Assessment

The online consenting and counselling package consists of a bespoke education package to ensure that you are fully informed about the risks and side effects of the stimulation phase and the legal framework which protects you and your eggs.  The next stage of assessment is a transvaginal ultrasound scan, some screening blood tests and an online consultation with a senior gynaecologis (HBsAg and The blood tests are either done at home using a home testing kit on a finger prick sample of blood or from a routine blood sample taken at the lab.  We will send the blood testing kit out to you as soon as the second stage payment is received.  We will also organise a transvaginal ultrasound scan to be performed at an accredited clinic near to you (either home or work).  The ultrasound scan will be arranged for day 3-6 of your cycle.  This will rule out any serious pelvic pathology and perform an antral follicle count, which helps to determine the dose of stimulation, and confirm that your ovaries are accessible for the egg collection.

The blood tests are standard screening tests required by the HFEA prior to any assisted conception procedure and currently include Hepatitis B (HBsAg & Anti-HBc) , Hepatitis C(Anti-HCV-Ab), HIV (Anti HIV1 & 2).  We also test for syphilis in case you may wish to donate your eggs to a third party at some stage in the future.  We also check an AMH test to help tailor the dose of stimulation and, along with the AFC, helps predict how many eggs are likely to be obtained from each cycle of stimulation. This information will be discussed further at your online consultation session

The screening tests ensure that no-one who is undergoing fertility treatment or storing eggs or sperm is able to start treatment if they have an undiagnosed infection that could, theoretically be passed to other gametes (eggs or sperm) or embryos in the storage dewars.  The tests must be done within 3 months of you starting your first treatment cycle, and remain valid for up to one year.  In the unlikely event that you test positive for any of the conditions we shall arrange an appropriate consultation for you to discuss the implications with a specialist in infectious diseases.  

Online Consultation

Once we have the results of the blood tests and scan, we will arrange an online video consultation with one of our senior consultant gynaecologists and fertility specialists who will review the health questionnaire with you, discuss your test results and ensure egg freezing is safe and appropriate for you. They will also give you an idea of the likely number of eggs you will get from the treatment cycle and discuss the issue of egg donation if you decide not to use your eggs at some stage in the future. If this is something you want to think about, we will organise some further screening tests and counselling.

There will be plenty of time to answer all of your questions before the consultant signs off on your medicines so that you can commence treatment, which will usually be when your next period begins.

Stimulation Phase

The treatment plan, instructional videos and our fertility nurses should ensure you are fully equipped for the stimulation process.  The necessary medication to complete the cycle will be sent to your home or work after payment for the egg freezing cycle and medication.

The process usually starts with 2 or 3 weeks on the oral contraceptive pill.  This helps to synchronise the growth of the follicles and allows us to predict when the egg collection is likely to occur.  Typically you will take the last pill on a Sunday evening and then start stimulation the following Friday.

You will then start with daily injections of a hormone called FSH which makes sure we get as many eggs as possible from your ovaries. You will carry out these injections yourself at home in the evening. We have some easy to follow videos to show you how to do this.  If necessary we can also arrange a home visit by a trained nurse and a fertility nurse is always available in case of any problems with the drugs. You will also need a second injection called cetrotide, which is a hormone called a GnRH antagonist.  This stops you from ovulating prematurely and we usually ask you to start this on the morning of the 6th day of stimulation.

The response to stimulation is monitored by ultrasound scans and sometimes blood tests.  At Ice Fertility we have developed a unique telemedicine home scanning service to avoid the need for you to take time off work for monitoring scans.  The  ultrasound scan probe will be delivered to you once the stimulation has started.  A detailed video programme will show you how to set up the scanner and manoeuvre the probe to optimise the pictures.  You will need to have a full bladder for the scan which is done using an abdominal probe over the lower part of your tummy.  If for any reason we are unable to adequately assess the scan we can arrange an urgent transvaginal scan at convenient clinic.

The stimulation phase usually lasts 10-12 days and during this time you will perform 3 or 4 scans.

It is important that you continue to use contraception in the lead up to starting stimulation, but there is no need to change your current method of contraception.

If you are currently using the oral contraceptive, we will usually ask you to take a few more or skip a few tablets so that you take your last pill on a Sunday.  If you use the Mirena or copper IUCD, there is no need to have it removed.  If you usually rely on the oral contraceptive pill for protection, it is important that you use another method such as condoms whilst you are being stimulated.

Egg retrieval and storage

Once the lead follicles have reached 18mm in diameter you will be ready for the final trigger injection to help release the eggs ready for collection.  90% of women will be ready for trigger injection on either the Saturday, Sunday or Monday of the week after they start their injections. Some will need a final scan on the Monday, depending on the response.

We will check that the receiving clinic can accept you and get a time for you to administer the final trigger injection. The timing of the egg retrieval is critical, so it is important that you take the trigger at the appointed time. Our app will set a reminder for you. The retrieval is done under sedation, but only takes around 15 minutes to complete. Using a transvaginal ultrasound probe, a fine needle is used to draw the fluid containing the egg out of each follicle on the ovaries. It is no more traumatic than having a blood sample taken, but is important that you lie still during the collection so it is done under a light anaesthetic.

You will be able to go home an hour or so after the procedure but will need to be escorted by a friend or relative as you should not drive.

After the collection, the eggs are carefully prepared for freezing in the lab and then frozen using an ultra-rapid freezing process called vitrification. The frozen eggs are then stored at -273C in liquid nitrogen and will last indefinitely. At the current time we are only allowed to freeze eggs for 12 years in the UK, however this limit is under review by the HFEA and is likely to change in the very near future.