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Step 1: Fertility Specialist Appointment

At your consultation with your fertility specialist, your medical history will be reviewed, any initial tests ordered, and initial advice provided. Based on the results of the initial tests, a treatment plan will be recommended. Should your doctor recommend IVF, the following points outline the main steps involved in a typical IVF treatment cycle (long down regulation).

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Step 2: New Patient Appointments

As a new patient, the Patient Liaison Administration team will contact you to arrange your new patient appointments. In accordance with the new ART Act 2008 effective from 1st January 2010, all patients undergoing ART treatment in Victoria are required to undertake a Criminal (Police) Record and Child Protection Order check, prior to commencing treatment. The Patient Liaison Administrator will talk to you about the checks at this time. It is advisable to review the ART Act 2008 information on this website for all the necessary details on how to go about organising your checks.

These appointments can be organised over the phone or face to face, and include a:

• Counselling appointment
• New patient appointment with a nurse; and a
• Patient Liaison Administration appointment

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Step 3: Mandatory counselling session

Attend a mandatory counselling session with both partners, to assist in considering any issues that may arise throughout upcoming treatment and to sign mandatory consent forms.

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Step 4: New patient information session with a nurse

Attend a new patient information session with a nurse who will explain the IVF cycle (with any specific treatment ordered for you by your doctor), injections techniques taught and medications discussed.

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Step 8: Down regulation medication begins

Down regulation medication is used to suppress your own natural hormones (referred to as down regulation) so that we can control the cycle. When the Follicle Stimulating Hormone is introduced and the eggs start to grow it will stop them from being released naturally. This medication is continued until the trigger injection two days prior to egg collection.

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Step 9: Hormone Stimulation

Once we have confirmed ‘down regulation’ of your own hormones through a blood test, the 'stimulation phase' of treatment can begin.

The FSH injection is a synthetic hormone that is self administered, which stimulates development of ovarian follicles (think of a small sac that holds the eggs). The nurses will have shown you how to give these.

Naturally there will be a number of follicles that a receptive to grow every month but only one reaches maturity. By giving a higher dose of FSH than is naturally produced each month, we are able to recruit some of those follicles that wouldn't normally grow to maturity.

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Step 10: Treatment Monitoring

Throughout treatment we monitor how you are responding to medication with blood tests and ultrasound scans, to measure the endometrial thickness, size and number of follicles on both ovaries. Based on this we will determine when you are ready for egg collection.

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Step 11: Trigger Injection

Once you have the optimum number and size of developed follicles you are ready for the trigger injection. The role of the trigger injection is to trigger the final maturation of the eggs ready for your egg collection. The nurses advise you two days before your egg collection of the exact time that you are required to administer the trigger injection. This is usually 37 hours before egg collection.

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Step 12: Egg collection-day surgery

The egg collection procedure is undertaken in the morning in a day surgery under a sedation anaesthetic and takes around 30 minutes. You will be at the hospital for around 4 hours and will need someone to drive or escort you home afterwards (don’t plan to work that day). The procedure is performed using an ultrasound guided probe. Attached to the ultrasound probe is a needle guide through which the fine needle passes through the vaginal wall into the ovary and draws the fluid (and egg) from the ovary. The tube containing the follicular fluid is then immediately passed to the Melbourne IVF laboratory and checked to ascertain whether it contains an egg.

On the morning of your egg collection your partner will need to provide a fresh semen (sperm) sample (unless using frozen sperm) so we can inseminate your eggs after collection.

Unstimulated ovary on ultrasound

Stimulated ovary on ultrasound

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Step 13: Fertilisation

Following egg collection, if you are having IVF the egg and sperm will be placed in a dish allowing fertilisation to occur naturally.

If you are having ICSI, an embryologist will insert one single sperm directly into the egg, allowing fertilisation to occur.

IVF

ICSI

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Step 14: Embryo Development

The day after egg collection a representative from the embryology laboratory will contact you to let you know the time for embryo transfer the following day.

The embryos will grow under the care of the embryologists for normally two days. Any extra suitable embryos will be frozen for future use.

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Step 15: Embryo Transfer

The embryos are returned to the woman’s uterus in a simple procedure called an Embryo Transfer, a simple procedure similar to a pap smear, performed by a fertility specialist.

No anaesthetic is usually needed for the procedure, which involves a speculum being inserted into the vagina, and a narrow (about 2-3mm diameter) soft tube called a catheter, gently passed through the opening of the cervix.

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Step 16: Embryo Freezing

Any additional embryos that are not used during a treatment cycle, and are suitable for freezing, can be frozen for future use.

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Step 17: Pregnancy blood test

A pregnancy blood test will be organised for two weeks (14 days) following embryo transfer.

A blood test is the only reliable pregnancy test, as urinary pregnancy test kits can provide a false reading due to the hormone medication used in IVF treatment.

Should the pregnancy test be positive, the nurses will organise an appointment with your Fertility Specialist for an ultrasound scan normally at around 6 weeks.