Aneuploidy screening of embryos

When the implantation of IVF embryos fails to occur, or the embryos fail to reach maturity, it is often due to chromosomal imbalances in the embryo. By selectively identifying and implanting those embryos that have a normal chromosome level (ploidy), patients can increase the chance of a healthy pregnancy.

Artificial Insemination

Artificial insemination with partner's (AIH) or donor sperm (DI) involves injecting the semen into the cervical canal (neck of the womb) at the time of optimum cervical mucus, which occurs immediately prior to ovulation. Patients are carefully assessed by one of our clinicians before treatment is initiated. The HFEA has made implication counselling compulsory for patients requesting the use of donated gametes.

Sperm donors are screened for sexually transmittable agents (including HIV) and genetically inherited diseases. Sperm are frozen and quarantined for a minimum of six months, at which point the test for HIV is repeated prior to use.

Characteristics that can be matched, if required, to a male partner are eye and hair colour, ethnic background and blood group. In all cases, when using donor sperm, the patient can receive a brief physical profile of the donor that lists such characteristics.

Assisted Hatching

Embryos have an outer shell known as the zona pellucida. Before an embryo can implant into the lining of the uterus it must ‘hatch’ out of this shell. This usually occurs five or six days after fertilisation. The most common reason for an IVF or ICSI cycle to fail is because embryos fail to implant: some because of a failure to hatch, many because the embryos have failed to progress.

Assisted hatching is a laboratory procedure whereby a hole is made in the zona pellucida of a two or three-day old embryo in order to help in the ‘hatching’ process and, therefore, help with the implantation of the embryo into the uterus.

The first assisted hatching techniques were carried out in the early 1990’s. Most IVF clinics use this procedure and many babies have been born as a result of assisted hatching.

Blastocyst Embryo Transfer

The Blastocyst stage in embryo development occurs approximately five or six days after fertilisation. It is at this stage that embryos implant into the uterus. Using special culture medium, it is possible to allow embryos to grow in the laboratory for this length of time. Some embryos will successfully reach the Blastocyst stage and these embryos can be selected for transfer. Research suggests that Blastocyst Embryo Transfer may improve pregnancy rates in certain cases.

Frozen Embryo Replacement (FER)

Good quality embryos remaining from your IVF treatment may be frozen and stored for use in a future cycle. Frozen embryos can be kept for five years; this can be extended to ten years in certain circumstances.

The frozen embryos are thawed and transferred into your uterus, either in a natural menstrual cycle or in hormone replacement cycle.

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic Sperm Injection (ICSI) involves the injection of a single sperm into each egg, and is used when the sperm is unable to fertilise the egg when mixed together in a test tube or dish, as in conventional IVF.

The rate of fertilisation is generally between 65 – 70%. The early stages of ICSI are the same as IVF treatment. The woman takes fertility drugs to stimulate her ovaries to produce eggs. Once the eggs have been selected, a chosen sperm is then injected directly into the egg.

The process is repeated for each egg. The elastic nature of the egg membrane means that the tiny hole made by the needle closes very quickly.

One individual sperm is picked up in a tiny needle, many times smaller than a human hair. This sperm is then injected directly into the centre of a mature egg.

Intra-Uterine Insemination (IUI)

Intra-uterine insemination (IUI) is a procedure in which sperm are placed directly into the uterine cavity near the time of ovulation. IUI increases the chances of pregnancy because the sperm are placed directly in the uterus, bypassing the cervix and improving the delivery of the sperm to the egg.

The cycle is monitored with ultrasound scans and an HCG injection is given to trigger ovulation. Insemination is performed at the time of ovulation, which occurs about 36 hours after the injection.

The IUI procedure is the most commonly used method of artificial insemination.

Ovulation Induction

The failure of ovaries to produce eggs results in irregular or absent periods. Egg production can be inhibited by inadequate or unbalanced release of Follicle-Stimulating Hormone (FSH) or Luteinizing Hormone (LH) from the pituitary gland or by polycystic ovaries.

Fertility drugs can induce ovulation. These drugs work in different ways, some acting on the brain to stimulate the pituitary gland and some acting directly on the ovaries. The choice of drugs used in ovulation induction is individually designed to suit the patient and is accompanied by careful ultrasound monitoring to check the development and number of follicles in the ovaries. If more than three large follicles develop during a cycle, treatment would be suspended as the risk of multiple pregnancies is greatly increased.

When one follicle reaches a diameter of at least 18mm, a Human Chorionic Gonadotropin (HCG) injection is administered to encourage the final maturation and release of the egg from the follicle. Sexual intercourse or IUI will be timed 36-40 hours after the injection.

Pre-implantation Genetic Diagnosis (PGD)

Pre-implantation genetic diagnosis allows individuals and couples who are concerned about passing on a hereditary disease to screen eight cell embryos for specific disorders. After undergoing egg collection and fertilisation, the embryos are assessed and normal embryos only are selected for transfer to the uterus. Diagnosis before embarking on a pregnancy can often be preferable to medically invasive and emotionally demanding prenatal diagnostic techniques.

Surgical Sperm Retrieval

Surgical sperm retrieval may be necessary in cases of impaired sperm production. This is especially indicated in men who have had a vasectomy.

It is possible to extract sperm through a very fine needle directly from the epididymis or the testes providing live sperm are being produced. Alternatively, if sperm are not found, a sample of tissue (testicular biopsy) can be taken from the testes.

Once the sperm have been collected, fertilisation is achieved using Intracytoplasmic Sperm Injection (ICSI), which involves injecting a single sperm directly into the egg. Excess sperm from the sample can be frozen for future use.

Surrogacy

A surrogacy arrangement is one in which one woman (the surrogate mother) agrees to bear a child for another woman or couple (the intended parents) and surrender it at birth. With full surrogacy (IVF HOST Surrogacy) the surrogate mother has no genetic link with the child but gestates embryos, which are usually created from the eggs and sperm of the intended parents using the IVF technique.

Although some countries allow surrogate mothers to be paid, the HFEA does not allow this and a surrogate arrangement in the UK is possible only in the case of a private arrangement between a couple and an altruistic surrogate mother. The Ethics Committee of The London Women's Clinic must approve all surrogacy cases.

We have treated women from over 65 countries worldwide