Curious about Assisted Conception?

Ever wondered what OI, IUI, ICSI mean?

Think it's odd when the IVF ladies talk about being on the pill but to scared to ask why?

Who has ever been curious about AC (assisted conception) but never been game enough to venture into the LT TTC forum to ask a question? I was before I started!! So here's the place to do it! Feel free to ask any questions you like, whether you are new to AC, considering it or even if you're just curious about the process. There's no big secret here, I'm more thn happy to answer questions, as most of the others would be too.

Who's going to be first?!

just subscribing to this one Sarah - i've been asked a number of questions in live chat - happy to answer whatever questions anyone might have!

Same here. Those of us going through AC get so immersed in it that we forget that others don't speak the language or understand what we're talking about. Sometimes it seems that they are a bit intimidated by the strangeness to actually ask... Whether it's here or elsewhere, please ask! We're only too happy to answer.

BW

Well... I'll start...
I am actually really curious (but have never asked :redface:) to know why some people have to go on the pill during IVF... And when...

And actually another one (geeeez, being a member so long you'd think I'd know something, but embarassingly I don't) is what is all the different terms... like is IVF different to ICSI... what does that mean for the people doing IVF, does it mean different medications or transferring at different times or does it have to do with what the lab people do...?

Hopefully this will help someone starting out with AC too.... but I am curious... I don't know a lot about IVF...

Hey Leasha,

Here's my answers quickly, but others may wish to elaborate:

- The pill is to regulate the menstrual cycle so that an AC cycle can commence at a certain time. At least in our case this is what happens.

- IVF is where the best sperm and eggs are placed in the same dish and left to do their thing. ICSI is where the sperm is injected directly into the egg. This is done either because of the quality of the sperm (ie, limited motility, other defects) or where the egg is difficult to penetrate. Basically, IVF and ICSI run exactly the same except the meeting of the sperm and egg is different.

Hope this helps ;)

ME! I'm learning slowly, thanks to the kind patience of BG and BW, but i always have more questions... Shall i see what i know already...?

OI - ovulation induction? Like with Clomid?
IUI - inutero insemination? Where sperm is washed and then put straight into the uterus when ovulation (induced or natural? DO they do IUI with natural O?) is imminent to maximise chance of fertilisation?
ICSI - don't know what the letters mean, but i think this is where the sperm is physically injected into the egg, rather than having to find its own way, a way to fertilise when the conditions in the uterus aren't brilliant or when the sperm count is low or the sperm quality means the little guys struggle to get into the egg?
Varicocele - a varicose vein in the scrotum which can cause problems with sperm count/quality, i think because it can make the area too warm? Is that right?

um...the Pill, is that so the FS can "get control" of a woman's cycle, so they can start with a hormonal flatline before the injections for an IVF cycle start?

OH!

IVF - invitro fertilisation - where the egg is taken out, fertilised and put back.
Stim cycle - stimulation cycle? Where the woman goes through multiple injections to stimulate the ripening of hopefully lots of follicles rather than one or two, so they can be collected in...
Egg collection - sounds dreadful from what has been mentioned (mentally hugs and applauds all the AC women who have been through this - you are incredible!) vaginal ultrasound and long needle used to collect eggs.
OHSS - ovarian hyperstimulation syndrome, where the woman's body produces too many follicles and eggs which might or might not mature to the point they can be collected, the ovaries get very inflamed and the pelviv cavity fills with fluid - very painful and dagerous - potentially fatal? I get the impression diet and exercise can play a role for some but ultimately some women's bodies do this in response to the drugs no matter HOW careful they are?
FET - frozen embryo transfer - where an embryo created in a stim cycle which was frozen is thawed and transferred into mummy?

You can mark me on that - i probably need to do more homework!

Things i'd LOVE to know more about:

Some of the tests for infertility - there is one has been mentioned where dye was put through the tubes to see if they're clear/healthy? What is it called and how does it work?

Also, BW and BG you have both mentioned a drug (possibly a pessary?) which is a nasty colour and put in after transfer or at least during a stim cycle? What is it for?

What are the drugs used in a stim cycle? What are they called and what does each one do?

Phew! Thanks so much for this thread guys, i am excited to know more!

Bx

Yep, the pill is basically used to control the cycle so that things can begin at the whim of the clinic. For those of us who don't ovulate, it's to ensure that we actually DO have a cycle so we aren't waiting forever to be able to start things. The other option is to use a drug to force ovulation and create a natural cycle that way. I switch between the two depending on whether I need to manipulate timing or not.

BW

Bec... I think on rare occassions they do an IUI procedure without OI... sometimes ovulation induction is done for convieniance... you know roundabouts when you're going to ovulate. Though for me, I didn't ovulate without it, so it was necessary. Plus you have that extra boost for egg and endometrium lining quality.
If there were issues of hostile CM, but no ovulation issues, IUI might be done on an unmedicated cycle.

Some of the tests for infertility - there is one has been mentioned where dye was put through the tubes to see if they're clear/healthy? What is it called and how does it work?
This is a HSG... or (geez I'll have to google the long name!!!) hysterosalpingogram.
You go into an xray clinic, and they insert a small catheter through your cervix and then squirt dye through the catheter and take xrays of the dye to see if it flows freely through both the tubes, and if there are any blackages. (A seemingly simple procedure, as long as you don't have a cervix that prefers to be closed constantly..... they used a screw to open my cervix... OUCHY!).
They can also do a basic dye study while doing a lap, they don't use xrays they just look and see if the dye flows through.

Leasha - i'm the same as Slyders wife - i was only put on the pill for the purpose of forcing a visit from AF when the FS was good and ready for her (pity my body is more stubborn than the doctor and she was STILL late)

it basically means they can get your body to fit in with the time frame that they need for introducing the drugs and things. for me, being a country bumpkin, there is only a one week window every 2 to 3 months when they can do any of the procedures, so it's key to bring everyone's cycles together

just for anyone's reference, thought i'd add here what i've been through

3 cycles of clomid for OI (ovulation induction) - all failed
2 cycles of down reg and OI for IUI (insemination) - cancelled as my body didn't respond to the OI
3 cycles of IUI (intrauterine insemination) - 2 BFN's, 1 Chemical Pregnancy
1 full stimulated cycle of IVF - failed - BFN
1 FET (frozen Embryo transfer) - BFN


Bec - there are a couple of Luteal Phase support drugs that are sometimes used after a stim cycle or transfer - they are basically progesterone supplements that help stop AF arriving too soon. i've used both crinone gel and the pessaries. crinone is a white gel that is delivered in a tube, while the pessaries are a waxy pellet. both are inserted into the vagina as the progesterone take up from the meds is best through the walls of the vagina. some people have injections for LP support - have to go out and help DH in the garden - will come back, and if no one has answered, will answer after that!

The pessaries are to administer progesterone. When eggs are collected in an IVF cycle, they are sucked out before natural ovulation. Thus, no corpus luteum, no progesterone (or at least not enough) produced by the body - we need to get it artificially.

More later - I have to shut down the laptop and switch rooms.

BW

YES! Crinone! THAT's what i was thinking of!

Of COURSE - i never thought of that (re: corpus luteum) - i had a corpus luteum cyst for months during PG (was 11cm across at 11wks, but never felt a thing).

Thanks :)

Bx

ICSI stands for Intra cytoplasmic sperm injection. Med-speak for injecting the sperm directly into the egg.

To go a little further with it - it's possible for this process to actually damage the egg and thus form a dodgy embryo.

To explain - Each egg has a polar body, which is where the excess genetic information is ejected during the formation of the egg, and a spindle, which is where the genetic information of the egg is located. The polar body can be seen with a regular microscope, but the spindle can't. In traditional ICSI, they assume the spindle is located directly underneath the polar body, and inject the egg in order to avoid that area. Problem is, not all spindles are located in such a place, and regular ICSI then damages the egg and the embryo will often fail to progress well.

By using a microscope with a special polarised light source, they can see exactly where the spindle is located and avoid damaging it. Two thirds of mine are located in the wrong spot, which explains why we had much better results with the polscope (also known as extended ICSI), than without.

BW

And in plainspeak, ICSI is an add-on treatment to IVF. So people having ICSI are also having IVF, but IVF does not have to include ICSI. Did I just make it more confusing? Lol!

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What are the drugs used in a stim cycle? What are they called and what does each one do?

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ok - i'll list the ones i know - and how they work (as far as my understanding goes) - anyone else that wants to correct me, go for it!

OCP/Pill - as mentioned before, it helps to get AF to visit when you need her to, and is the first step in a fully down regulated cycle. i get the feeling this tends to apply more to people that have something of a cycle of their own (however irregular), as they have natural production of hormones that the clinic don't want them to produce. the clinic likes to have full control over hormones being introduced to the body so as they can expect (well, hope for!) a specific response. it's also an additional step to ensure that no early, undetected pregnancy, is trying to take hold when other drugs, far more detrimental to a developing fetus, are introduced

Synarel (nasal spray) or Lucrin (injections) - these are the drugs that basically shut your ovaries down before starting a stim cycle - as it was explained to me, the drugs basically put your ovaries into a drug-induced menopausal state. the clinic want your hormones (estrogen and progesterone) at non-existent levels (as they would be day 1 of AF) naturally, so that they can introduce the synthetic hormones in a controlled manner. These continue along until very close to egg pick-up or insemination as they also prevent the bodies ability to have a surge ot luteinising hormone (LH) - which is the hormone that naturally causes ovulation. for those of us that can't use these meds (or some that do, but need extra help to stop OHSS developing etc, they may use antagonist meds which i'll explain below)

for some people, this step is excluded - this is what happens with me. i have relatively flat-lined hormones all the time - and when my body is forced into the menopausal state, my ovaries refuse to wake up again!

Puregon or Gonal-F (injections) - for a lot of the drugs, there are two main manufacturers - so a lot of them have two names, but essentially the same action! these are an injection of follicle stimulating - basically it's used to encourage the development of a uterine lining, and, more importantly, the follicles on your ovaries. the hope is that each follicle would contain a nice little egg that is maturing nicely - unfortunately, that's not always the case - sometimes, a follicle will develop that contains only fluid - others will not mature enough to be a viable egg. the injections are administered daily, and the follicular development monitored. the aim is to get a number of dominant follicles that are large enough to include a mature egg.

for some people, they have a nice number of healthy mature follicles that give them nice mature eggs - for others, particularly those of us unfortunate enough to have PCOS - this can be a very difficult tight rope to walk - need enough meds to encourage follicular development, but not so much as to overstimulate the ovaries and develop OHSS.

Cetrotide/Orgalutron (injections) - these are the antagonist meds i mentioned earlier. for those of us who don't have the synarel or lucrin, these meds are injected after about a week of the stim drugs. basically, they're used to prevent the LH surge. you have them every 24 hours to stop the body naturally trying to ovulate. it helps to give the follicles the extra few days to develop nicely , the eggs to mature, and to stop ovulation occuring before the doctors want it to happen! for IVF in particular, the timing of ovulation is really important - without that level of control, ovulation may occur too early, or too late, and everything you've been through would be a waste of time!

Pregnyl/Ovidril (injection) - this is the shot that "triggers" ovulation. it forces the LH surge, finalises the maturation of the egg, and, in IUI, it will allow the release of the egg. In IVF, it is used to force the maturation of the eggs, but before the eggs are released, they're collected (egg pick-up or EPU). in some cases, pregnyl (in particular, haven't heard of it with ovidrel) is used as a "booster" during the luteal phase. basically it's there to help you maintain the luteal phase long enough for the embryo to take hold before the progesterone levels drop off and AF arrives. as BW explained before, progesterone support is important as you don't have a corpus luteum after EPU to help keep the levels high enough to sustain a pregnancy

Crinone or progesterone pessaries have been explained before...


when you move onto FET's and the like, there are more options again. for some people, they ovulate naturally, so may need no additional meds - this happens more often when there is male-factor or unexplained infertility. some natural cycles the clinic will automatically use the progesterone support (crinone/pessaries/pregnyl). for others, drugs such as clomid are used to induce ovulation. for others again (like me) the drugs don't work to force ovulation, so i go into a fully medicated FET. Hormone Replacement Therapy (HRT) is often used by post-menopausal women to ensure they're hormone levels aren't too low - it can often be used to help treat the nasty side effects of menopause (hot flushes etc) - for IVF purposes, it's used to artificially create a uterine lining. basically HRT is an estrogen supplement, so it will help to develop a lining. after a certain amount of time, the thickness of the lining is checked to make sure it's dense enough to support an embryo. progesterone support is started on what the clinic will label as ovulation day (even though no O occurs) - then depending on the age of your embryo's (day 3, day 5 etc) - they'll be transferred when appropriate.


hmmm, i think i've waffled enough - hope that helps!! anyone that wants to add to, or correct, anything i've said - feel free

BG

If anyone had trouble with my gobbledygook ICSI/polscope information - it's all fixed and sensible now. :)

BW

Great thread guys, well done!! :clap:

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There is a plasma-based solution (I think - BW/BG??) that is in with the eggs/sperm which makes conditions good for making embies.

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as far as i know, the sperm sample is "cleaned" to make sure they're in a friendly solution with no "debris" from when it was produced - and the eggs and sperm are placed together in a dish which i believe contains a medium that includes Human Serum Albumin (HSA) - not sure how it works - just know i had to sign something to say i was ok with it being used!

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I just wanted to clarify that in IVF without ICSI the sperm and the eggs are placed in a plastic dish with the hope that the next morning the sperm will have fertilised the eggs. The condition of the uterus is not a factor for ICSI as the fertilisation is done outside the uterus anyway. There is a plasma-based solution (I think - BW/BG??) that is in with the eggs/sperm which makes conditions good for making embies.

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Kim, that's correct. Where the sperm sample in the dish (typically some tens of thousands) is judged to be normally motile and normally shaped, they are generally left to their own devices, unless the egg/s are know to have a particularly tough zona (exterior).

As for ICSI, it isn't really to do with the environment of the uterus (or vagina etc), as straight IVF overcomes any potential issues there.

Ah DP has friends who had ICSI and they told him their FS said she had a "hostile environment" which was killing the sperm before they got to the egg, and so they had to have the sperm injected into the egg instead, but maybe there was a male factor to it too, or maybe they just meant straight IVF as no-one actually SAID ICSI, iykwim.

Thanks for the drugs info BG, that was great!

Bx

Yep, IVF certainly overcomes the hostile environment factor. As for the ICSI component, like you say, there could've been MF issues, or in some cases I've read that some clinics just do ICSI routinely regardless of whether it is technically needed or not. I don't agree with this personally, but that's a whole 'nother story :)

Thanks for this thread. I am about to take my first clomid tablet tomorrow! After seven months of known donor self insemination and 1 year of tracking my cycle, it appears that i may have a luteal phase defect (lp 9-11 days). Have just done a cycle of serial progesterone levels and was told yesterday that the peak was only about half what it should be. My ob seems fairly convinced i am ovulating as regular cycles, af pain, biphasic bbt and regular monthly positive opks. So he says i am ovulating but it needs to be done better as such. Can anyone tell me why i am going down the clomid track rather than being given progesterone if thats where the problem is? Plus he doesn't seem to think he needs to check for tubal patency/endometriosis etc at this stage, he didn't think it was even worth checking for chlamydia antibodies. While i am relieved to not need more invasive procedures at this stage i am mildly concerned that other problems may be being missed which will ultimately prolong TTC What are other's experiences re. investigations at what stages? Thanks

DrGirl, clomid is regularly used to treat luteal phase defects, not just to force ovulation when it doesn't normally happen. The reason is that it often makes you ovulate better or "stronger" - this means that the body produces more of the right hormones by itself, rather than being pumped full of artificial hormones. Progesterone can also be used, but I'm under the impression that things work better if the body is able to produce its own hormones - at least that's what my FS tells me.

In short - it's a normal treatment for LPD, so don't panic!

BW

Thanks BW. I'm starting on 25mg cd3-7 which seems like small dose but i'm assuming its 'cause its to improve ovulation rather than make it happen in the first place. Does that make sense to others?

in light of Kel's recent poll regarding IVF, and the fact that a lot of members mentioned not knowing how IVF worked/what we go through etc, i thought i'd bump this thread. there are a number of IVF/AC members subscribed who will happily answer any questions you have regarding the process of IVF. knowing more about the process might also explain a little more why some of us are so highly offended at the portrayal of IVF being the "easy" option!!

please, if you're curious about any of it - ask away. i know in livechat i've discussed with a number of ladies bits and pieces of my treatment - and i'm sure they're not the only ones curious!

Ok I have a *silly* question regarding DH's sperm and where to go from here....

We have had 2 SA's done and each time his rapidly progressive % has been less than 5%. Is this too low for IUI? Will IVF still work if his count is that low, or will it have to be ICSI? If they do ICSI, do they still make the sperm swim uphill before selecting a sperm so that they get the best one / a healthy one?

Thanks, I have so many questions!

i think you'll find with rapid progressive sperm count as low as it is, IUI would have negligible value for you - the chances aren't that great that it will work even with a good SA result (they're significantly less than with IVF), so i'd think you'll be steered toward IVF

having said that, IVF doesn't have to involve icsi - because the egg and sperm are put in close proximity, the ability of the sperm to swim won't be a problem. what they'll look at is whether there are unusual deformities to the shape of the sperm that may prevent them being able to penetrate the outer shell of the egg. you might have an FS that prefers to use ICSI due to the higher fertilisation rates, particularly if you don't get a high egg count at epu

FWIW, my hubby has a good SA, with all his results being within the normal range, so we're able to try IUI (and have had two chemical pg's from IUI) - but when we next do IVF (later this year if we don't get a sticky IUI pg before then) we'll use icsi as our fertilisation rates in the lab weren't that great.

BG thank you very much for that response, it did help to clear things up a lot.

I'm really curious about whether or not to give up hope on natural conception, so that I dont get so disappointed each month, and just hang onto hope for AC? Going through cycle after cycle of disappointment is so hard, and I think I'd do better if I resigned myelf to only hoping on AC cycles.

Has anyone who has gone through IVF / ICSI / AC come to this point? Did it help? Sorry to intrude if it is a personal question. It isnt really the medical side of IVF that bothers me, its whether or not I'm going to slide into depression while trying to make it through it.

there is a social group about ltttc that you might get some benefit from hun - it's about our emotional struggles and how we've dealt with them. go give it a read - and if you want to join, pm dusty, gargy or sushee for access.

fwiw - i pin all my hopes on AC - but i also don't ovulate regularly, so it's different for me than for someone that has a "cycle" as such. i think that putting your faith in the AC procedure and just enjoying life for a while can have a lot of positives for you in the short term - but, realistically, you're like all of us - you'll still know when you O, you'll still know when AF is due, and you'll still feel that disappointment that you didn't get that miracle to stop you needing ivf...

Some of the tests for infertility - there is one has been mentioned where dye was put through the tubes to see if they're clear/healthy? What is it called and how does it work?


I'm having a Hy-Co-So on Monday ( Hysterosalpingo contrast sonography ) which is similar to what Leasha mentioned, but uses ultrasound instead of x-rays. This is what I found out about it after googling it:

"Hysterosalpingo contrast sonography (HyCoSy) has been compared favorably with HSG in the literature, and has received growing attention as a minimally invasive screening test. Many clinical trials report it to be as accurate as HSG in evaluating tubal function, while maintaining the advantages of ultrasonography as a safe and well-tolerated imaging modality. Others emphasize its superiority in demonstrating ovarian morphology, which is also pertinent to infertility investigation. This review of the literature will summarise the existing data on hysterosalpingo contrast sonography and compare it to existing modalities in terms of accuracy, tolerability, and cost-effectiveness in order to determine whether it can practically replace HSG as a primary screening tool."

Looking forward to reading more in this thread as IVF is starting to look like a possibility for us.

I have a known, very definite fertility issue (completely blocked tubes) and even knowing that, I still (even now) get disappointed and upset by the arrival of AF. I don't think you ever completely give up on a miracle. Nor should you. Hope should spring eternal. :)

what a great thread.

just wanted to know with all the drugs you need to have...are the side effects bad?

and are you glad for IVF? after everything you need to go through and the disappointment

I know I'm eternally grateful for IVF. If not for IVF, I would not have my son. It's as simple as that.

BUT it was very very hard doing all those injections, all those blood tests, being prodded, pulled, your modesty a thing of the past, your fertility short-comings discussed by all and sundry, your life dominated by drugs and appointments, your life ruled by the results of your hormone levels, to again and again find out your cycle wasn't successful. Never knowing if IVF would even work for you, if you will finally have a child after all this pain and stress and emotional investment.

It was hard always harbouring the fear that despite all you're going through, that you'll be the one of the small percentage of patients for whom IVF won't give you that longed for child. And if it doesn't, you have no where else to go from here. That was what screwed with my head each and everyday on IVF.

So yes, I am thankful for it in hindsight, but while in it, it was the most stressfull, hell-ish time of my life.

side effects vary drastically from one person to another - and even one cycle to another

the BCP is defininately different for each person - i have had horrific issues (GP thought i was having a stroke) so will never go there - for a lot of people, it's nothing to worry about

lucrin/synarel - headaches are common. it's also effectively putting you into a medically induced menopausal state - so think of what people go through with menopause (hot flushes etc) and you're there. not everyone gets this, and again it varies. i found i got very crampy - like AF was on her way - but she never showed

puregon/gonal-f - this one varies greatly. i found i was bloated and felt a bit nauseous, but nothing unmanagable. it was worse during IVF stim cycle than it was during IUI as they stim you to get more eggs. i also found during ivf stim i was fairly uncomfy (BD was out of the question after a while) as my ovaries were significantly swollen. this can be much worse for some, especially if they develop OHSS

pregnyl/ovidrel - think early pg symptoms!! these contain HCG, so you are likely to have some early pg symptoms (morning sickness at ovulation - FUN!). also a lot of people have a reaction at injection point from this one. red welts etc. this one is also that one that, if you're going to develop ohss, can tip you over the edge. it triggers ovulation, and can be the shot to start the fluid leakage into your abdominal cavity

progesterone/crinone - apart from the ick factor, they are similar to what you'd feel in early pg - depending on the person, you can have some consitipation (or the other extreme!), bloating, discomfort. will also delay the arrival of AF whether you are pg or not

add to all this the hormonal mood swings, and it's not much fun at all!

Oh and side effects I got from the drugs:

Follicle Stimulating Hormones - headaches, bloating, weight gain, abdominal soreness, mood swings including lots of tears, shortness of breath.

Progesterone - bloating, sore boobs, nausea, headaches, flatulence, abdominal cramps (yes all the symptoms of pg!)

Wow i must say you ladies are so strong and brave

Just subscribing.
My best friend is looking into IVF due to complications from endo. I'm reading through atm, but am sure to be back with loads of questions for you all.