In Vitro Fertilisation Treatment
In Vitro Fertilisation (IVF) is one of the most common procedures performed at Cayman Fertility Center. IVF refers to “fertilisation in the lab” and is a process where a woman’s eggs are combined with a man’s sperm outside of her body, to produce embryos. IVF is an option for many couples who struggle to become pregnant on their own. Once embryos are created they are transferred to the woman’s uterus after 3 to 5 days and it is here that nature takes over, and the embryo/s implant and progress to a successful pregnancy. At Cayman Fertility Center our patients come to us from all over the world to avail of our high IVF success rates which considerably higher than the national average rates for both the UK & US.
Blastocyst Transfer IVF
In nature, fertilisation of eggs occurs in the fallopian tube. As the embryo travels down the tube toward the uterus, it grows and divides until arriving in the uterus 5-6 days after fertilisation. This stage of embryo development is referred to as a blastocyst.
By growing the embryos to blastocyst stage you have the potential to choose the best developing embryos and also to transfer fewer embryos, which results in increased pregnancy rates and lowers the multiple pregnancy rates. It is also at this stage that a few of the embryos cells can be sampled for genetic testing, called Pre-implantation Genetic Testing (PGT).
However, not all patients have embryos that develop to the blastocyst stage and may choose to transfer at the day 3 stage of development. At Cayman Fertility Center we will walk you through this process and help you make a decision on what works best for you.
There is another critically important component of the embryo that is often overlooked, the zona pellucida (ZP) or the egg shell. The zona pellucida surrounds the egg and has several important functions, such as:
During fertilisation, it serves to prevent the access of more than one sperm to the egg. It keeps the cells of the embryo together during early development, until the embryo reaches the blastocyst stage. At the blastocyst stage, the embryo has enough structural integrity that it no longer needs the protection of the ZP and the embryo “hatches”.
Since the late 1980s, research has shown assisted hatching can improve implantation rates in certain patients. Patients that may benefit from assisted hatching include: women older than 36 years of age, those with elevated FSH levels, those with previous IVF failures, embryos with an abnormal (or thickened) appearing zona pellucida, and when using cryopreserved (frozen) embryos.
When you begin IVF treatment, you are prescribed a custom set of fertility medications by our IVF Physician, based on your reproductive health profile and tests. These medications are the same hormones your body releases to naturally grow an egg. The amount of hormone however is typically higher than what is seen in your body. Thie intentionally allows greater stimulation of the ovaries with the goal of developing several mature follicles (specialised cysts on the ovaries), with the hope that each follicle contains an egg. This process is regularly monitored through ultrasound and blood testing to ensure the ovarian stimulation process is progressing appropriately.
Once mature follicles have been produced by your ovaries, the eggs are then collected at Cayman Fertility Center during a minor office-based procedure, which is performed under sedation/local anaesthetic by Dr Davis. The process is completed using an ultrasound-guided needle which travels through your vaginal wall and into your ovary, where the needle collects the eggs. Once the collection process has been completed, your eggs are immediately sent to the embryology laboratory.
On the same day that your eggs are collected, a semen sample is either produced by a male partner or donor sperm is thawed. The semen sample is prepared in the laboratory in an effort to consolidate as many motile (moving), normal-looking sperm as possible. The prepared sperm and eggs are then combined together and placed into a laboratory incubator overnight.
The following morning, your eggs are inspected for signs of fertilisation. Those eggs fertilised normally are grown in the laboratory for another 24-48 hours. The fertilised eggs are now called embryos. The development of your embryos are monitored and the you are kept advised of their progress.
Once we have determined that embryos are ready to be transferred to the uterus, you will meet with Dr. Davis. Prior to this procedure, you and Dr. Davis will discuss how many embryos you will transfer. During your appointment, the embryo transfer procedure will be performed using a small catheter which is inserted through the vagina into the uterine opening, similar to a PAP smear. The embryo transfer procedures takes no more than a half hour and most women experience little or no discomfort.
Following the embryo transfer procedure, any embryos that were not transferred will be assessed for their suitability to be cryopreserved for use for another attempt at pregnancy in the future.
Success rates are dependent on many factors and can vary depending on your individual circumstances. Your specific success rate will be communicated to you by our IVF team once your medical history has been reviewed.
Intra-Cytoplasmic Sperm Injection (ICSI)
Intra-Cytoplasmic Sperm Injection (ICSI) is a procedure performed during in vitro fertilization, where you egg is fertilised outside the body by injecting the sperm directly into it. This differs from conventional fertilisation where the sperm and egg are placed together in a dish and the sperm fertilise the egg on their own without assistance. The embryo(s) are then introduced back into the your uterus in the same way as for IVF.
ICSI is typically recommended for certain conditions when fertilization may be part of the problem getting pregnant or where genetic testing of the embryos is being performed. Examples of when ICSI might be performed are:
- Men with abnormal semen parameters
- Previous poor fertilisation using conventional IVF
- Advanced Maternal Age
- Previously frozen eggs (either a donor or your own)
- When having pre-implantation genetic testing (PGT)
The first ICSI baby was born in 1992 and subsequently millions babies have been born through this technique.