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 Hungary
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:
- Professor
Ovrang Djahanbakhch, a professor of reproductive medicine and a
luminary in assisted reproductive technology of St. Bartholomew Hospital,
- Ms
Pamela Turner – Chief Scientist/Embryologist.
Both of them, apart from
establishing the Bridge Centre fertility unit in London Yugoslavia Italy Kuwait Greece 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
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
Mr. Shola Akinyan (Patient Coordinator) 07042176166
Dr. Adeyemi
Adedoyin (Clinical Manager) 07039324220
Dr. Michael Ogunkoya
(Consultant Gynaecologist & Fertility Specialist) 08033069466
BENIN
CITY
Dr. uwuseba Ewomaeiano
(Clinical Manager) 07042176188, 08050240728
Dr. Michael Ogunkoya
(Consultant Gynaecologist & Fertility Specialist) 08033069466
Mr. Taofeek Malik (Patient Coordinator) 08029071507
BRITHISH COLLABORATIVE TEAM
Professor O.Djahanbakhch professor of reproductive
Medicine,
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:
- Patients
whose eggs have not fertilized using IVF
- Patients
who have too few sperm for conventional IVF
- Patients
who have extremely low sperm motility ( movement )
- Patients
who have a high number of abnormally formed sperm
- Patients
with antisperm antibodies present
- 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
In Nigeria 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
- 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.
- Where
a child’s father and mother were not married to each other at the time of
his birth.
- The
mother shall have parental responsibility for the child.
- 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.
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
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:
- 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.
- Metrodin and Gonal-F (containing
FSH). The effect to these drugs
is to stimulate the ovaries to produce the follicles which contain the
egg.
- Human chorionic gonadotrophin (HCG,Pregnl
or Profasi) is given in the night two days before egg collection to mature
the egg within the follicle.
- 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:
- The
ovaries may not respond to the stimulating drugs
- 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.
- Fertilization
may not occur.
- 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.
- 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)
- 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 Nigeria
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.
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