Test tube fertilisation

- in vitro fertilisation IVF

Definition

The process

The illustration shows a normally functioning uterus

1. What is test tube fertilisation?

Test tube fertilisation is also called In Vitro Fertilisation (IVF). In IFV, mature eggs are aspirated from the ovaries and fertilised with sperm outside the body in the laboratory. In vitro is Latin for in glass. Once the eggs have been fertilised, they are  transferred to the uterus.

IVF treatment is efficient: within three periods of treatment, 70 percent of our patients are pregnant with at least one child.

We recommend IVF in cases if:

·         the woman has blocked tubes

·         the male has poor quality of semen  

·         we fail to explain the cause of infertility

At Copenhagen we avail ourselves of various different methods of treatment, which allow us to cater for the different needs of the individual couples.

 1.2 IVF step by step:

1.      Consultation with your doctor

2.      Examination of your reasons of infertility

3.      Hormone stimulation

4.      Ultrasound scan of the follicles

5.      Semen sample

6.      Egg aspiration

7.      Fertilisation of the egg

8.      Transferral of the fertilised egg

9.      Pregnancy test

10. Pregnancy scan

If you have any questions, please do not hesitate to contact Copenhagen Fertility Centre.

 1.3 Treatment implies

·         that the woman has a normal uterus. We will examine this by an ultrasound scan or a water scan.

·         that the woman is ovulating, either by herself or assisted by hormonal treatment.

·         that the man is producing sperm cells. Or the sperm cells can be recovered from the testicle or the by-testicle. There is also the option of using donor semen.

·         that the woman either has had or has been inoculated against rubella within at last the past three months. This can be examined by a blood sample.

·        That you have received counselling about possible hereditary genetic diseases.

·        That both the woman and her partner have been tested for HIV and Hepatitis B and C prior to the treatment. The tests which needs to be taken are: HbsAg, Anti-HBc, anti HCV and anti-HIV 1 + 2

See the below illustration of the normally functioning uterus:

Illustrated by Lotte Clevin

The illustration shows the development of the follicle, ovulation, fertilisation, embryo development and finally the adherence of the embryo to the endemetrium of the uterus.

The illustration shows the interaction of the hormonal system.

The illustration shows how the hormones develop throughout a normal menstruation cycle.

2. About the female reproductive system

In this chapter you can read more about how the hormonal system interacts and the impacts on the reproductive system. The chapter is meant as help to understand the treatment you are about to have.

The female reproduction system is, somewhat simplified, constructed through the interplay of three elements:

·         The hormonal interplay between the pituitary gland in the brain and the ovaries, where the eggs mature and the ovulation takes place.

·         The uterine tubes, where the egg is fertilised and transported to the uterus.

·         The uterus, where the fertilised egg adheres to the endometrium and becomes a pregnancy.

 2.1 The development of the follicle

In the ovaries the egg is matured and fully developed prior to the ovulation. The egg is caught by the uterine tube, which leads the egg to the uterus. If the egg is fertilised, it will adhere to the endometrium in the uterus and further develop.

This process is steered by the hormones. If you know something about the influence of the hormones, it will be easier to understand the examinations and treatments you are going through.

The development of the follicle and the embryo is illustrated below:

Illustrated by Lotte Clevin

2.2 The interplay of the hormones

Most of the superior sex hormones are formed in the pituitary gland, which is a gland in the brain. The hormone is transported via the blood to its destination (the organ), where a reaction takes place and a signal is sent back to the pituitary gland. See illustration below:

Illustrated by Lotte Clevin

Below the functions of the individual hormones are briefly described.

GnRH-Gonadotropin releasing hormone. GnRH causes release of FSH and LH in the pituitary gland.

FSH (Follicle stimulating hormone) - is formed in the pituitary gland and stimulates the growth of the follicles, which mature the eggs.

LH-Luteinizing hormone - is formed in the pituitary gland and causes ovulation.

Prolactine is formed in the pituitary gland and is in interplay with the breasts and the ovaries. Prolactine causes growth of the mammary gland during pregnancy and stimulate the milk production after childbirth. A too high level of prolactine can restrain the ovulation.

Estradiol is formed in the ovaries. During a menstrual cycle estradiol causes growth of the en endometrium in uterus. A high level of estradiol in the middle of the cycle results in an increase of LH, which leads to ovulation.

Progesterone. During the menstruation progesterone together with estradiol prepare the endometrium in uterus to receive the fertilised eggs. During a pregnancy progesterone restrains the contractions of the uterus.

Androgens are formed in the ovaries and stimulate growth of the hair and the sexual instinct. An overproduction of androgens restrains ovulation.

HCG (human chorion gonadotropin) is formed in the placenta and prevents that the follicles are destroyed during pregnancy. We analyse this hormone to find out if you are pregnant.

During the menstruation the ovaries contain several small follicles, each of them containing an egg. The pituitary gland releases the hormone FSH, which leads to development of one single follicle to be approximately 20 mm in size. When the follicle is mature, the ovulating hormone LH is released. The hormones are interdependent, and for some hormones the rule is that an increase in one hormone results in a decrease in another.

Below you can see how the hormones normally develop during each menstruation cycle. At the very top of the illustration you can see how the follicle develops and matures throughout the cycle.

Illustrated by Lotte Clevin

Down regulation

Stimulation

Laboratory

After-treatment

 <