CARE have developed many new techniques and procedures with the objective of maximising IVF success rates and helping more and more people.

Array CGH

In 2008, a team at CARE Fertility, led by Professor Simon Fishel, pioneered the use of Array CGH (Comparative Genomic Hybridization) to screen the eggs of patients undergoing IVF. The first case, a 41 year old woman with 13 previous failed cycles of IVF at other clinics, successfully conceived through CARE using this revolutionary approach. Simon Fishel, who led the pioneering team, said that the arrival of baby Oliver showed that the test could help couples who have repeatedly failed to become pregnant.

Approximately 70% of embryos produced either through natural conception or IVF are lost before birth. A major cause of embryo loss, including miscarriage, is a chromosome anomaly (known as aneuploidy) where there is either a loss or gain of a chromosome. Using the technique of Polar Body Array CGH, it is possible to screen all the chromosomes of a human egg prior to the creation of the embryo.

During the procedure, a microscopic structure called the polar body that lies between the egg itself and its outer 'shell', and contains a copy of all the chromosomes in the egg, is removed before the egg is fertilised. The polar body of each egg is tested using the Array CGH method, providing us with information on the complete chromosome make up of the egg. In this way we can screen for the chromosomally normal eggs. As the polar body is a 'surplus' structure within the egg and normally disappears a few days after fertilisation, this is an ideal way of testing the chromosome material without disrupting the actual chromosomes within the egg itself.

The technology of Array CGH has the potential to:

• Greatly improve IVF birth rate per embryo transferred
• Minimize the incidence of miscarriages and birth defects caused by irregularity in the chromosome number of eggs (and conditions such as Downs, Edwards or Patau Syndromes)
• Reduce the incidence of multiple pregnancies whilst maintaining a high live birth rate

Array CGH is suitable for all patients. It is particularly suitable for the following groups: women who are aged over 37; men who have been shown to have sperm at risk of carrying abnormal chromosomes; couples who have had several miscarriages or several attempts at IVF but failed without explanation. But, knowing that even the younger female is at risk of up to half her eggs carrying a chromosome anomaly, it could be argued that using Array CGH to effectively eliminate all such eggs or embryos will increase the chance of success for those couples.

Array CGH is available at both CARE Nottingham and CARE Manchester. Please contact the clinic for further information.

BBC news – IVF Pregnancy from screened egg

Daily Mail – Fertility test that could double the success of IVF,
offered to childless couples for the first time

For a successful pregnancy to occur, the woman's immune system must allow it. The embryo must escape the usual immune surveillance. If this special immunity fails, then the process by which the embryo implants and is not rejected falters. Successful implantation may therefore not occur and if implantation starts, the risk of miscarriage may increase.

Special tests may identify couples who are at risk of these problems. Treatment which stimulates the proper immune response (immuno-modulation) in the mother may then improve the chances of a successful pregnancy.

Reproductive Immunology Patient Story

Pre-implantation Genetic Diagnosis is a technology which allows genetic testing of an embryo prior to implantation and before pregnancy occurs. It is used in conjunction with IVF and allows only those embryos diagnosed as being free of a specific genetic disorder to be transferred into a woman to try to achieve a pregnancy.

PGD at CARE Fertility

Egg Vitrification Egg Storage (EVES) - Freezing your eggs at an early reproductive age can help to preserve your fertility and maximise your chances of a future pregnancy if you should experience fertility problems in the future. Vitrification is a super cooling technique for egg freezing which substantially improves egg freezing and thawing rates.

EVES at CARE Fertility

Fertility drugs trigger egg production. This is called ovulation induction and different drugs are used to overcome the different conditions which can cause the failure of the ovaries to produce eggs.

The most common groupings include drugs which work on the brain, drugs which stimulate the pituitary gland and those which act directly on the ovaries themselves.

IUI is a simple fertility treatment with a good track record of success with women whose tubes are healthy and fertile sperm. The chances of conception taking place are increased by inserting specially washed sperm into the womb around the time the ovaries release an egg. It is usually employed in conjunction with the woman taking fertility drugs. The man's sperm is prepared so that the best available specimens can be selected.

IVF was originally developed to to help women with damaged or absent fallopian tubes which prevent the sperm from meeting the egg. It is now used to treat a wide range of fertility problems including unexplained fertility.

Ovarian Stimulation

Fertility drugs are used to stimulate your ovaries, thus maximising the number of eggs you produce. During treatment there are several different types of drugs, and different ways that the drugs can be given. The specific type of regime prescribed for you will be your ‘Protocol’. This will be described in detail and you will be given your Protocol in writing from us, and any further advice or help will be available from the nurses.

Monitoring

During the days leading up to egg collection your progress is monitored closely to establish exactly when is the best time for your eggs to be collected.

Egg Collection

Your eggs are recovered using a vaginal ultrasound procedure. This is a straightforward process which takes about 30 minutes. A sperm sample is usually required around the time of egg collection. Please remember that your semen sample is generally at optimum quality after 2-3 days abstinence from ejaculation, so we advise, where appropriate, ejaculation 2-3 days prior to the day of egg collection and then to abstain until we require you to produce the semen sample.

Egg Insemination

Once the eggs have been recovered they will be put into a special culture medium and safely transferred to an incubator to provide the right environment and temperature conditions. The next stage is to add the sperm to the eggs, and then incubate for typically another 24hours. The first signs of fertilisation are shown by the presence of two pronuclei within the egg. If this has occurred, the fertilised egg should then divide in to two, and subsequently three, four or more cell embryos. A CARE embryologist or nurse will arrange a time to give you your fertilisation result and also when we need to see you again for embryo transfer.

Embryo Transfer

This procedure is straightforward and almost always performed without the need for sedation. The transfer specialist will use a speculum(like the one used for a smear test) and the embryologist will load the embryos into a fine, soft catheter for the transfer specialist to place through the vagina and cervix and in to the womb. The embryo(s) will be injected into a tiny drop culture medium and the catheter will be removed and checked under the microscope to ensure they have been successfully transferred. The process should take about 15 minutes. During the period after embryo transfer, it is important that you take the hormone progesterone, this helps the lining of the womb prepare for the implanting embryo, it is very important that the progesterone is taken until the first pregnancy test.

Pregnancy Test

Assessing the outcome of your treatment is performed in two ways - the Pregnancy Test and the Pregnancy Scan. The Pregnancy Test is usually taken 14 - 16 days after embryo transfer. The test results indicate whether or not an embryo has implanted in the womb, it might be necessary to repeat this test and you will be given advice on this. If the Pregnancy Test is positive, an appointment will be booked for an ultrasound scan to see if the heartbeat is visible to show an ongoing pregnancy. Once this is confirmed you will then be discharged into the care of your GP who will arrange ante-natal care.

This technique represented a huge step forward in the treatment of male infertility when it was first used in 1992. It is used in a wide variety of situations – where the sperm count is low; sperm motility is poor; there is a high percentage of abnormally shaped sperm. It is also used for cases where sperm has been surgically collected from the man eg. because of an obstruction or failed vasectomy reversal. In ICSI a single sperm is injected directly into the centre or cytoplasm of an egg and the embryo is then placed in the womb in exactly the same way as in the IVF treatment. Over 2000 babies a year are now born as a result of this treatment.

In certain conditions sperm are not present in the ejaculate due to absence or blockage of the tube carrying the sperm from the testes. In these cases, minor surgery can be performed to obtain sperm from the reproductive tract. These sperm are functionally competent but can only swim very weakly, if at all. However, they can be injected into and successfully fertilise eggs using the ICSI technique.

Recent research has suggested that where embryos are transferred to the womb at the Blastocyst stage (4 to 6 days after insemination, rather than 2 or 3 days after insemination as with conventional IVF), pregnancy rates may be improved. This procedure involves allowing the embryos to develop in the laboratory to the blastocyst stage before placing them in the womb.

This technique has been developed at CARE in order to concentrate small numbers of sperm from multiple semen samples. This procedure may be particularly useful for men with only occasional sperm, and as a trial before embarking on surgical sperm recovery.

Natural cycle IVF can be useful for certain patient groups:

• Low ovarian reserve
• Poor responders
• Young women with tubal factor subfertility
• Stimulation drugs are contraindicated

Natural cycle IVF involves the collection of a naturally selected egg which is then fertilised in the laboratory.

Patients in a natural cycle are asked to attend CARE for a blood test and an ultrasound scan on days 2- 5 of the menstrual cycle.Further monitoring will commence after day 7 of the cycle. Oral tablets are given to try to stop spontaneous ovulation from occurring. Following egg collection and fertilisation, transfer of the embryo into the uterus takes place 3 days after egg collection.

Your Consultant will be able to advise if the treatment is right for you and what your likely success rates will be.

Embryos not transferred to the womb may be frozen (cryo-preserved), according to the wishes of the couple. If appropriate, these embryos might be suitable for transfer at a later stage.

This provides a solution to two problems:

• Firstly, there is a shortage of donor eggs which affects those who need to use donated eggs for their fertility treatment.
• Secondly, with relatively limited NHS funding for IVF available nationally, many couples with fertility problems have not been able to afford the treatment that they need.

Egg Sharing provides subsidised IVF treatment for infertile couples who are prepared to share some of the eggs collected at their egg collection and provides donor eggs to those couples who need them.

More Egg Sharing Information

You can view dates or reserve a space at one of our Patient Information Evenings

Patient Information