In-vitro fertilisation (IVF)

Stimulation

A typical IVF cycle takes four to six weeks. This includes:

• your nurse-co-ordination appointment
• administering injections at home for 8-14 days
• egg collection (34 to 38 hours after your final injection)
• embryo transfer (usually 5 days after your egg collection); and
• taking a pregnancy test 10-12 days later

You will have regular scan and blood test appointments throughout your cycle. If you are pregnant, you will continue your hormone treatment for another 8-10 weeks before transferring to the care of a maternity team.

Treatment will include  injections used to stimulate your ovaries and control ovulation. . The injections used to stimulate your ovaries to grow eggs last for 8 to 14 days on average. During this period, you will need to visit our unit for vaginal ultrasound scans to monitor how your ovaries and the lining of your uterus respond to your daily FSH treatment. Some patients will have two scans, others will have as many as five. Your scan appointments will typically take about 20 minutes, with another 10 minutes for blood tests.

Egg collection

At the end of the stimulation phase, we will instruct you to give yourself a final injection (the trigger injection), which matures your eggs. Your eggs should be ready for collection within 34-38 hours, so we will schedule another appointment for you then.

You and your partner will need to attend your egg collection appointment together. You will be sedated and your eggs will be collected using ultrasound guidance. This appointment will take two to four hours. On the same day, your partner will be asked to produce a semen sample. The eggs will be mixed with the sperm and cultured in the laboratory. The embryology staff will call you to let you know how many eggs have been fertilised.

You will need to return to clinic for your embryo transfer appointment, usually five days later. Your embryo transfer appointment will take two to three hours. Following embryo transfer, you will go home and take a daily dose of the hormones progesterone and oestrogen until you perform a pregnancy test, which is usually done 16 days after egg collection.

Pregnancy test

If your pregnancy test is positive, we will invite you in to perform a scan and confirm your pregnancy. You will then continue your hormone treatment until you are at least 10 weeks pregnant.

At that point, we can refer you directly to our maternity service, or back to your GP to discuss your options for maternity care. Find out more about NHS and private maternity services at Imperial College Healthcare, which are the first in London to receive an outstanding rating from the Care Quality Commission (CQC).

If we identify any potential risks or complications when we perform your scan, we will refer you directly to the early pregnancy unit at Queen Charlotte’s & Chelsea Hospital.

If your cycle has not been successful, we will offer you a consultation to discuss your next steps.

Ovarian hyperstimulation syndrome (OHSS)

Ovarian hyperstimulation syndrome (OHSS) is a reaction to fertility drugs used to stimulate egg production. In some people, fertility drugs stimulate the ovaries to develop too many eggs, resulting in large and painful ovaries. Around one third of women will have mild OHSS, while fewer women will have moderate or severe OHSS. In very rare cases, severe OHSS can be life-threatening. Symptoms include:

• Swollen stomach and stomach pains
• Nausea and vomiting
• Shortness of breath
• Faintness
• Reduced urine output

Most who develop strong OHSS symptoms do so the week after egg collection. Please contact us immediately if you experience these symptoms.

Multiple pregnancy or birth

Multiple births (twins, triplets or more babies) are classed as high-risk pregnancies.  You are more pre-disposed to miscarriage and are at a increased risk of premature birth which also has the potential for associated health conditions.  You will be reviewed more frequently throughout your pregnancy journey by your care provider.

Ectopic pregnancy

An ectopic pregnancy occurs when a baby develops outside the womb, usually in the fallopian tube. Unfortunately, the pregnancy is lost as it is not possible to move the baby to the womb. While all pregnancies risk an ectopic pregnancy, if you receive IVF treatment, you may be more at risk.

Symptoms include:

• a one-sided low abdominal pain
• vaginal bleeding or dark brown or red vaginal discharge
• diarrhoea or pain when you go to the toilet.

Please contact us immediately if you experience any of these symptoms.

The HFEA offers more information about the risks associated with fertility treatment.

Possible birth defects

The risk of birth defects is very low – about two per cent of children in Europe are born with birth defects. Some research has suggested fertility treatments may be associated with an increased risk of birth defects. However, it is not yet clear whether that risk is linked to the fertility treatments themselves or to fertility challenges in parents. Research in this area is on-going.