Fertility Treatments

IVF or ‘in-vitro’ treatment means ‘in glass’, which is where the term ‘test tube baby’ originates. However, no test tubes are actually involved in the process. It seems deceptively simple to mix sperm and eggs together until the eggs are fertilised, but it requires closely controlled laboratory conditions and skilled embryologists to maintain. Once the eggs are fertilised, the embryos are then carefully incubated and the best candidates are selected for transfer into the womb a few days later. The remaining embryos can be frozen at this point.

What does IVF involve?

IVF treatment encompasses a number of procedures referred to as the ‘treatment cycle’.

All IVF treatments begin with hormone therapy to stimulate the ovaries to develop more follicles than usual. These hormone injections are self-administered with very shallow injections, and the cycle is monitored by the doctor to ensure that ovulation is triggered at the right time.

Ovulation is triggered with another hormone, called human chorionic gonadotrophin (hCG). The eggs are then collected and fertilised. Egg collection is relatively quick and painless, and general anaesthetic is not normally required.

Once the resulting embryos have grown and developed in-vitro, under the supervision of the embryologist, the best 1-2 are transferred into the uterus through the vagina. Ideally, the embryo then implants to become a pregnancy, but this does not happen in all cases. That is why surplus embryos are frozen so that another transfer can be attempted without having to complete the hormone therapy again.

In some instances, the transfer may be left a few days later so that the embryo can reach an advanced stage of development and becomes a blastocyst. This is only offered in under certain conditions, and our usual policy is to attempt IVF with embryos.

What should I expect from IVF treatments?
IVF is an ongoing process for a number of weeks, and can be emotionally and physically taxing. For the best chance of success, it’s important that you are healthy before the treatment cycle begins, and that you remain healthy throughout the process.

You will need to visit the fertility clinic throughout these weeks for check ups, consultations, and treatment. During this time, it’s also extremely important that you eat well, avoid smoking/alcohol, and remain relaxed so that your body is receptive to the treatment. We can offer counselling for IVF patients to help you remain calm and understand how your body is reacting to the hormone treatments.

What are the risks of IVF?

One of the most widely reported risks is multiple pregnancy. That is why clinics only implant 1-2 embryos at a time and freeze the remainder.

There is also a very small risk (1-2%) relating to the hormone drugs, which can cause an adverse reaction in a very small percentage of women. Ultrasound and hormone monitoring during the treatment ensure that any overreaction is monitored and dealt with before the issue develops.

Concept Fertility has a fantastic IVF success rate
We do believe that our IVF success rates are great when compared to the equivalent national average but it is important when using statistics to know exactly what they are measuring. We advise that you read through our success rates pages from beginning to end to get an idea of the different ways the statistics could be produced. Success rates vary according to age, health, and reason for infertility, so it’s important to keep healthy and ensure that your body is ready for the treatment before commencing.

We owe this success rate to our care, ongoing monitoring and holistic approach to fertility and general wellbeing.

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What is Minimal Stimulation IVF?

Minimal stimulation IVF differs from standard IVF in that lower doses of medication are used to stimulate the ovaries. In standard IVF, high doses of hormones are injected with the aim of retrieving the maximum number of eggs from the ovaries. Because lower doses of injectable hormones are used with minimal stimulation IVF, this means that less medication is used overall but this also means that fewer follicles develop and fewer eggs are collected.

What are the advantages of Minimal Stimulation IVF?

The advantage of Minimal Stimulation IVF is that less medication is involved and patients find this more convenient and less stressful. There is less chance of developing complications such as OHSS (Ovarian Hyperstimulation Syndrome) and there are fewer side effects (bloating, fatigue, breast tenderness) due to the lower doses of medication. The cost of the medication may be lowered by several hundred pounds. It is particularly useful for patients known to have an intolerance to fertility medication.

What are the disadvantages of Minimal Stimulation IVF?

The main disadvantage of Minimal stimulation IVF is that the pregnancy success rate is lower. Fewer embryos are created due to fewer eggs maturing and being collected. There may even be no embryos at all to transfer to the womb. With convention IVF transfers are more likely and surplus embryos would be cryogenically preserved for future use, meaning the patient can have a second chance with a frozen embryo transfer requiring greatly reduced medication and injections. With Minimal stimulation IVF there is less chance of having spare embryos to freeze.

Who should use Minimal Stimulation IVF?

There are many factors to consider before choosing minimal stimulation IVF, such as age and the risk of Ovarian Hyperstimulation Syndrome. At Concept Fertility, most patients choose standard IVF protocols. However there are patients who are suitable for Minimal Stimulation eg: patients who do not develop multiple eggs with standard medication, patients with a high risk of OHSS and patients who have a good ovarian reserve.

In the past, ovarian stimulation resulted in high rates of premature ovulation and very few eggs at retrieval but as more knowledge about stimulation protocols was gained, methods improved and premature ovulation rates have been greatly reduced. Most doctors prescribe injectable hormone medication in order to collect as many eggs as possible. The reason for collecting multiple eggs is that many are abnormal. Therefore there is a greater chance that at least one will result in a normal embryo and increase the chance of a successful pregnancy.

In Conclusion

At the present time the chances of achieving a pregnancy with conventional stimulation methods are higher than with minimal stimulation IVF, often significantly so. However, the success rates from minimal stimulation IVF have improved significantly as knowledge has been gained. Whether Minimal Stimulation IVF can ever increase pregnancy rates similar to standard IVF rates remains to be seen. It does, however, have several advantages over conventional IVF and may be an appropriate choice for a select group of patients.

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There are many variations on the IVF technique, and one that is particularly important concerns what happens where there are sperm present, but they are hardly swimming or not swimming at all, or there is some other barrier to fertilisation. The causes may be genetic or environmental. In normal IVF, the eggs and sperm are mixed in a petri dish and fertilisation occurs spontaneously.  When the sperm are not active enough, this fertilisation does not happen. Fortunately ICSI was developed to account for this problem. By using sophisticated microscopic manipulation equipment, a single sperm can be manually injected into an egg resulting in fertilisation just as if a swimming sperm had encountered the egg naturally.

The procedure is called intra-cytoplasmic sperm injection (ICSI). Cytoplasm is just the scientific name for the inside of the egg. The other parts of the IVF cycle, the controlled ovarian stimulation and embryo transfer, are just the same as normal.

The ICSI Technique

Firstly, in ICSI, the egg and sperm are prepared separately. Then the egg is held in position by a pipette with gentle suction from a microinjector, with the polar body held away from the area to be injected. The embryologist then picks up the prepared sperm with a glass micropipette, pierces the shell of the egg and injects the sperm into the egg’s inner cytoplasm. The egg/sperm will then be placed in a culture medium, as normal, and checked the next day to see if it has fertilised. The egg and sperm are tiny and all this takes place using micromanipulators and a powerful microscope.

The ICSI Decision

Often the plan to use ICSI is made before the IVF cycle starts. A previous semen analysis will have identified the deficiencies mentioned above or, for example where sperm has previously been surgically removed from the testis, we would expect the sperm to need the help of ICSI. However, the final decision will almost always be reviewed by the embryologist when he or she sees the actual eggs and sperms on the day of the procedure. This sperm sample may be better than the semen analysis suggested, or it may be worse. Where possible we will always let nature take its course and let the sperms and eggs mix as naturally as possible without using ICSI.

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Intrauterine insemination involves preparing semen in a laboratory to select only the highest quality sperm for insemination. The treated semen is then introduced into the womb just before ovulation, and can be used with either natural ovulation or in conjunction with clomid or injectables such as follicle stimulating hormone to induce ovulation.

How is intrauterine insemination performed?

Once the man has provided a sperm sample, it is then filtered (or ‘washed’) to ensure that only high quality, motile sperm are used for the procedure. This process means that it’s a good treatment for couples where the male may suffer from a low sperm count of poor sperm mobility.

If the man is unable to produce sperm, or the treatment is for a single woman or same sex couple, donor sperm is also suitable.

During the procedure, the treated semen is passed directly into the woman’s womb using a catheter. The process is largely painless, although some women report experiencing mild cramping similar to period pain. The process generally takes 10 minutes, and does not require overnight stays in hospital.

Who is IUI used for?

Intrauterine insemination is recommended for:

• Single women or same sex couples who would like to conceive
• Couples with unexplained infertility
• Couples where the man experiences impotence or premature ejaculation
• Couples where the man’s sperm is slightly sub-optimal
• Couples where one or both partners are unable (or find it difficult) to have vaginal intercourse
• Couples where one partner has a viral infection that can be sexually transmitted
• Couples where the woman has mild endometriosis

While success rates are slightly higher using fresh sperm compared to frozen, it is suitable for a range of different infertility issues. Success rates vary depending on age, reasons for infertility, and overall health.

IUI can be used in conjunction with other fertility treatments

IUI is often used together with ovulation induction to provide the best chance of success. In cases of unexplained infertility, IUI may be tried if ovulation induction alone hasn’t helped.

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Ovulation induction is recommended for women who haven’t yet reached menopause but aren’t ovulating. We only suggest a minimal drug regimen if absolutely necessary, so fertility drugs are not our immediate response to lack of ovulation.

We begin by using ultrasound to see whether there is a follicle maturing. We would then use the information from your ultrasound to recommend either natural ovulation, tablets or a series of injections to encourage your body to produce a mature egg. Then you can either use natural timing or another injection to trigger ovulation at exactly the right time. This means that you have the best chance of getting pregnant without any further medical intervention. This treatment is often successful and is used as the first option when treating infertility due to polycystic ovarian syndrome or other conditions which inhibit ovulation.

Who is best suited to ovulation induction treatment?

This is often the preferred fertility treatment for women with polycystic ovarian syndrome (PCOS), but it is also suitable for women who are not ovulating for a variety of other reasons. However, it is essential that women opting for ovulation induction have not begun the menopause.

What are the risks?

At Concept Fertility, we always provide a full range of options based on your causes of infertility, your health, and the possibility of getting pregnant with each treatment. Your doctor will explain all of the risks of each treatment to ensure that you begin the procedures fully informed.

Ovulation induction is not invasive and regular monitoring with ultrasound and hormone measurements ensures that we can catch ovarian hyperstimulation syndrome (OHSS) early and ensure that only one or two follicles are developing. As women with PCOS are often sensitive to fertility drugs, more than one egg may be produced which leads to twins or triplets. This only occurs in 5-10% of cases.

Prolonged use of the medicines involved in inducing ovulation can have a negative effect on the lining of the uterus, so we check that during our monitoring processes too. If we do notice any damage, we offer alternative medication to continue with the treatment without further risks to your health.

How many times can I induce ovulation?

If ovulation induction hasn’t resulted in a pregnancy through natural insemination within 3 treatments, we will discuss other treatments.

Depending on your age, this treatment is 10-20% successful. For women whose only fertility issue is anovulation, up to 80% of patients ovulate once induced and 50% of those conceive.

What is an FET?

Frozen Embryo Transfers (FETs) use embryos, unused and cryopreserved, from a previous IVF cycle. They are thawed, checked to ensure that they have survived and are growing, and transferred into your uterus. The resulting outcome will be the same as if it took place following a natural or IVF pregnancy.

The whole process is a lot simpler than its preceding IVF cycle as you do not need to take the follicular stimulating hormones that you previously self-injected to produce the eggs, and you do not need to have the operation to retrieve the eggs from your ovaries. Instead, you will take hormones to build your uterine lining in preparation for receiving the embryos. You will still need to be monitored by ultrasound to check progress.

If a woman finds the initial stages of IVF, up to egg collection, very stressful, she may choose not to have any embryos transferred at that time. Instead she may prefer to freeze all her embryos and have a FET a few months later in a more “normal” cycle. Forecasts are that in future this will be the recommended course of action for IVF cycles.

How Many Embryos Should you Transfer?

By law you may transfer one or two, or if you are over 40 you may transfer three. Generally the transfer of only one embryo at a time is preferred, to avoid the likelihood of twins. However, it is your choice and our guidance will consider your age and the embryo quality.

The number of embryos transferred will depend on several factors: your age, the embryo quality and how many have survived the thaw. Generally speaking, we will thaw one more embryo than were transferred in your fresh cycle.

Do you Thaw all Embryos?

Unused embryos can be frozen again but this should be avoided as there is no point in subjecting them to the extra stress. Instead we thaw only the ones required for transfer and we do this early enough so that, if they don’t survive, there is still time to thaw and check another before your transfer time. Any unused embryos can remain frozen until you need them. You may carry a pregnancy to birth, wait a while, and then have another FET to have a second child. Or a third, or fourth.

A HyCoSy fertility scan is a short procedure to detect whether the fallopian tubes are damaged or blocked. It is sometimes called a Tubal Patency Test or a Dye Test and can be a substitute for a HSG (Hysterosalpingography) or Laparoscopy and Dye, without the use of X-rays. A small thin catheter is passed through the cervix into the uterus and ultrasound contrast medium is passed through the fallopian tubes. The progress of the fluid can be monitored by ultrasound and any blockages or abnormalities can be detected.

How Much Does It Cost?

HyCoSy (fallopian tube patency test) – £425

This is designed for women who have concerns about their fallopian tubes. A dye is passed through the fallopian tube under ultrasound guidance and each of the fallopian tubes is assessed for adhesions and blockages etc. The technique is called Hysterosalpingo-Contrast Sonography (HyCoSy). Patients should empty their bladder before the HyCoSy.

HyCoSy (fallopian tube patency test) and Consultation – £605

This service is exactly the same as the above initial HyCoSy treatment and investigations, with the addition of a full post-test consultation with your doctor to discuss the results of your test and the wider implications for your fertility and possible fertility treatment. Patients should empty their bladder before the HyCoSy. This treatment option consists of the following:

• Ultrasound scan of uterine and pelvic physiology, including Antral Follicle Count
• Fallopian tube patency test (HyCoSy)
• Medical history review
• Full consultation & plan

When to have a HyCoSy (fallopian tube patency test)

If you are considering this treatment it is advisable to contact us on the 1st or 2nd day of your period to arrange an appointment. The best time to perform the HyCoSy test is usually between days 5 to 12 of your monthly cycle.

The HyCoSy Procedure

Our HyCoSy test takes place using 3D ultrasound, which allows for a significantly better assessment of the uterine anatomy than with 2D ultrasonography. It consists of the introduction of a contrast medium through the cervical canal into the uterus, through the Fallopian Tubes and into the peritoneal cavity.

The passage of the contrast medium is monitored through a transvaginal (internal) scan. This procedure determines whether there are any blockages present in the Fallopian Tubes which would prevent an egg passing safely through them when you ovulate. It should be performed after menstruation in the first half of the cycle, sometime between days five and twelve.

HyCoSys are highly-skilled treatments performed at the Concept Fertility Clinic, by our own staff, for our patients. We also perform these procedures for the patients of other fertility centres or fertility specialists as well as patients referred by GPs and gynaecologists or by patients self-referring themselves after discussion with our specialists. (Examples include unexplained infertility at a young age or if they are concerned that an infection such as chlamydia could have scarred their Fallopian Tubes.)

During the procedure itself, a catheter is passed through the vagina, through the cervix into the uterus (womb). A small balloon is then inflated to keep the catheter in place in the uterine cavity before the contrast medium is introduced through the catheter. This may cause some discomfort and feels similar to the uterine cramps experienced during menstruation. Throughout the process the procedure is monitored by your doctor via an ultrasound scan. This allows your doctor to view the contrast medium flowing through your Fallopian Tubes.

How Long Does A HyCoSy Test Take?

Our HyCoSy (fallopian tube patency test) procedure takes approximately 30 minutes to complete and no anaesthetic is required.

Sexual Intercourse and HyCoSy Treatment

It is recommended that you avoid intercourse from the first day of your last menstrual period until after the HyCoSy (fallopian tube patency test) procedure itself. After the test you can continue with your normal daily activities including protected or unprotected sexual intercourse if you wish.

HyCoSy & Chlamydia

Before your HyCoSy (fallopian tube patency test) your Consultant may suggest that you have a high vaginal swab and chlamydia screen which will be performed to exclude and eliminate infection prior to the HyCoSy testing or, alternatively, you may be prescribed a course of antibiotics.

Painkillers & Antibiotics

We recommend that you take two Paracetamol tablets, or any other common painkiller, one or two hours before the procedure. If you have any concern regarding this procedure and the use of painkillers for any reason, including any medical condition that you may have, please contact our experienced staff for more information and advice.

Follow Up Treatment Options After HyCoSy (fallopian tube patency test)

After the HyCoSy has been completed, your doctor will discuss the results with you and you will receive a written report by post. The procedure shows where the contrast medium has spilt (i.e. where it has flowed without impedance). If any abnormality is indicated, laparoscopy and/or hysteroscopy may be recommended to investigate the situation further. A discussion will be arranged with your Consultant to discuss this in more detail.

Post-treatment, you will be required to take a course of antibiotics for five days to reduce the chance of infection. These will be prescribed to you on the day of the procedure.

Much like egg freezing, sperm freezing allows men to use their sperm if they need to delay conception or if they are undergoing medical procedures that are likely to affect fertility. Unlike eggs, sperm can be frozen and stored indefinitely – there are no limits placed on how long sperm can remain frozen before use.

Sperm Freezing Success Rates

Whilst it is generally thought that the freeze-thaw process may damage some of the sperms in a sample, some studies actually find the opposite. It is most likely that there is a small drop in quality. Where possible we test samples by freezing and thawing a small amount to check for vitality after the process.

Do I Need to Freeze My Sperm?

Storing your sperm allows you to use it for treatment in the future. You may want to consider sperm freezing if:

• You are about to undergo a vasectomy
• You have a low sperm count or your sperm quality is deteriorating
• You have difficulty producing a sample on the day of treatment
• Your sperm is going to be used for donation
• You have a medical condition that may result in infertility later in life
• You are facing medical treatment that may affect your fertility

What are the Risks of Sperm Freezing?

As a non-invasive procedure, there are no risks associated with the actual process of collecting sperm. There are also no risks to recipients of embryos created with frozen sperm, or to children created from those embryos.

The Process

Before you begin the procedures, you they will be explained in more detail by your clinician. As an overview, there are 4 main steps to sperm freezing:

1. You will be screened for infectious diseases, including HIV, HTLV and Hepatitis B/C
2. You will provide written consent for your sperm to be stored
3. You need to produce a sperm sample at the clinic
4. Your sperm is frozen and stored in liquid nitrogen

How Much Does Sperm Freezing Cost?

At Concept Fertility, your first freeze and 1 years’ storage is £425. If you require other treatments or would like to continue storing your sperm after the first year, this will be charged separately.

Concept Fertility can help you extend or preserve your fertility period through egg freezing. Babies born through the freeze-thaw process are healthy, and success rates are high (depending on a range of factors such as number of eggs removed and age at the time of freezing).

Why Would I Freeze My Eggs?

Women freeze their eggs for numerous medical and social reasons. If you would like to delay parenthood to focus on other areas of your life, it’s an excellent option. It’s also recommended for women undergoing certain cancer treatments that may affect fertility.

How Does Egg Freezing Work?

To begin the process, you have a series of hormone injections to make the ovaries release more eggs than usual (ovarian stimulation). Collecting as many eggs as possible improves the success rates for this procedure.

The actual egg collection is carried out with a needle, guided to the correct area with an ultrasound probe. It takes around 15-20 minutes to complete the procedure, which is performed under sedation. Ideally, this should result in a collection 10-12 eggs for freezing.

The majority of the water is removed from the eggs to reduce the chances of damage during the freezing process, after which they are stored in liquid nitrogen for up to 10 years.

Once you have decided that you would like to use your eggs, they are thawed through a carefully controlled process before being warmed up. The egg is then inseminated, embryos are created and inserted into your uterus. The rest of the pregnancy should continue normally.

Egg Freezing vs. Embryo Freezing

Freezing embryos rather than unfertilized eggs improves the chances of a successful pregnancy. Embryos have been frozen for longer than unfertilised eggs, and the procedure has been improved over a longer period; the success rate for unfertilised frozen eggs is around half of the success rate for frozen embryos. However, these rates continue to improve as new techniques are discovered.

Freezing Ovarian Tissue

If you are undergoing cancer treatment, you may wish to take the option of freezing ovarian tissue instead of individual eggs. This involves taking tissue from the ovaries (which contains eggs) and freezing it until you would like to conceive. The tissue is then placed back into the body so that the eggs can develop. This is suitable for women who many not have time to undergo the full treatment to freeze eggs or embryos, or for girls who have not reached puberty.

Safe Births from Egg Freezing

Risks from this procedure are very small, and many children have been born from embryo and egg freezing. There are no significant risks of birth defects or further problems during pregnancy.

Embryo freezing is an established procedure in fertility clinics. It has been used successfully since the 1980’s and has resulted in the birth of hundreds of thousands of healthy babies worldwide. In more recent years embryo vitrification has taken over from slow freezing in most fertility clinics and has improved frozen/thawed embryo survival rates and their resulting pregnancy rates so that they are almost as high as when using fresh embryos. In fact, some scientists argue that it improves the rates over fresh cycles. At Concept we only use vitrification for both embryo and egg freezing.

Before embryos can be frozen they must be produced and this is virtually always done via an IVF cycle. In the normal course of events the woman is medicated to produce several eggs. These are then collected by a minor operation and taken to the IVF lab where they are fertilised and grown for a few days. Then they are either transferred back into the woman’s uterus or frozen. If there are too many to transfer back at once, and we normally recommend transferring only one, the extra ones can be frozen to use in a future cycle. This is called a Frozen Embryo Transfer cycle and is much simpler and cheaper than another full IVF cycle.

Embryo Freezing for Fertility Preservation

Sometimes people choose to freeze all their embryos rather than replace any of them. This may be for social reasons – they may wish to delay starting their family until later, they may wish to have a big family and decide to “lock-in” their current fertility, or it may be for medical reasons if they have an illness to deal with which could affect their fertility.

Once embryos are frozen, they cannot be stored or used without the consent of both parents (except in the case of donated sperm or eggs) so people should be wary of storing their embryos unless they are in a stable relationship. Consent can be withdrawn at any point up to the actual embryo transfer so single women or ones in a non-stable relationship may wish to consider freezing their eggs instead.

If people do not wish to start their families now, nor to store their embryos or eggs, they could consider egg donation at a later stage.

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We do not recruit sperm donors here at Concept. Instead we have sourced dedicated sperm banks with good reputations with whom we, and other fertility clinics we liaise with, have had good pregnancy/birth results.

How to Obtain Donor Sperm

The process is streamlined and basically the same no matter which sperm bank you use. You go on to their website and select your donor. They confirm with you/us that the donor is appropriate for your requirements. You pay them online then their lab and ours liaise and arrange the shipping and compliance with legal and quality requirements. Once you have made your selection we normally receive the sperm within 2 days.

Known Sperm Donors

You may wish to provide your own sperm donor rather than use a sperm bank. He may be a family member or he may be a friend, the latter being more common amongst same-sex couples. There are a couple of other considerations in these cases. The first is to account for scenarios where you, the donor and the child might meet, either together or separately. We have implications counselling for you and the potential donor to take, where you will go through these scenarios, be able to put some questions to the professional counsellor and consider some possibilities.

The second consideration is the cost and time. Donor selection involves a sequence of consultation, viral testing, counselling, donating, quarantining and retesting. All of this costs money. Sperm banks reject most, maybe 95%, of their applicants. These costs have to be added too. They address this by spreading the costs of donor selection over all the recipients. A donor may be allowed to produce 10 families in the UK but they can produce additional families in other countries too, depending on their laws. Therefore sperm banks can divide these costs amongst many but if you are using a known donor you will probably have to pay all the costs yourself.

There are several reasons why women would use eggs donated from another woman. Examples include; having early menopause, infertility after cancer treatment, a genetic mutation, choosing to have a family later in life or there is some other reason why their eggs will not let them develop an embryo. Even if they cannot produce a child using their own eggs usually their wombs are perfectly capable of maintaining a pregnancy through to a healthy childbirth. Modern science can help these patients by implanting an embryo created from an egg from a donor and sperm from the patient’s own partner, or another donor, using a variation of standard IVF.

The Egg Donation Process

The process involves firstly selecting your donor. You may have a donor you wish to use or else we can usually arrange one. If you have your own donor she will have to be fertility-assessed, screened and counselled before being accepted or rejected. Donors from the programs we use will already have been through this process. Then your menstrual cycle is synchronised with the donor’s, after which you are medicated to ensure that your endometrium is properly receptive to implantation, whilst the donor is medicated to ensure she produces the right number of good quality eggs. After this, the eggs are collected, fertilised and grown in the lab for 3-5 days, and an embryo transferred into you. It is effectively an IVF cycle split over two women.

Egg Donation in Spain

Many of our egg donation patients travel to Spain for treatment where we have an arrangement with a clinic in Malaga. Assessment and diagnostics take place here in London, along with preparation of the patient (ultrasound, blood tests, medications and any necessary medical procedures) and treatment co-ordination. Then the patient just has to travel to Spain for the fertilisation (from the patient’s partner) and the implantation of the embryo, which usually takes place three days later with a very simple procedure which does not require anaesthetic or any onerous medical processes.

The male partner can travel earlier if he wishes and leave sperm to be frozen. That way fertilisation can take place when the female recipient is still elsewhere and she just needs to travel for embryo implantation. In fact, this is the process which takes place when donor sperm – which is free of charge – is used, where the woman either does not have a male partner or he has been diagnosed as requiring donor sperm.

Because of our close relationship with this clinic, and because we have agreed protocols, our doctors and nurses can guide you through the whole process.

Patient-Sourced Centres

Many patients choose their own egg donation centre overseas and just need a fertility centre in London for diagnostics such as Aquascans or HyCoSys, or to perform blood tests and monitoring ultrasound scans. We are happy to help. However you should be aware that different doctors and clinics have different protocols. For that reason, and because we will not know the history, treatment and protocols followed we cannot give a second opinion on your treatment unless you have a full consultation with us and supply all information. Only with our own partner clinic in Spain are we able to give full cycle support and coordination. We do understand that people may prefer certain clinics, perhaps if they originated in that country, but we urge people to consider the support they will need before they start treatment. We get many calls for help from patients who feel that they have been left stranded by their clinics.

In standard IVF, embryos are grown under very strictly controlled conditions in the laboratory for two or three days. They are then transferred into the woman’s uterus (womb) and any additional embryos can be frozen for future use. Blastocyst culture refers to growing the embryos in the laboratory for two more days at which point they are referred to as blastocyst embryos. Blastocyst transfer simply means that the blastocyst embryos are transferred to the woman’s uterus on day 5 in exactly the same way that day 3 embryos are.

How do embryologists monitor embryos/blastocysts?

Every day the embryologists will look at the embryos to see how many of them have divided and assess their quality, and they will keep the patient informed with any developments that require patient input. When the embryos develop to the blastocyst stage, they use a 3-character grading system which focuses mainly on the Inner Cell Mass (ICM), the Trophectoderm (the outermost layer of cells) and the degree of expansion and size of the embryo. Under IVF culture conditions only about 60 to 70% of human embryos progress to the blastocyst stage after 5 days. Several eggs (oocytes) may have initially fertilised, but not all of them will progress to the four-cell stage on day two and to the eight-cell stage on day three in culture, and even fewer will develop into blastocysts.

Simply put, this self-selection process can be viewed as “survival of the fittest”. The embryos that survive to this stage of development are more likely to be strong, healthy, and robust. Depending on the number and quality of the embryos on Day 3, and the patient history, the embryologist will recommend to transfer them on this day or to delay the transfer to Day 5. Patients who have fewer oocytes retrieved, fewer fertilised, fewer dividing by day 3 or fewer good quality embryos by day three have no advantage using blastocyst culture, since little is to be gained in further embryo “self-selection”.

Why not culture embryos in the laboratory beyond 5 days?

The diagram above, which is not to scale, shows the egg/embryo’s path and growth over the first six days. The egg starts off in the ovary in the centre of the diagram. In it’s first day it is picked up by the fimbria and guided into the fallopian tube where it meets the sperm and is fertilised. It then stays in the fallopian tube for a further two days where it grows into a day 3, 8-cell, embryo before moving on to the uterus (womb). The section to the right of the diagram shows a portion of the uterus with the embryo at the edge of the endometrium. Around day 5 it starts embedding itself below the surface of the endometrium and this is the reason why we cannot keep the blastocyst in the laboratory at this stage – it cannot delay starting the process of embedding in the uterus.

Advantages of blastocyst culture

The human body is the best incubator for human embryos but if there are several embryos to choose from on day 3, we know that not all will survive to day 5 whether they are in the laboratory or the womb. Keeping the embryos in the laboratory for these two extra days eliminates the possibility of transferring a (healthy-looking) embryo on day 3 which would naturally perish before day 5. Therefore it gives a better chance of transferring an embryo which will lead to a successful pregnancy and birth.

The decision to choose a day 3 or day 5 embryo transfer will depend on the circumstances at the time. The embryologist will fully discuss this with the patient. We believe it is correct to proceed to day 5 wherever possible and do not believe that finance should play a part in this decision. Therefore, since summer 2017, Concept Fertility does not charge for blastocyst culture and transfer.

There are two normal scenarios whereby people may wish to preserve their fertility – medical and social. Preservation normally means cryopreserving eggs, sperms or embryos for use at a later date with the intention of locking-in your current fertility for the future.

Preservation for Medical Reasons.

The original reason scientists developed cryopreservation techniques was to offer future fertility treatment to cancer sufferers. More often nowadays the cancer treatment is successful in treating the sufferer but at the same time it reduces their fertility reserve or renders them sterile. Cryopreserved eggs, sperms or embryos, although often successful, can never be guaranteed to produce a child but if this is the only choice people have, they should discuss their options with their doctor.

Fertility Preservation for Social Reasons

Increasingly people wish to delay starting their families and freeze their eggs, sperms or embryos for use later. People should be aware that no treatment can guarantee success and that this delaying decision may lead to them not having children. Eggs and sperms have been frozen for many years now. The techniques are established, results are known and gold-standard scientific reviews have been carried out. We can be confident that the thawed items will produce nearly as good results as if they were fresh. This standard of data still does not exist anywhere for egg freezing, as it is a newer and more difficult procedure, and therefore egg freezing is still classified as experimental by most clinics. Nevertheless, it is an option that is becoming more and more common and we offer it here at Concept, as well as sperm and embryo freezing.

Men or women expecting to face a hazardous environment, eg in a military situation or if they may be exposed to radiation or chemicals, may wish to consider their fertility preservation options.

For Women

A decision has to be whether to have their family naturally (consider their social/work reasons or settle for Mr Almost-Right?) or to cryopreserve. And if it is the latter, whether to cryopreserve eggs or embryos. Donor sperm is available to create embryos (and these offer a better chance of producing a child than if the eggs are preserved) but this eliminates the option of a future male partner being the genetic father.

For Men

There are fewer social reasons for freezing sperm as, although male fertility does decline with age, it is usually viable well into old age. If men have to have their sperm surgically extracted, it is usually cryopreserved so that it can be used for planned fertility treatment.

Egg, Sperm or Embryo Donation

Many people cannot use their own eggs or sperms to produce a child, or they just don’t have a partner who can provide the missing gamete (egg or sperm). Modern medical practices allow a solution for this problem through donation from another person of their eggs or sperm or even embryos. Of course people have always found ways of doing this themselves but there are certain advantages of receiving gametes through a fertility clinic.

Advantages of a Fertility Clinic

Firstly, the donors are screened to minimise the chances of them passing on a virus or genetic defect. It is impossible to guarantee perfection but donors have a consultation and a family history taken and are tested for the more common viruses and genetic conditions.

Secondly, the law does not allow the donor any access rights to the child, nor does he/she have any financial obligations. In Britain the donors are also non-anonymous, which means that they are not identified to the recipient but the child has the right to find out the identity of the donor when he/she turns 18. The central health authorities keep a register of donors to allow this and also to allow contact if there is any medical need. A varation on this applies, of course, in cases of known donors – where the recipient finds their own donor who may be a family member or friend.

Thirdly, there are rules about how many families are permitted to be formed from any particular donor. This is mainly to reduce the possibility of consanguinity.

The techniques behind gamete donation are well established. The first child born through egg donation was born in 1983 and sperm donation rose to prominence in the 1980’s but the first medically-reported case actually dates all the way back to 1790.

Genetic Parents

People should be aware, when thinking of producing a child through gamete donation, that one of the people who raise the child will not be its genetic parent. Modern society does generally consider the person who raises the child to be the “real” parent although there is no genetic inheritance, and in the case of women there is also some evidence that carrying the child through a pregnancy actually can affect its gene expression, if not the genes themselves. Another important consideration is whether or not to tell the child that a donor was involved. Whilst every case is unique, the general consensus is that the child should be informed when it is quite young because it can deal with this much more acceptingly than if it finds out itself at a later stage and feels betrayal that it has been misled.