Nicola’s day in an IVF clinic
I am new to the world of IVF and only five weeks into my new role with Access Fertility. There is LOTS to learn! I jumped at the kind offer from a partner IVF clinic to get up close to the amazing egg collection process. I spent time in theatre and the lab with the doctors, nurses and embryologists. This was going to help me put everything I had learnt from Google and text books into context.
I was rather nervous in the run up to the visit as I, like the majority of the population, have never set foot in a theatre. I had no idea what to expect, apart from what I’d seen watching Casualty and Scrubs. I was convinced I would pass out and cause theatre chaos, completely embarrassing myself and getting fired in the process. Thankfully, I didn’t faint, I am still employed and there was a private changing room so my big pants didn’t get a public viewing.
The IVF clinic
The clinic had very comfy recovery rooms where patients wait before entering theatre, and where they return after the procedure. While the patient was completing the relevant forms and receiving appropriate sedatives, the nurses were busy preparing the theatre. They laid out all the equipment to ensure it could be passed to the doctor in a timely way. They also ensured everything in the theatre was clean and sterile, while the doctor reviewed the patient’s information.
There was a nurse who was responsible for passing the doctor the right equipment, and for passing the eggs to the lab. Another nurse was sat with the patient and monitored the stats. A third nurse supported the doctor making sure any problems were dealt with quickly. In the theatre, there was an adjoining door to the lab, where an embryologist sat to collect the fluid handed through by the nurse during the procedure. The theatre was a small, intimate room with dim lighting and a calm atmosphere. There was none of this Casualty-style lights in your face and people rushing around business.
Before entering theatre, I thought egg collection was where a doctor inserted a camera/microscope device into the follicle and ‘sucked’ out each egg individually, like picking strawberries on a microscopic level. This is not how it’s done. The doctor uses an ultrasound probe then inserts a very fine needle that he can see on the screen into a follicle. Follicles appear on the screen as a black ‘blob’. This black ‘blob’ is how fluid shows up on the screen. I saw a group of follicles that needed to be drained, it looked almost like a bunch of grapes on the screen.
The needle is used to drain the fluid in each of these follicles, collecting the eggs in the process. Sometimes a slightly different needle is required to flush out the follicles to collect the eggs, if they are a bit stubborn. The technical term is ‘aspiration of the follicles’. On the screen, I could actually see the black blob slowly disappearing as the fluid drained away.
The fluid was drained into a test tube and, once the follicle was empty, the nurse handed the test tube immediately over to the embryologist in the lab. She then poured the fluid into a dish to checked under a microscope how many, if any, eggs were in the fluid.
This was repeated for all the follicles. The embryologist shouted out the number of eggs as she went along.
In the lab
Across the other side of the door in the lab, if there was an egg in the fluid, the embryologist removed it from the fluid by sucking it up into a very fine needle and added it to a fresh dish, which was then popped into a dark, warmed compartment to minimise any shock in temperature from being outside of the body.
Even the microscopes are designed to have a heated plate to ensure the eggs don’t get too cold. Special light is used underneath to reduce the effect of light on the eggs.
While all this is going on, the gentleman in the relationship (if there is one!) produces his sample, which is then passed through another door to the lab. You may think, as I did, that this would then be added to the eggs – nope! First the semen needs to be ‘prepared’. This involves spinning the semen in a centrifugal chamber so that the good, high quality sperm end up at the bottom and the poor quality sperm and seminal fluid ends up at the top. Once the sperm have been separated and washed in the little washing machine, the good quality sperm are able to be added to the eggs. It varies, but on average the embryologist told me that there may be up to 5 eggs in a dish and 200,000 sperm. If you have more than 5 eggs a second dish is required. In IVF, the eggs and sperm are placed in the same dish and left to do what they would do naturally.
If there is a male infertility factor, the embryologist may need to hand pick an individual sperm with a needle as fine as a human hair. Sperm are so fast that they first need to be put in a sticky, glue like liquid that slows them down. This doesn’t harm them but helps us to catch one. The tail of the selected sperm is then broken, it is sucked into the needle then injected directly into the egg. This process, I learnt, is called ICSI, Intracytoplasmic Sperm Injection. Before this experience, I thought IVF was injecting sperm directly into an egg. I was a light bulb moment realising there are two different processes. This process needs to be done as quickly as possible.
Once the eggs and sperm have fertilised they become embryos. They are kept in the dark in incubators to keep them in the conditions as close to the womb as we could hope for. Many clinics today use time-lapse technology to watch how embryos are developing,. This helps to identify the best quality embryos and the best time for transfer. Most clinics today aim to transfer embryos back into the uterus on day 5 when the embryo is at what is called the ‘blastocyst’ stage. The incubators are amazing and I could see each patient’s embryo on the front display without even opening the incubator and disturbing the embryo.
And that’s it! Not a simple process by any stretch and I haven’t even covered all of it here. I found this process and the detailed, microscopic work that goes into helping couples in their dream of becoming parents genuinely fascinating. The IVF doctors, nurses and embryologists are fantastically clever people. I wish you all the best if you are embarking, or going through the IVF process.
IVF / ICSI process overview
As you may have gathered, I am not clinical and certainly no expert, so here is a link to an official NHS summary of the process: https://www.nhs.uk/conditions/ivf/what-happens/ and a video of ICSI: https://www.youtube.com/watch?v=-Cj3pQnm-Qo