Embryology

Pre-Treatment

+-How can we improve the quality of our eggs/sperm?

It is important to maintain a healthy lifestyle to maximise your fertility potential. Maintaining a healthy weight is a key part of this. Female obesity is known to cause hormonal disturbances which reduce the chance of an egg being released naturally each month and may reduce the quality of your eggs. Being overweight is also associated with an increase in the risk of miscarriage. The evidence also suggests that overweight and obese men are more likely to have no sperm or low numbers of sperm compared to men of healthy weight.

Virtually all studies have indicated that smoking is detrimental to female fertility, increasing the time it takes to conceive, accelerating the loss of eggs and can advance the onset of menopause. Some studies have also shown adverse effects on sperm numbers, although this evidence is less clear. Passive smoking could adversely affect your partner's fertility. It is widely recommended that both men and women trying to conceive keep their alcohol intake at low levels. There is evidence that drinking to the point of hangover increases time taken to become pregnant for women and negatively affects sperm shape and movement for men.

From research and our own experience at Burton we have often seen a severe negative effect on fertility in male patients that have taken body building steroids and/or supplements. These can cause an almost immediate and complete stop in the production of sperm but production will often return when the steroids or supplements are ceased.

A few clinical studies have demonstrated that DHEA (a natural androgen hormone) taken by women prior to IVF treatment may increase the number and quality of eggs collected. For more information on our research study or where to source DHEA please contact our partnership clinic Nurture in Nottingham on 0115 8961900.

A varied, balanced diet is also recommended. Some literature has indicated that a high intake of saturated fats may be related to lower semen quality and a diet rich in poly unsaturated fatty acids (specifically Omega 3) may help to increase quality. We would therefore recommend a healthy diet rich in fruit, vegetables and oily fish.  Antioxidant supplementation and supplementation with specific micronutrients such as zinc and selenium may also have a beneficial effect on sperm quality.

+-I have a low AMH/ovarian reserve, how might this affect my cycle?

AMH is predictive of how well your ovaries will respond to stimulation during an IVF cycle. It can be used to tailor the stimulation drugs to an individual patient and can predict which patients may expect low or high egg numbers and even patients at a higher risk of OHSS. Patients with a low AMH or Antral Follicle Count do have lower pregnancy rate but the severity of this reduction is age related, with patients ≥39 yrs have a significantly lower chance of pregnancy than patients with the same AMH who are <39yrs. Pregnancies have been reported in patients with very low, or barely detectable AMH levels. Patients with a low AMH (<3.08 pmol/l) also have an increased risk of failed fertilisation across all age groups.

Sperm

+-What happens if I can't produce a sperm sample on the day of treatment

If you are concerned that you may struggle to produce a sample on the day of treatment please speak to an embryologist about freezing a sample prior to treatment which can be used for back up. This can help to alleviate stress on the day. You may also be able to produce the sample at home and bring the sample into the Unit. If we do not have a semen sample on the day of treatment we may be able to extract sperm surgically or freeze the eggs.

+-What happens if my sample is poorer quality than it had been previously

We will speak to every couple on the day of treatment about their sperm quality and discuss the best treatment option. If the sample is poorer in quality than expected we may need to use a procedure called ICSI. This is where we inject a single sperm into each egg to help maximise fertilisation rates, and can be done with very small numbers of sperm. If on the day of treatment numbers are extremely low or we fail to find sperm we may be able to do a surgical procedure (SSR) to recover sperm for treatment.

+-Can I produce a sperm sample at home?

Samples produced off-site need to be brought into the Unit within one hour of production. If this is feasible it can be arranged for the sample to be produced at home, this will need to be accompanied with a form stating the sample is your own.

+-I have been told I need a Surgical Sperm Retrieval (SSR), what is the chance of obtaining sperm?

This will depend on the reason you need the SSR. Men who have no sperm in their ejaculate due to a blockage have a higher chance of retrieving sperm than men who have testicular failure. Retrieval rates range between 25-75% but please speak to your doctor at your consultation for a more accurate estimation based on your own diagnosis.

+-I have been advised to go on the donor sperm waiting list, how long will this take and what is the process?

We obtain donor sperm from sperm banks both nationally and internationally. There is no waiting list for purchasing donor sperm from international banks, though it does take around 6-8 weeks for the process of matching and importation to take place >  There is approximately a 6 month wait to obtain donor sperm from a UK sperm bank.

If donor sperm is required your doctor will arrange for a CMV blood test to be performed and will also provide you with a 'physical characteristics' form.  This form needs to be completed & returned to the Embryology team at Nurture.  Once the embryology team are in receipt of the 'physical characteristics' form they will then attempt to find a sperm donor with similar characteristics for you to use in treatment.  Please be aware, it is not possible to get a precise match in most cases, but we do try to match hair & eye colour where possible.

Once an appropriate donor is identified, the embryology team will call to discuss the donors characteristics with you and you can then decide whether you wish to proceed with the donor.  If you wish to proceed the embryology team will then arrange for the sperm to be transported to our main clinic Nurture in Nottingham  It is not possible to commence with your treatment cycle until the sperm has arrived at Nurture.

+-How many vials of donor sperm do I need to order?

The embryology team will advise as to how many straws or vials of sperm will be required for your treatment cycle.

IVF/ICSI Treatment

+-What is the difference between IVF and ICSI?

IVF (In Vitro Fertilisation) is where a high number of (prepared) sperm are added to a dish containing the eggs and the sperm are left to swim to the eggs on their own. The sperm & eggs are left together overnight and checked for fertilisation the following morning.

ICSI (Intra Cytoplasmic Sperm Injection) is where a single sperm in injected into an egg by an embryologist. This technique may be used if the sperm concentration or motility are low or if poor fertilisation had been achieved previously with IVF.

+-What is blastocyst culture and when is this recommended?

'Blastocyst culture' is the term commonly used to describe the culture of embryos until they are five days old.  A blastocyst has a large number of cells and consists of two distinct cell types. Around 40% of embryos will reach the blastocyst stage and those that do have a higher chance of implanting once transferred.

Blastocyst culture is usually recommended for patients with a good number of fertilised eggs (3-4), where it will be difficult to choose the best quality embryos at an earlier stage of development, allowing the best embryos to select themselves. This will be discussed with all patients on the day of egg collection and again on the day of fertilisation.

+-Is there a chance that none of my embryos will form blastocysts?

Approximately 40% of embryos will reach the blastocyst stage. Those at a compacting or cavitating stage (the stage before the blastocyst stage) can still be transferred but do have a lower chance of achieving a pregnancy. There is a small chance that all of patients' embryos may stop developing at the embryo stage, this happens in approximately 2% of blastocyst cycles and results in the embryo transfer been cancelled.

+-What is EmbryoGlue®? Will I be offered it?

EmbryoGlue ® is a culture medium that is used to transfer your embryos back to the uterus.  It is unique as it contains a high concentration of hyaluronan, a substance which is naturally occurring in the uterus & known to be involved in implantation. Through our own research at our partnership clinic Nurture, we have shown that a small sub-group of patients may benefit from using EmbryoGlue ®. They saw a dramatic rise in pregnancy rates in womenover the age of 34 who had previously had multiple unsuccessful IVF cycles.  Our 2012 results show a clinical pregnancy rate of 55% in day 5 transfers in this group; this is an increase of 19% compared to the previous year. EmbryoGlue ® is available to this group of patients having blastocyst transfer for an additional cost of £150.

+-What is time-lapse monitoring? Will I be offered it?

The Primo Vision Time Lapse System consists of a series of specialist cameras that are housed inside an incubator. Photographs of patients embryos are taken every 20 minutes and these are linked together to form a video sequence of embryo development. Time Lapse can be used to gain additional diagnostic information about the development patterns/timings and quality of a patient's embryos.  Primo Vision also has a built in algorithm which is a mathematical formula that helps the embryologist select the best embryo for transfer.  Primo Vision can be used in IVF & ICSI cycles and can be used in combination with blastocyst culture.  

Patients who may particularly benefit from this technology include those with; previous failed attempts at IVF/ICSI, known poor embryo quality/low fertilisation rates, previous miscarriages, cycles using surgically retrieved sperm samples.  Primo Vision is available at an additional cost of £500.

+-I have been advised to consider a single embryo transfer (SET), why is this beneficial to me?

If you have been recommended for SET you are a patient with a high chance of achieving a pregnancy from IVF treatment. A high chance of pregnancy is accompanied by a higher risk of twins if we replace two embryos, with the following increased risks:

For mum a higher risk of early and late miscarriage, a higher risk of pre-eclampsia developing - 30% in twin pregnancy, 2-10% in singleton pregnancy, a higher risk of gestational diabetes developing- 12% versus 4%, Caesarean-section is much more common for twin deliveries because birth complications are more likely, the risk of haemorrhage and anaemia is higher, the risk of stress and depression is higher for mothers after a twin birth.

For babies at least half of twins are born prematurely - before 37 weeks, and with low birth weights, putting them at increased risk of serious health problems and neonatal death.   40-60% of IVF conceived twins need to be transferred to the intensive care unit when they are born as compared to 20% of singleton IVF babies.  A small percentage of twins also have severe health problems that will affect their entire lives e.g. cerebral palsy (affects 4-6 times as many twins compared to singletons).

+-How are my embryos graded?

At the early stage of development when an embryo is 2/3 days old, embryos are graded based on the number & quality of their cells and amount of fragmentation present.  Each embryo is given a grade on a scale of 1-4, 1 is the highest grade and 4 is the lowest. Embryos graded 1 or 2 are suitable for freezing.

Blastocysts are assessed by observing their expansion status and by taking into account the quality of the two distinct cell types within the blastocyst. Blastocysts will be graded from A to C, with A been the highest grade.  Blastocyst that are grade A or B are suitable for freezing.

+-Will I be able to freeze my spare embryos?

Embryos which are not transferred can be frozen if they are of a suitable quality. At the time of embryo transfer the Embryologist will discuss with you the quality of the embryos for transfer and any remaining embryos and will advise you if these meet the criteria for freezing. On average we freeze for approximately 25% of patients. There are extra costs involved for private patients.

+-What are the pessaries for and how do I take them?

Cyclogest pessaries contain the active ingredient progesterone, which is a naturally occurring female sex hormone. They help to support early IVF pregnancies. They are used twice daily, once in the morning upon wakening and once at night before going to bed, and they are inserted either into the vagina or rectum (back passage). You should lie down for approximately 30 minutes after inserting a pessary, allowing them to melt and the progesterone to be absorbed into the bloodstream. It is normal to find that some of the excess pessary is discharged; your body absorbs what it needs.

+-What is my chance of success?

Latest HFEA Results - Published May 2014

Clinical Pregnancy Rates 2013 (year ending 2nd quarter)

Clinical Pregnancy Rates (IVF & ICSI) per treatment cycle started

Clinical Pregnancy Rates per treatment cycle started

Clinical Pregnancy Rates (IVF & ICSI) per treatment cycle started
AgeNurture Fertility/Burton IVF
< 35 46.2%
35 - 37 41.2%
38 - 39 46.7%
40 - 42 18.3%
Clinical Pregnancy Rates per treatment cycle started
All AgesNurture Fertility
Frozen Embryo Transfers 46.5%
Treatment Using Donated Eggs 31.4%
 

Freezing and Frozen Embryo Transfer

+-I wish to consider egg freezing to preserve my fertility, what does this involve?

There are many reasons why a patient may wish to consider egg freezing. This may be prior to having chemotherapy treatment or treatment which may render them prematurely infertile. We also offer egg freezing for other groups, such as those who may wish to preserve their fertility and have children later in life.

Patients will need to undergo the normal pre-treatment process such as consultation, blood screens, AMH, AFC. The results of these tests will determine whether they are suitable to go through the egg freezing procedure. An egg freezing cycle involves the same initial steps as a stimulated IVF cycle.

+-What proportion of embryos survive the freezing/thawing process?

We find approximately 80% of frozen embryos survive the freezing/thawing process. This can vary depending on the stage of development that the embryos were frozen and an individual patients' embryos susceptibility to the process.

+-How many embryos should I thaw for my frozen embryo replacement cycle?

Our aim is to give you the best chance possible of pregnancy with each frozen embryo replacement cycle. Not all embryos have equal potential to form a pregnancy and each will be affected differently by the freeze and thaw process. This may not be immediately clear to us after thawing. For this reason we usually thaw more embryos than you would like to have transferred back to the uterus. This gives the embryologist a chance to select the best quality & highest surviving embryos from a group and therefore gives you a higher chance of pregnancy. If you have embryos frozen at the day 2/3 stage of development we will usually recommend thawing at least 4 and culturing them in our incubator until the blastocyst stage to help us choose the best embryos. If you have embryos frozen at day 5 of development (blastocysts) we will usually recommend thawing at least one more than you wish to have transferred.  Blastocysts are thawed and transferred back to the uterus on the same day.

+-Why can we only consent to three years storage of frozen embryos/sperm in the first instance?

It's really important that we stay in touch with you if you have frozen embryos/sperm in storage. We will contact you when your embryos/sperm near the end of the period of storage you have consented for.  We have found that if patients consent to storage for longer periods it is more difficult to contact them when this period ends and it is important for us to find out your wishes at this time. Please remember to let us know of any address changes.

+-Will you contact me to remind me when the period of storage we have consented for is coming to an end and what will our options be?

We will send you a letter about 6 months before the period of storage is due to end. This will outline your options and include a consent form for you to return to us. If you don't reply to this first letter promptly, we will send you a second letter, attempt to contact you by phone and contact your last known GP.

Your choices at the end of the storage period are: to use the embryos/sperm for treatment before the end of the consent period, to extend storage for a further 3 years at a cost of £500, to discard the embryos/sperm if you no longer plan to have treatment, or to donate to another couple or to research (applicable in some circumstances).

+-Do frozen embryos deteriorate over time in storage?

Frozen embryos are stored in liquid nitrogen at a temperature of -196°C. This means they are held in a suspended state and do not deteriorate with time in storage.

+-Can I transfer my frozen embryos/sperm samples from a different licensed clinic within the UK to Nurture or vice versa?

Yes, this is something that can be arranged between the two licensed centres. You will need to complete consent forms for the transfer to take place and decide whether to use a specialist courier or whether to transfer the samples yourself using a dry shipper hired from the Unit.

Please bear in mind that at Burton we do not recommend transferring vitrified embryos or blastocysts between Units. These embryos are "frozen" in very small volumes of media that are very susceptible to temperature changes and therefore it is safer not to transfer these. It may however be possible to have all of your investigations at a Unit in close proximity to your location and then travel for your embryo transfer procedure.

+-Can I transfer my frozen embryos/sperm samples from a clinic outside of the UK to Nurture or vice versa?

It is possible to transfer your frozen embryos/sperm from a clinic outside of the UK to our clinic in Nottingham or vice versa.  The HFEA stipulate that certain criteria must be met in order to fulfil conditions for a general license to transport gametes/embryos.  If conditions under the general license are not met, we would then apply for a special license which would allow us to transfer samples between clinics.  An external courier will take care of the actual transportation of your gametes/embryos to or from our Nottingham clinic in conjunction with the receiving clinic.  More details about this can be found on the HFEA website