Assisted Conception

IVF can be quite stressful and many couples say that it seems to take over their lives.  Most patients say that it is helpful to be able to talk about how they are feeling during the IVF treatment with someone who understands what you might be experiencing and is there to support you.

Around half of my work is with patients who are trying to improve their fertility or going through IVF.  Over the years I’ve found that acupuncture is excellent for supporting a woman through her treatment cycle.

Combined with the dietary and lifestyle advice that I give couples, my success rates are substantively higher than the norm.

The average success rate for IVF is about 23% per cycle and 12% for frozen embryos. The success rate decreases with the woman’s age. The body is more responsive first time round, after 4-5 cycles the process has a toll on the body.

IVF Drugs send a woman into a menopausal state, the drugs can lead to hot flushes, sweating, palpitation, emotional imbalance. IVF disrupts the yin/yang energetic balance of the body. Acupuncture can help to correct the balance and alleviate the side effects of the drug regime.

Research has shown that acupuncture given immediately after embryo transfer increases success rates.

You should prepare for IVF at the very least 4 – 6 weeks beforehand:

No coffee, tea, wheat, salt, dairy. Drink 2 litres of fluid daily, take a good multivitamin, DHA supplement 4 x 350mg capsules.  Ideally, you should give yourselves 3 months to prepare by following my fertility programme.

The fertility clinic will carry out Pre-IVF tests:

Aids/hepatitis C on both partners.

Prolactin blood test. Needs to be between 0 and 25. High levels may interfere with the ability to produce follicles.

FSH levels are usually tested on day 3 of the menstrual cycle. FSH needs to be below 10. High levels of FSH suggest a perimenopausal state and may be an indication that eggs may not be able to function properly.

Semen analysis for sperm count, quality, quantity, motility and behaviour.

Hysteroscopy to examine the inside of the uterus for surface lesions, polyps, fibroids or scarring that could affect chances of success.

Flush through of the fallopian tubes to check for any blockages.

The IVF Protocol

Stage 1 – suppression. 

Drugs are given by nasal spray or injection from day 21 of the cycle in the luteal phase.

The Pituitary gland normally releases a small amount of FSH and LH in response to gonadotrophiin releasing hormone being released from the hypothalamus. The suppression drugs will make the pituitary gland release all of it’s FSH and LH so that your body does not begin to ripen an egg in the next cycle.

As a result of depleted levels of these hormones, follicles no longer have any fuel to grow and for one to dominate. The follicles stop growing until the stimulation phase of treatment, when a number will grow at an equal rate.

Period then occurs.

Down regulation generally takes 10 to 12 days. A blood check or baseline scan will measure the oestrogen level to determine if your system is suppressed.

Suppression drugs continue into Stage 2, when stimulation drugs are given. This is to avoid you ovulating on your own and give the clinic control over ovulation and egg collection.

Cysts can stop down regulation. Cysts may be drained and the cycle may be abandoned.

The scan may show that down regulation has not occurred. A drug will be necessary to activate a normal period and the cycle will have to start again.

Side effects from the nasal spray can include mood swings, breast tenderness, hot flushes, headaches, changes in sex drive.

Stage 2. – Stimulation 

Drugs are given by injection to stimulate the follicles to grow at an equal rate. They are given night and morning from the second or third day of the cycle.

The pituitary gland starts to release FSH to stimulate follicles. The drugs stimulate the release of extra FSH and LH to support follicular growth.

Drugs used are derived from the urine of menopausal women, which contains FSH and LH.

Frequent scans and blood tests are needed to monitor the development of follicles.

Essential Fatty Acids (Omega 3) are very important, together with water and red meat to build blood. If you don’t eat red meat, then wheatgrass/barley grass and spirulina are good.

Some women can get ovarian hyper-stimulation syndrome. The signs and symptoms are ovarian cysts, discomfort, nausea and vomiting, shortness of breath, abdominal pain and swelling. Always go back to the hospital immediately if you have these symptoms.

Side effects from the drugs include abdominal bloating, nausea, diarrhoea, weight gain, fatigue.

Stage 3 – Egg retrieval/ sperm collection

When the follicles are stimulated, a scan will look for eggs between 18 and 23mm. Quality is more important than quantity. A scan will look for the most eggs in the right range, some may be over-mature and others under-mature.

When the eggs have matured they will be retrieved using ultrasound guided egg collection. This is the most common technique and may be done under mild sedation or a general anaesthetic. A fine hollow needle is passed under ultrasound guidance via the vagina and each egg is removed in turn. The procedure usually takes 20 to 30 minutes. Occassionaly the needle is passed through the abdominal wall. Spotting can occur 24 to 48 hours after retrieval and that’s nothing to worry about. Heavy bleeding should be reported to the clinic.

A couple of hours before the egg collection, the male partner will be asked to produce a sample of sperm. The sample will be prepared to be combined with the eggs.

Women can feel sore and bruised after retrieval. Take Arnica and plenty of fluids if a lot of eggs have been retrieved. Use a hot water bottle on the abdomen to relieve pain.

Stage 4 – Fertilisation

Eggs are prepared and placed in an incubator. After about 3 to 6 hours, depending on their maturity, the eggs and sperm will be placed together in a specially prepared culture medium.

This medium is prepared in a carefully labelled dish that is kept in an incubator and is inspected the following day to see whether the sperm have fertilised the eggs. If they have, the resulting embryos will be left to grow for a day or two longer.

There may be a mixture of IVF and ICSI at this point. (ICSI is where the man usually has a low sperm count and the sperm is injected into the egg.)

Day 0 – egg retrieval, sperm collection and preparation, insemination.
Day 1 – eggs checked for fertilisation
Day 2 – Embryos at the 4 cell or more stage of development
Day 3 – Embryos at the 8 cell or more stage of development
Day 4- Embryos at the compacted marula (16 – 32 cell) stage
Day 5- Embryos at the blastocyst stage of development

Numeric grading systems for multi-cell embryos usually have 4 levels:

Grade 1 – even cell division, no fragmentation
Grade 2 – even cell division, small fragmentation
Grade 3 – Uneven cell division, moderate fragmentation
Grade 4 – Uneven cell division, excessive fragmentation
Blastocysts are graded differently with a number and 2 letters.

Assisted hatching is where the outside edge of the egg is nicked to help the embryo attach to the uterus when it is put back. This technique is commonly used on the eggs of older women who have a hardened outer surface on the egg.

Stage 5 – Transfer 

The transfer process is usually uneventful and pain-free compared to the retrieval process.
Embryos are loaded into a thin flexible catheter which is inserted into the uterus.
The embryos are place as far into the uterus as possible without touching the back wall (0.5 = 1.0cm away from it).
Once the embryos are in place, the catheter is slowly removed.
The catheter is sent back to the lab to make sure there are no embryos sticking to it.
If this happens, the embryo is reloaded into the catheter and transfer re-attempted.
If the womb lining is poor or too thin, the embryo may not embed.

After transfer:

Avoid caffeine, smoking, alcohol, and drugs.
Avoid heavy lifting
Avoid strenuous exercise and housework including vacuuming.
Avoid bouncing activities such as horseback riding, aerobics.
Avoid sunbathing, hot saunas, hot tubs, jacuzzis, swimming baths due to the risk of infection.
Avoid sex and orgasm.
No air travel
Don’t cramp the body up. Rest is vital for 2 or 3 days or more.

Visualise and do deep breathing meditation.

There may be spotting after transfer, always let the clinic know.