Wednesday, 19 September 2018

THE HOPE VALLEY FERTILITY CLINIC


CONTENTS

PAGE

Introduction                                                                                             4­­­ - 5


Unit Staff                                                                                                  6


The Facts about infertility                                                                      7

What is G.I.F.T?                                                                            7
What is I.V.F?                                                                                7      
What is I.C.S.I?                                                                    8

Factors influencing the outcome of Treatment                                  11



Protection for the welfare of the Unborn Child                                  12


Parental Responsibility                                                                           14

Consent                                                                                                     15


Folic Acid Recommendation                                                                 15


The Drugs                                                                                       15


Possible Side Effect                                                                                 16


Starting Treatment                                                                                  16


Starting Stimulation                                                                                17


Reasons for Cancellation of Treatment                                               17



The Egg Collection                                                                                  17








Semen Collection                                                                                     19

After Egg Collection                                                                               19

Embryo Transfer                                                                                     20

Embryo Freeze – Thaw Cycle                                                               20

Number of Embryos                                                                                20

What you can do after Treatment                                                        21

Possible complications of Treatment                                                   21

Ovarian Hyper stimulation Syndrome                                        22

If Pregnancy Occurs                                                                               22

Cryopreservation and Replacement of Human Embryos                 22

Patients information for frozen Embryo transfer                     25

Counseling                                                                                                25

Additional information Related to Your Treatment                          25

Follow – Up Consultation                                                                      26

New Technology                                                                                     26

Contacting the Assisted Conception Unit                                            27






 


 

 

INTRODUCTION


The Hope Valley Clinic is an assisted conception specialist fertility center with international collaboration providing comprehensive and confidential services of exceptional high standard to assist couples achieve pregnancy.

Our equipment is new and represents the best of German and British technology and the latest the world can offer. The above services are delivered in an environment of warmth, psychological support, understanding and unlimited access to information.

The clinic is very committed to sub-fertility treatment and we at the clinic are proud in providing the best in terms of medical and scientific laboratory personnel in the field of sub-fertility management.

The Managing Director of the unit is Dr. Michael Ogunkoya, a tested Chief Consultant Gynaecologist and Fertility Specialist. He has worked and gained extensive experience in leading Teaching Hospitals in England, Wales and Hungary. He leads as experienced team of doctors, fertility nurses, embryologists, counselors and administrative staff.

THE HOPE VALLEY CLINIC was set up and is being managed in collaboration with a team of British Fertility experts from a leading London Teaching Hospital.
Viz:
  1. Professor Ovrang Djahanbakhch, a professor of reproductive medicine and a luminary in assisted reproductive technology of St. Bartholomew Hospital, University of London-Clinical Head.

  1. Ms Pamela Turner – Chief Scientist/Embryologist.

Both of them, apart from establishing the Bridge Centre fertility unit in London some 18 years ago, have undertaken similar collaborative ventures in other countries i.e. Yugoslavia, Italy, Kuwait, Greece and Turkey.

The center has a fully equipped IVF/ICSI Laboratory and sonogram machines for egg recovery and blood flow studies.

The following is a brief summary of the services we offer:-












A. FERTILITY SUB-SPECIALITY SERVICES

              I.      ASSISTED REPRODUCTIVE TECHNIQUES
In-vitro Fertilisation & Embryo Transfer (I.V.F. – E. T.)
Intra Cytoplasmic Sperm Injection (I. C. S. I.)
Testicular Sperm Extraction (TESE)
Testicular Sperm Aspiration (TESA)
Percutaneous Sperm Aspiration (PESA)
                                                           
                                                       
           II.      CRYOPRESERVATION
Quarantined Sperm Banking.
Embryo Freezing/Storage.

         III.      DONOR PROGRAMMES
Egg donation
Sperm donation
Embryo donation

        IV.      SEX-SELECTION
Family Balancing/Equilibration.

B. OTHER FERTILITY SUB-SPECIALIST SERVICES


  • Follicular Tracking & Hyperovulation Induction.
  • Detailed and advanced semen evaluation and culture.
  • Advanced ultrasonography – Abdominal and Transvaginal.
  • We offer Artificial Insemination (Intracervical or Intrauterine) using husband or donor sperm with or without ovarian stimulation for selected cases.
  • Laparoscopy / Hysteroscopy (minimally invasive surgery)

C. OTHER SERVICES


  • Counselling.
  • Support Services.
  • Demonstration of injection techniques.
  • Patient enlightenment programmes.


We record an enviable clinical pregnancy and live birth rates per treatment cycle.









UNIT STAFF


During your treatment at The Hope Valley Clinic international you may meet the following clinical Staff:-

LAGOS CLINIC

Mrs. Rosaline Ogunkoya          (Head of Embryology Unit)                                   08037227238
Mr. Anslem Oghinan                 (Trainee Embryologist)                              01-4618989
Miss Agnes Achibong-Omon (Trainee Embryologist)                                07042176185
Mr. Segun Isaac                       (Head, Patient-Coordinator)                                 01-4618990 080290071507
Dr. Williams                             (Clinical Manager)                                               08071359290
Dr. Michael Ogunkoya   (Consultant Gynaecologist& Fertility Specialist) 08033069466, 07084009453

PORT-HARCOURT CENTRE

Dr. Humphrey Fonjong       (Clinical Manager)                                       07039179885,07042176189
Dr. Donatus Duru                  (Clinical Manager)                                                 07039179885
Dr. Michael Ogunkoya      (Consultant Gynaecologist& Fertility Specialist) 08033069466

 

KADUNA CENTRE

Miss Amina Ibrahim               (Nurse)                                                                  062-371253, 07035903551
Dr. Mrs. A. La’ah                (Clinical Manager)                                                   062-371253, 07035903551
Dr. Michael Ogunkoya       (Consultant Gynaecologist& Fertility Specialist) 08033069466
ABUJA CENTRE
Miss. Akudo Uhuaba                (Nurse)                                                               07042176166
Mr. Shola Akinyan                   (Patient Coordinator)                                           07042176166
Dr. Adeyemi Adedoyin (Clinical Manager)                                               07039324220
Dr. Michael Ogunkoya       (Consultant Gynaecologist & Fertility Specialist) 08033069466
BENIN CITY CENTRE
Dr. uwuseba Ewomaeiano   (Clinical Manager)                                        07042176188,                                           08050240728
Miss. Enefele Gladys            (Nurse)                                                                    07042176188
Dr. Michael Ogunkoya       (Consultant Gynaecologist & Fertility Specialist) 08033069466
Mr. Taofeek Malik               (Patient Coordinator)                                                08029071507



BRITHISH COLLABORATIVE TEAM

Professor O.Djahanbakhch                               professor of reproductive Medicine,
University of London

Miss. Pamela Turner                                         Chief Embryologist

THE FACTS ABOUT INFERTILITY
Research shoes that as many as one in seven couples experience some difficulty with achieving a pregnancy.
Difficulties are found as often with the male as with the female partner. We suggest that you share the problems and work together to solve them. It is quite normal to take a year to achieve a pregnancy even when there is no problem.
Heightened publicity in recent years has made people more aware of the implications of infertility and the new modalities of treatment that are available. It is important to understand that many couples can be helped to conceive without resorting to such specialized treatment as In-vitro Fertilization (IVF), sometimes referred to as ‘test tube baby’. Those patients for whom this form of treatment is appropriate are very much in the minority.

Regrettably, even with today’s technical advances there is no guarantee of success. Some couples eventually may have to terms with their childlessness.

WHAT IS G.I.F.T?

This stands for Gamete Intra Fallopian Transfer. A gamete is the medical term for the cells reproduction, in other words, the egg and sperm. The preparation for GIFT involves the use of drugs to stimulate the ovaries for the formation of eggs which are collected at laparoscopy, and immediately mixed with the partner’s sperm and replaced in the Fallopian tube. In nature, fertilization occurs in the Fallopian tub.

If GIFT is not advisable, for example, if your Fallopian tubes are blocked or damaged, the doctor may advise you that IVF would be the preferable method of treatment for you. This decision can take place at operation for the proposed GIFT procedure.

WHAT IS I.V.F?

In-vitro fertilization means fertilization of eggs by sperm outside the body. IVF is used as a treatment for infertility in couples where there is impaired sperm function, problems with passage of sperm to the egg, and in some cases of unexplained infertility.
The preparation for IVF is similar to that of GIFT. Drugs are used to stimulate the ovaries to produce eggs, which are collected under ultrasound guidance. The eggs are then placed with the partner’s sperm in the laboratory and the fertilized eggs (embryos) are replaced two days later in the womb.

In a natural cycle, it is usual to produce one egg, which is released from the developing follicle two weeks before the next period starts. The follicle is a fluid filled cyst which grows to about 16 – 22mm before releasing its eggs. A mature follicle will usually contain an egg.

In IVF cycles, the aim is to achieve the growth and development of several follicles in order to maximize the chance of collecting several eggs. Once fertilization has taken place, the best 2 to 3 embryos can be selected and replaced in the womb.

When fertility drugs stimulate the ovaries, it is usual for several follicles to develop in the ovaries. It is important that we do the egg collection procedure when as many eggs as possible are appropriately mature. In order to achieve this, we routinely use a combination of drugs that takes over from the body’s natural hormone cycle.

The hormones, which stimulate ovulation, are luteinizing hormone (LH) and follicle stimulating hormone (FSH); both of which are produced by the pituitary gland in the brain. FSH and LH stimulate the growth of follicle, which produce oestrogen before ovulation and progesterone after ovulation. Oestrogen promotes growth of the lining of the womb (endometrium), and progesterone maintains the endomentrium in a favorable state for the implantation of the embryo(s).

WHAT IS I.C.S.I.?

Introduction:

In vitro fertilization (i.e. fertilization outside the body) has undoubtedly revolutionized the treatment of infertility. In the space of two decades it has progressed from a highly experimental research technique, available in a handful of centers throughout the world, to a standard fertility treatment. In the same time span, the indications for In- vitro fertilization have expanded. Initially, it was only used for patients with blocked fallopian tubes, but now this group forms only about half of all treated couples. IVF is now seen as a recognized treatment for infertility associated with endometriosis and immunological problems as well as in couple where no cause can explain their difficulty in having a baby. One of the more recent applications of IVF is in infertility due to problems with the sperm. Here too IVF has enable many couples to have children who might otherwise not have done so. However, IVF is not a universal cure. It has limitation, particularly in the treatment of low sperm counts.

The process of fertilization

Following sexual intercourse sperm swim from the vagina up through the cervix (neck of the womb), through the uterus (womb) and then into the Fallopian tubes where, if it is the right time of the month, they meet the egg. Many sperm are lost en route, particularly weak ones or ones that do not swim well.

For the sperm which reach the egg, the ongoing route remains difficult. An egg is surrounded by several barriers. The first is a very think mesh of cells called the cumulus which completely covers the egg. These cells attached the egg to the wall of the follicle when it was still in the ovary. The sperm release a cocktail of enzymes which help to dissolve a track through the cumulus cells. With vigorous swimming the sperm can pass through.

Once through the sperm are confronted with another obstruction called the zona pellucida. This thick ‘coat’ surrounds the egg. The sperm need to attach to this coat in order to release another batch of enzymes which bore a small hole in the covering.

Although tens of hundreds of sperm may attach to the zona pellucida, only one will break through if fertilization is normal. The sperm can now swim up to the egg itself and penetrate the thin surrounding membrane to fertilize the egg.
 Normally approximately 300 million sperm are produced at every ejaculation. What might appear to be an enormous amount is what nature uses in fertilization. It is hardly surprising therefore that when sperm quality is poor, either due to low numbers or because the sperm do not swim well, infertility can result.


In-Vitro Fertilization with Poor Sperm

IVF can be a useful treatment for infertility due to sperm problems. By combining the sperm with the egg directly in the laboratory, the problem of sperm being unable to swim to the egg is eliminated. Furthermore, the sperm are specially prepared in the laboratory so that only the hardiest are used to fertilize the egg. As several eggs are often obtained, the chance of at least of them fertilizing increase. Even the specially selected sperm still have to battle their way through the barriers surrounding the eggs. When the sperm quality is low, they may be unable to do this, and the IVF attempt cannot proceed because the egg has not been fertilized.

Microsurgical fertilization for treating male infertility

In the past few years there has been a great improvement in the fertilization rates of men whose sperm previously was unsuitable for IVF. Modern techniques which place the sperm within the egg membrane only require a few sperm. Many couples, who once had to rely on donor sperm, can now be helped. These procedures involve operating on the egg once it is in the laboratory. They are collectively known as microsurgical fertilization.

The first technique to be developed was Partial Zona dissection (PZD) which involved making a gateway in the zona pellucida (surface of the egg) through which sperm could pass. This was followed by Sub- Zonal sperm injection (SUZI) where two or three sperm are collected in a very fine needle and injected through the zona pellucida so that they are in direct contact with the membrane of the egg.

Intra- cytoplasmic Sperm Injection (ICSI)

ICSI is the latest and most successful microsurgical fertilization technique to be developed. It assists fertilization when the sperm is of extremely poor quality. The technique employs the same technology and microsurgical expertise as PZD and SUZI. However, when ICSI is performed, a single sperm only is injected directly into the center of the egg (cytoplasm). In this way, the sperm is not required to penetrate any of the barriers surrounded the egg. Once injected, the eggs are incubated for sixteen hours.

The embryologist will then check to  see if fertilization has occurred, and if it has, up to three of the resulting embryos will be transferred in to the woman’s uterus as in normal IVF treatment.

When is ICSI appropriate?

ICSI may be appropriate in the following:

  1. Patients whose eggs have not fertilized using IVF
  2. Patients who have too few sperm for conventional IVF
  3. Patients who have extremely low sperm motility ( movement )
  4. Patients who have a high number of abnormally formed sperm
  5. Patients with antisperm antibodies present
  6. When sperm have surgically aspirated from the epididymis, part of the testes or extracted from a testicular biopsy.

What are the advantages for ICSI over conventional IVF?

1                    It can be used in cases where patients have only a few hundred sperm.
2                    It can be used in cases where hardly any of the sperm are moving.
3                    It can be used where semen samples contain a high number of abnormal formed sperm.

What are the disadvantages of ICSI

1                    As ICSI is a very delicate procedure, eggs may be damaged during the procedure thereby making them unsuitable for transfer
2                    As ICSI is a new technique, there is limited information relating to any possible risks to a child conceived by ICSI.
3                    There are some indications that there is an increased risk of congenital, chromosomal or development abnormalities following this procedure.
4                    Some infertile men may pass the same type of sub fertility to their sons.
5                    A minority of men with no sperm or a severely low sperm count may be carriers of cystic fibrosis or sex chromosome abnormalities. In selected cases, genetic testing of both partners is advisable and the Unit will counsel patients according to their individual circumstances.
6                    There may be an increased miscarriages rate with ICSI pregnancies.
7                    Further research into ICSI is being undertaken in many centers and we closely monitor all research in this area.

Success Rate for ICSI

Most centers around the world currently achieve encouraging pregnancy rates. ICSI has been available as a treatment worldwide now for over 7 years and the overall success rates has been over 25% clinical pregnancy.

FACTORS INFLUENCING THE OUTCOME OF TREATMENT:

Success rates improve all the time as research into this area continues.
Success rates are governed by a number of factors:

-                     Age of female partner.
-                     Quality of Sperm, eggs, and embryos.
-                     History of previous pregnancies.
-                     Number of eggs or embryos suitable for replacement.










PROTECTION FOR WELFARE FO THE UNBORN CHILD

In the UK, the Human Fertilization and Embryology Act (1990) requires that the welfare of the child must be taken into account before any treatment can commence at a licensed centre. This includes the welfare of any child born as a result of the treatment (including the need of that child for a father), and of any other existing child who may be affected by the birth.

In Nigeria, there is no such Authority as at the moment. However, we shall be guided in the mean time by similar principles as in the Human Fertilization and Embryo Act in the U.K.

In the very near future it shall be necessary for such a control body to be established here.

People seeking treatment are entitled to a fair and unprejudiced assessment of their situation and needs. These include who would be legally responsible for any child born as a result of treatment, and who would be responsible for bringing up the child. This is conducted with skill and sensitivity appropriate to the delicacy of the case and the wishes and feelings of these involved.

The HFE Act (UK) dose not excludes any category of woman from being considered for treatment. However, in situations where the child will have no legal father the clinic will pay particular attention to the prospective mother’s ability to meet the child’s need throughout childhood. Where appropriate, the clinic will consider whether there is anyone else within the prospective mother’s family and social circle willing and able to share the responsibility for meeting those needs, and for bringing up, maintaining and caring for the child.

The assessments will involve the centre taking a detailed medical and social history covering:
-                     Your commitment to having and bringing up a child/children.
-                     Ability to provide a stable and supportive environment for any child produced as a result of treatment
-                     Your medical histories and the medical histories of your families
-                     Your health and consequent future ability to look  after or provide for a child’s needs
-                     Your ages and likely future ability to look after or provide for a child’s needs
-                     Your ability to meet the need of any child or children who may be born as a result of treatment, including the implications of any possible multiple births
-                     Any risk or harm to the child or children who may be born, including the risk of inherited disorders or permissible disease, problems during pregnancy and of neglect or abuse.
-                     The effect of a new baby or babies upon any existing child of the family.

In addition, where treatment involves the use of donated gametes, the following will be taken into account:
-                     A child’s potential need to know about their origins and whether or not the prospective parents are prepared for the questions which may arise whilst the child is growing up.
-                     The possible attitudes of other members of the family towards the child, and towards their status in the family.
-                     The implications for the welfare of the child if the donor is personally known within the child’s family and social circle.
-                     Any possibility known to the centre of a dispute about the legal fatherhood of the child
The centre is also required to satisfy that the parent’s referring doctor knows of no reason  why either might not be suitable for the treatment to be offered. The referring medical practitioner will be asked to provide factual information, medical or otherwise that might have implications for the health or welfare of any resulting child.

Written consent will be sought before any contact with a parent’s doctor is made. This should be given after discussions about these issues and prior reading of the questionnaire that will be sent to the doctor.
However, failure to give consent will be factors that may be taken into account in considering that whether or not to offer treatment.

If any of these inquiries give cause for concern, the center will make further inquiries of  any relevant individual, authority or agency. Again, consent will be sought before any contact with these bodies is made.

However, failure to give consent will be a factor that may be taken into account in considering whether or not to offer treatment.
The clinician responsible for administering the fertility treatment is responsible for making the final decision about whether or not treatment will be offered.

Treatment may be refused on clinical grounds or, if the centre believes that it would not be in the interest of any resulting child, or any child already existing, to provide treatment, or is unable to obtain sufficient information or advice to reach a proper conclusion.

If treatment is refused for any reasons, the centre will explain the reason for this and the factors, if any, which may persuade the centre its decision. It will also explain the options that remain open and where counseling can be obtained.

Parental responsibility

Where an unmarried couple is being treated, the male partner will not have ‘parental responsibility’. In countries such as the UK, parental responsibility is defined by the children Act 1989 as ‘all the rights, duties, powers, responsibility and authority which by law a parent of the child has in relation to the child and his property’. Section two of the Act states;
  1. Where a child’s father and mother were married to each other at the time of his birth, they shall each have parental responsibility for the child.
  2. Where a child’s father and mother were not married to each other at the time of his birth.
  1. The mother shall have parental responsibility for the child.
  2. The father shall not have parental responsibility for the child, unless he acquires it in accordance with the provision of Act.

Unmarried couples are therefore recommended to seek their own legal  advise about the male partner’s rights and responsibilities in relation to the potential child who may be born as a result of  the treatment.

(The Government in U.K., intends to amend the Children Act 1989 so that an unmarried father who registers hi child’s birth jointly with the mother will acquire parental responsibility without further formality)


CONSENT

Before treatment begins, both of you will be required to read and sign forms to give consent for treatment and for the use of your eggs and/or sperm. You will need to consider the number of eggs or embryos replaced. The Human Fertilization and Embryology Act in England for example prohibits the transfer of more than three eggs or embryos because of risk of multiple pregnancy with its associated complications. The doctors and staff will discuss this with you. (please see page 18)

FOLIC ACID RECOMMENDATION

There is some evidence that folic acid tablets taken before pregnancy decreases the risk of spina bifida; therefore, it is advised that all patients considering IVF should take 400 micrograms of folic acid daily. It is recommended that you take these tablets when trying to conceive and at least two weeks before starting fertility treatment. These tablets can be obtained from your chemist without prescription.

THE DRUGS

We usually use the following drug regime, although there may be variations depending upon specific requirements of individuals:

  1. Buserelin Injection-0.5ml injection once a day. This has the effect of ‘switching off’ the pituitary natural production of FSH and LH which otherwise could interfere with the drugs. Your response to this drug is monitored, and you might find your periods are different to usual.


  1. Metrodin and Gonal-F (containing FSH). The effect to these drugs is to stimulate the ovaries to produce the follicles which contain the egg.


  1. Human chorionic gonadotrophin (HCG,Pregnl or Profasi) is given in the night two days before egg collection to mature the egg within the follicle.


  1. After the egg collection, Progesterone support is given in the form of either a vaginal pessary or cyclogest suppository. This keeps the endometrium receptive and healthy for an early pregnancy. Occasionally additional hormone support is provided in the form of HCG injections (profasi or Pregnyl). These preparations may delay the onset of the next period even if you are not pregnant. A pregnancy test should always be performed if you fail to bleed two weeks after embryo transfer.

If you are pregnant, you may need to continue the cyclogest for a further eight weeks.







POSSIBLE SIDE EFFECTS OF DRUGS

Busrelin & Metrodin/Gonal-F                                                 Cyclogest

Headaches                                                                               Breast Tenderness
Breast Tenderness                                                     can delay onset of next period
Mood swings                                                              by two or three days
Tiredness
Hot flushes
Nausea (Very occasionally)
Periods different from usual (Buserelin)

We hope that you do not experience any side effects at all, but it is necessary for you to know the possible side effects prior to taking the drugs.If you experience any side effects whilst on the fertility drugs and are concerned, please speak with the Nurse Co-ordinator.

STARTING THE TREATMENT

Day 1-3 of period:

You should contact our nurse co-ordinator within 3 days of the start of your period. At that time we will confirm that you will receive treatment in that cycle, and be given an appointment.

Before starting Buserelin, an ultrasound scan would have been done to exclude any abnormalities.

Buserelin usually starts on day 19-21 of your cycle although occasionally a day 1-3 start is recommended.

On the first Wednesday after you have been taking Buserelin for approximately 14 days, another ultrasound scan will be performed. This is performed with a thin probe passed into the virgina. This method is quick and painless providing a clear picture; a full bladder is not required.The first scan checks that the uterus and ovaries look normal before stimulation starts. A blood test to measure oestradiol is taken on the same day. If the scan is normal and the oestradiol level is low,Gonal-F or Metrodin can be started. We aim to start stimulation on Wednesday and plan to do the egg collection 12-14 days after.

Occasionally the scan shows a thick womb lining and/or a small cystic area on the ovary. This happens in about 5% of cases and usually means that the oestradiol level is not low enough to start stimulation. Although this is a nuisance for you, the scan will then need to be repeated.






STARTING STIMULATION

1.      Metrodin/Gonal-F is given sub-continuously (into the skin) on a daily basis. You will be taught how to self – inject.

2.      In the following week further scans and blood tests will be performed.

3.      When your follicles are big enough and oestradiol level is high enough, you will be asked to have 10,000 iu of HCG (Profasi) sub-continuously, at this time you should stop taking Buserelin. It is important that this injection is given 34-36 hours before operation. This will usually mean having it between 10.00pm and 12 midnights 2 days before the operation. You will be advised to the exact time by the nurse co-coordinator.

               REASONS FOR CANCELLATION OF TREATMENT

1.      If, after being on injections for several days, there is little or no follicular development, you will see one of the doctors to discuss the future course of your treatment.


2.      If you over react to the drugs, you will speak with one of the doctors about this hyper stimulation and how to proceed. You could be asked to consider having an egg collection where the embryo is frozen and trans ferred in a later cycle.


3.      If the Ovarian Hyperstimulation Syndrome (see page 20) becomes evident after the collection, you may be asked to abandon the current treatment cycle in order to minimize the symptoms and risks. The embryos  will not be replaced , but will be frozen until they can be replaced at an appropriate time in a subsequent cycle.

                THE EGG COLLECTION

This is usually performed under sedation, although occasionally general anaesthesia is used. Whether you have a general anaesthestic or sedation, you should have nothing to eat or drink from midnight before collection. This enables us to change from sedation to general anaesthethic in the rare case when it becomes appropriate. You may feel twinge but should not feel pain.

The procedure is usually performed vaginally. The scan probe has a fine needle attached to it which is passed into the ovary where the fluid from each follicles is collected. We expect to obtain an egg from about 80% follicles.

After the egg collection you may feel drowsy for the rest of the day,but you should be ready to go home after two hours after sedation or four hours after anaesthesia. It is important to have somebody to accompany you on either occasion.


Following egg collection you will be prescribed an 18 day course of cyclogest to be inserted as a vaginal pessary or rectal suppository each night.

















Figure 1: Transvirginal Ultrasound Guided egg collection.

























SEMEN COLLECTION

For GIFT -       2 hours BEFORE operation
For IVF -         2 hours AFTER operation

Occasionally the male partner will be asked to produce a sample before the egg collection begins so that it can be frozen and used as an alternative in the event that he is unable to produce a sample on the day of egg collection.

AFTER THE EGG COLLECTION

It is normal to feel some lower abdominal discomfort, for which you can take aspirins or paracetamol every four hours. If you feel sick avoid eating substantial meals and stick to fluid for the rest of the day. A small amount of vaginal bleeding is normal. It is best to use sanitary towels rather than internal protection (tampons).

Once the eggs are collected they will be transferred to the laboratory and placed in an incubator for 3 to 5 hours where they continue to grow. They are then inseminated with the prepared sperm. Inseminated eggs are left undisturbed in the incubator for 16-20 hours when the embryologist will check to see if the eggs have fertilized ( a day after collection). Fertilization does not always occur for a variety of reasons. If this is the case, we will want to see you to discuss the possible reasons. But in general we expect 75% of eggs collected to fertilise.





















Figure2: Human Egg and Pre-embryos after egg collection.

EMBRYO TRANSFER: Patients are asked to phone the unit at mid-day on the day following egg collection to see if any eggs have fertilized. If fertilization has occurred, the embryo transfer will be planned for the next day.

This is the stage at which the embryos are transferred into the uterus with a fine catheter. The technique is similar to that of a cervical smear test and does not cause much discomfort.
Fourteen days after the embryo transfer a pregnancy test should be performed if you have not started a period. It is important to realize that the drugs given after embryo transfer may artificially delay your period, even if you are not pregnant, in which case only a pregnancy test will tell you one way or the other.

















Figure 3: Embryo Transfer


EMBRYO FREEZE – THAW CYCLE

If you develop Ovarian Hyperstimulation Syndrome ( See Page 20) the embryos will be frozen and transferred in the subsequent cycle or at a later date.

NUMBER OF EMBRYOS:

It is well known that replacing more than one embryo can result in a multiple pregnancy. The maximum number of embryos that can be replaced is three which may result in a multiple pregnancy. The potential risks of multiple pregnancies includes: the increased risk of early and late miscarriage, a higher incidence of premature birth, and the complications of prematurely.
Other risks include complications in pregnancy and the social and physical implications of a multiple birth. To minimize these risks, many units encourage the replacement of only two embryos. We discuss individually with each patient whether two or three embryos are to be replaced as there is a multiple pregnancy rate of about 30% (25% twins, 5% triplets) with three embryos.

WHAT YOU CAN DO AFTER TREATMENT

It is wise to take things easy after the egg collection with perhaps a day off work. After the embryo transfer, you may resume your normal life style, walk about, bathe, shower and undertake normal activities. It is advisable to avoid strenuous activity and heavy lifting until you feel more comfortable. Sexual intercourse can be resumed whenever you feel like it.

Abdominal distension and a bloated feeling is common, and this may be associated with a feeling of nausea. Some times these symptoms occur after a few days. It is important to drink plenty of fluids and to take paracetamol for pain relief if necessary. Please phone the unit if you have any worries or concerns.



POSSIBLE COMPLICATIONS OF TREATMENT:

Despite continuing efforts to develop and improve treatment. IVF and GIFT remain complicated procedures during which problems can arise and cause the treatment to be cancelled or to fail.

These include:
  1. The ovaries may not respond to the stimulating drugs

  1. Very rarely, when follicles are aspirated they contain useable eggs. Although we are able to view the follicles by ultrasound, it is not possible to see if they are empty or contain immature eggs.

  1. Fertilization may not occur.

  1. In the case of IVF it is necessary for the fertilized eggs to divide before embryo transfer can take place. If this does not occur, embryo transfer will not be performed, or may be performed later.

  1. On the day of egg collection, it may be found that your partner has a diminished sperm count in which case, after consultation with you, we may consider performing intracytoplasmic sperm injection (ICSI)

  1. Very occasionally, ovarian hyper stimulation may occur.






OVARIAN HYPERSTIMULATION SYNDROME :

This may occur if the ovaries over react to drug stimulation and produce too many eggs or high levels of oestrogen. If this happens, the injections are stopped and you continue with Buserelin for a further two to three weeks until the ovaries settle down.

The ovarian hyper stimulation syndrome is characterized by lower abdominal discomfort, swelling and nausea. Some times vomiting and difficulty in breathing may occur. It is important to drink plenty of fluids to avoid dehydration. If you have any of these symptoms, you must contact the clinic. If it is out of hours, please follow the procedures described on page 25.

Occasionally, ovarian hyper stimulation syndrome be very severe. Fluid  may collect in the abdominal cavity and chest. Kidney and liver functions may be affected, and a clot may form in the vessels.

These may result in a life threatening situation. In severe forms of hyper stimulation, hospital admission for intravenous fluid therapy is necessary.



IF PREGNANCY OCCURS:

Your pregnancy will not require you to do any thing different than some one with a naturally conceived pregnancy. We will scan the pregnancy at 6-8 weeks to confirm the condition and number of feotuses.

There is a 5% risk of an ectopic pregnancy, one which has attached to the fallopian tube not to the womb. Ectopic pregnancies do not develop normally and require an operation to remove them.

As in any naturally conceived pregnancy, a miscarriage is possible, particularly in the first twelve weeks.

There is no higher rate of abnormalities in IVF and GIFT babies than in those conceived naturally.

CRYOPRESERVATION AND  REPLACEMENT OF HUMAN EMBRYOS

The following information should give you some idea of what cryopreservation and frozen embryo transfer cycles entail, and your involvement. If you would like more details about anything mentioned below, please feel free to ask the staff for further information.

Embryo cryopreservation is a method of sustaining the viability  of embryos by cooling them and storing them at a very low temperature. Embryos from an In-vitro Fertilsation cycle can, following cryopreservation, be transferred to the uterus or the fallopian tubes at the appropriate time in a future cycle. This procedure and the potential risks of it are explained below.

Following a GIFT procedure at which 2 or 3 eggs are replaced, all of the remaining eggs can (with your consent) be mixed with sperm and any resulting high quality embryos(again with your consent)be cryopreserved. In an IVF or ICSI cycle 2 or 3 embryos are selected for transfer, and any high quality embryos in excess of this can be cryopreserved. A signed consent must be obtained prior to this procedure.

The appropriate method of ovulation and timing of the transfer will be decided upon by the IVF team. These embryos must meet certain criteria before being considered suitable for replacement and provided they meet the criteria, they will be transferred into the uterus in one or more menstrual cycles.

BENEFITS

The benefit to you will be the possibility of subsequent replacement of embryos without having to undergo stimulation of ovulation and egg retrieval. Often, no hormonal stimulation is necessary, thus providing a better environment for replacement. There may be enough frozen embryos for more than one subsequent cycle.

DISADVANTAGES

Approximately 30% of the embryos do not survive the freeze/thaw cycle and occasionally, all of the embryos from one patient fail to survive.

Another disadvantage of frozen/thawed embryos is that they are more likelt to fail to implant, and therefore the pregnancy rates are less than those following fresh embryos transfer.

COST

Initially, there is a free for freezing embryos and for the first year of storage. There after, there is a fee for each additional year of storage.

The fees for frozen embryo transfer include the preparation, embryo thawing transfer, pregnancy test and follow up care. If embryos fail to thaw you will be charged a cancellation fee.

A list of current charges is available from the unit.

It is important you understand;
1.                  some eggs do not fertilise. If too few eggs fertiise, cryopreservation may not be pratical.
2.                  the quality of the embryos resulting from In-vitro fertilization may be insufficient to allow their cryopresevation.
3.                  embryos considered to be satisfactory for cryopresevation may not survive the freezing and thawing process.
4.                  There is no guarantee that the transfer of thawed embryos will result in pregnancy. The results, in fact, are generally much lower than at an IVF/GIFT attempt.
5.                  Extensive experience in humans and animals has shown no evidence to suggest that the risk of having an abnormal foetus following assisted conception treatment is greater than that of a naturally conceived pregnancy. However there is no guarantee that any child born following this treatment will be normal.

Signed consent must be obtained from both partners before the procedure. One copy of this will be held by the unit and one copy held by you. You may request disposal of the stored embryos at any time.
In all cases, people giving consent to the storage and/or use of their gametes or embryos produced from them may vary or withdraw their consent at any time up until the time that the genetics material has been introduced into the patient i.e. the embryos have been replaced.
It is important that your consents are compatible, otherwise they are invalid and the future use of the future use of the embryos will be affected.

You are also required to state whether or not the storage period for the embryos should be equal to the legal maximum (5 years) in the United Kingdom. No agreeable limit is available for Nigeria as at now. If you wish the storage period to be less than the legal maximum, please specify the number of years. It is possible to extend the storage period for a further 5 years (i.e. to a maximum of 10 years) and your written consent is essential. In extreme circumstances embryos can be stored for longer than 10 years.

Excess embryos which are neither transferred nor frozen will not survive for long under laboratory conditions, and all due care and respect is given to this potential human material in terms of disposal.
If you change address during the period of storage, please inform the unit. The storage period is governed by the law and we do not require your consent to remove these embryos from storage at the completion of statutory storage period.

If you need any help in deciding whether or not to freeze, or if you have any ethical dilemmas, please feel free to speak to our counselor or a member of the team.

TREATMENT PLAN FOR FROZEN EMBRYO TRANSFER

Detailed information is available at The Hope Valley Clinic, Lekki Phase II.








COUNSELLING

We appreciate that this Is an emotionally stressful time for you and your partner. As it is helpful in alleviating this stress to talk to someone, we have a counselor at the unit who specializes in help patients’ undergoing fertility treatment. She is available to talk to you in strict confidence during your treatment. Appointments are arranged via the nurse coordinator.

ADDITIONAL INFORMATION RELATED TO YOUR TREATMENT

1.                  Ultrasound scans are usually performed in the morning.
2.                  The egg collection procedure is carried out in the morning. You will be able to travel home by early afternoon.
3.                  Drugs should be stored in the fried.
4.                  Prior to your egg collection you will be required to read and sign a consent from for operation.
5.                  Prior to starting treatment, it will be necessary to carry out various investigations. Every patient will have following;

·        Full blood count.
·        High vagina swab and Chlamydia swab (to rule out infection)
·        Blood sample for hormone levels, when indicated.
·        Semen analysis and bacteriology.
·        Ultrasound scan (Abdominal and or vaginal).
·        Hysterosalpingogram

GENERAL ISSUES IN IVF AND GIFT:

Recent publicity has focused on some of the ethical issues which arise from the technologies and research used in IVF and GIFT. If you wish to know the appropriate authorities.




NEW TECHNOLOGY:

These techniques are still very much in their infancy. Results improve as new methods of assisted conception are discovered.

We endeavor to improve the methods by which we conduct IVT, GIFT and ICSI hoping that our research will result in greater success rates.