service (NHS). What happens – IVF (Page last reviewed: 01 August 2019).

    Available: https://www.nhs.uk/conditions/ivf/what-happens/ (last accessed on April 2021).

    UK-RMMH-2100024 | Date of preparation: June 2021

  6. Helping your partner during IVF

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    Helping your partner during IVF1

    Some handy tips that will help keep you both feeling in control

    Although fertility treatment – with all the injections, the procedures, and the hormone fluctuations – can physically impact the female partner more than the male, it’s important to realise that the emotional impact can be more equal. Here are some tips to help keep things manageable.


    It may seem simple, but it’s important to let your other half know you’re there for them. Of course, they might not always want to talk, but it’ll be reassuring to know you’re happy to listen if and when they want to express their feelings or concerns.


    Whenever you can, consider joining your partner during appointments at the fertility clinic. It’ll mean you’re more informed and better able to understand what’s going on.


    The fertility hormone treatments can make some women feel completely differently to how they normally are. Although it’s difficult to imagine what she’s feeling like, try to be understanding if you can and remember her mood changes will be temporary. Doing so can help prevent you from getting worked up the wrong way.

    References:

    1. National Institute of Health and Care Excellence. Fertility problems: Assessment and treatment [CG156].

    Available: https://www.nice.org.uk/guidance/cg156 (last accessed on April 2021).

    UK-RMMH-2100023 | Date of preparation: June 2021

  7. Monitoring your progress throughout IVF

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    Monitoring your progress throughout IVF1

    At several stages after you start taking your IVF treatments your clinic will ask you in for check-up appointments

    These check-ups may take the form of vaginal ultrasound scans (using an ultrasound probe that is inserted into the vagina) and blood tests. Based on the results of these checks your clinic may need to make adjustments to the treatments you’re taking or the number of days you take them.

    References:

    1. National Institute of Health and Care Excellence. Fertility problems: Assessment and treatment [CG156].
    Available: https://www.nice.org.uk/guidance/cg156 (last accessed on April 2021).

    UK-RMMH-2100022 | Date of preparation: June 2021

  8. Preparing your eggs ready for collection

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    Preparing your eggs ready for collection1

    Just before you come in for your egg collection appointment, you’ll need to take a final
    hormone injection

    This treatment is usually hCG (human chorionic gonadotrophin). It is often called a ‘trigger hormone’ because it progresses
    your eggs into their final stage of maturation.

    References:

    1. Hershko Klement A, Shulman A. hCG triggering in ART: an evolutionary concept. International journal of molecular sciences. 2017 May;18(5):1075.

    UK-RMMH-2100021 | Date of preparation: June 2021

  9. Preparing your womb for implantation

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    Preparing your womb for implantation1

    After your eggs have been collected, you may need to take progesterone to help prepare your
    womb to support a developing embryo

    Every month, the lining of your womb sheds and then regenerates itself, ready to receive a fertilised egg.
    During IVF treatment, you may need to take a drug called progesterone that helps encourage your womb
    lining to thicken at just the right time for the developing embryo to implant successfully and also helps to
    maintain early pregnancy after successful IVF.

    Progesterone is usually administered after the egg preparation injection of hCG or on the day the embryo is
    returned to the womb.

    Progesterone can be administered as:
    • – Vaginal drug delivery system
    • – Injection

    References:

    1. National Institute of Health and Care Excellence. Fertility problems: Assessment and treatment [CG156].

    Available: https://www.nice.org.uk/guidance/cg156 (last accessed on April 2021).

    UK-RMMH-2100020 | Date of preparation: June 2021

  10. Suppressing your natural cycle

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    Suppressing your natural cycle1, 3

    As part of preparing your body to accept IVF treatments, sometimes you’ll need to take drugs that suppress the natural hormones your body produces

    There are several different types of cycle-suppressing drugs. They alter the levels of hormones that control ovulation, suppressing (in a process called ‘down regulation’) your natural menstrual cycle. Your fertility clinic will recommend which, if any, is appropriate for you.

    These can include one or more of:

    Gonadotrophin-releasing hormone (GnRH) analogues2, 3

    This type of treatment blocks the release of a hormone produced by the pituitary gland at the base of the brain, which controls naturally occurring ovulation – the release of an egg by your ovaries. Blocking the release of this hormone therefore down regulates your natural monthly cycle, and stops the release of eggs from your ovaries until they are ready to be collected. There are two forms of GnRH analogues:

    – GnRH agonists:

    • Commonly used in ‘long’ IVF cycles
    • Usually taken for a week or so before and after the first day of your period – they are also taken for about two weeks after your period
    • Available as a nasal spray (several times a day), a daily injection or a monthly injection

    – GnRH antagonists

    • Commonly used in ‘short’ IVF cycles
    • Usually taken for about a week after the first day of your period
    • Taken as daily injections

    References:

    1. National Health Service (NHS). What happens – IVF (Page last reviewed: 01 August 2019).

    Available: https://www.nhs.uk/conditions/ivf/what-happens/ (last accessed on April 2021).
    2. Al‐Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin‐releasing hormone antagonists for assisted reproductive technology. Cochrane Database of Systematic Reviews. 2016(4).
    3. National Institute of Health and Care Excellence. Fertility problems: Assessment and treatment [CG156].
    Available: https://www.nice.org.uk/guidance/cg156 (last accessed on April 2021).

    UK-RMMH-2100019 | Date of preparation: June 2021