ICSI treatment

First, we carry out an initial fertility assessment (OFO). If the OFO shows that ICSI is the most suitable treatment, the doctor draws up a treatment plan. We discuss this treatment plan with you carefully and then turn it into a treatment schedule and timeline.

During the stimulation phase, the ovaries are stimulated daily with hormones so that multiple follicles grow. This phase lasts 10 to 14 days and is followed by trigger medication (hCG injection) to induce ovulation. 

Using FSH medication
Every day you inject yourself with hormones in your abdomen, allowing multiple follicles to grow. How long you need to inject depends on the growth of the follicles. We monitor the growth of the follicles with regular ultrasound scans. When there are enough follicles and they are large enough, we schedule the egg retrieval.

Using hCG medication
Before the scheduled retrieval, you administer the trigger medication (hCG). This induces ovulation , loosening the eggs within the follicles so that they can be collected more easily during the retrieval.

During the retrieval
During the egg retrieval, the eggs are aspirated from the follicles using a thin needle. You lie in the gynaecological chair and the doctor inserts a thin needle through the vagina to puncture the follicles and aspirate the eggs. These are then taken to the laboratory¹ for fertilisation. 

After the retrieval
After the procedure, your recovery begins. We give you tailored advice to take home. You will hear the same day how many eggs have been retrieved. Then, as agreed with us, you start using progesterone to prepare the uterus optimally for the embryo transfer. After the procedure, you rest in our recovery room and we let you know how many eggs have been retrieved. 

Pain relief
If you wish, you can use pain relief before the egg retrieval. Always discuss this with the doctor. 

More information about what happens during an egg retrieval.

¹Nij Clinics Gorinchem does not have its own laboratory and therefore works together with Erasmus MC for heterosexual couples, and with the other Nij Clinics clinics for single women and lesbian couples.

On the day of the egg retrieval, the sperm is prepared; how this is done depends on the situation:

• Intended father or known donor: The intended father or known donor hands in a sperm sample at the laboratory¹. The sperm is then prepared in the laboratory, so that the well-moving sperm cells are separated from the less motile ones. If the sperm quality is poor, ICSI can be used. For optimal sperm quality, it is important not to ejaculate in the two days before handing in the sample, but also not to abstain for too long, as that is not good for sperm quality either. 
• Sperm donor from a donor bank: If a sperm donor from a donor bank is used, the donor sperm has already been prepared and frozen. The laboratory¹ will prepare (thaw) the frozen sperm for use in the treatment. Read more about sperm banks.

¹Nij Clinics Gorinchem does not have its own laboratory and therefore works together with Erasmus MC for heterosexual couples, and with the other Nij Clinics clinics for single women and lesbian couples.

In the laboratory¹, the IVF lab technician fertilises the eggs with sperm cells from the intended father or sperm donor. A single sperm cell is injected into each egg. After fertilisation, the embryo grows for a few days in an incubator. The embryo is then transferred to the uterus or frozen for later use. If the embryo implants successfully, you are pregnant.

This method is often used in cases of severely reduced sperm quality or if previous IVF attempts were unsuccessful. 

Fertilisation rates
It is important to know that not all eggs obtained during the retrieval will be successfully fertilised. Even if the sperm cell manages to penetrate the egg, this does not always result in successful fertilisation. Usually around 60–70% of the eggs are fertilised. These fertilised eggs can then develop further into embryos. On average, about half of these fertilised eggs grow into a good-quality embryo, but this can vary considerably from person to person.  

¹Nij Clinics Gorinchem does not have its own laboratory and therefore works together with Erasmus MC for heterosexual couples, and with the other Nij Clinics clinics for single women and lesbian couples.

After one day, our embryologists can see whether fertilisation has taken place and whether an embryo has developed. The embryos are cultured in incubators in Petri dishes with a special culture medium. In the EmbryoScope , the temperature, humidity, CO2 and pH are regulated to create the ideal environment for culturing embryos.

EmbryoScope
With this EmbryoScope , our embryologists can use time-lapse technology to monitor the development of the embryos without opening the incubator and disturbing the embryos' environment. A photo of the embryos is taken every 10 minutes. The embryologists use advanced software to review the time-lapse recordings and select the best embryos for transfer and/or freezing.

We allow the embryos to grow for 3 to 5 days under optimised conditions. When the embryos have grown sufficiently and are ready for transfer, we schedule an appointment for the embryo transfer. The embryo with the best assessment is transferred. Any remaining embryos are frozen for a future transfer in a natural cycle.

During the embryo transfer (ET), one embryo is transferred to the uterus to keep the risks as low as possible. In exceptional cases, for women over 38 or after three IVF cycles, two embryos may be transferred, although a multiple pregnancy carries greater medical risks, such as premature birth or pregnancy complications.

After the transfer
After the transfer, the embryo will implant in the wall of the uterus. To prepare the uterus for this, you started using Utrogestan after the retrieval. With a thicker endometrium with a better blood supply, the uterus is optimally prepared for the implantation of the embryo. In principle, you will not feel the implantation; 20 to 30% of women experience implantation bleeding.

You can take a pregnancy test eleven days after the embryo transfer.

Freezing embryos 
Any remaining embryos are frozen for a future transfer in a natural or artificial cycle. You will discuss the policy for this with a doctor.

Ten days after the embryo transfer, you do a pregnancy test at home using morning urine. An exciting moment! Please let us know the result as soon as you have it.

Positive test – Pregnant
Congratulations! If the test is positive, we schedule an ultrasound scan at around 7 to 8 weeks of pregnancy. This is 3 to 4 weeks after the positive test. If the scan shows a well-growing embryo with a beating heart in the uterus, the treatment has been successful. We then refer you to a midwife of your choice for further pregnancy care. In some cases, a referral to a gynaecologist is needed. We would love to hear how your pregnancy and the birth go. Read more.

Negative test – Not pregnant
A negative test or the start of your period is of course disappointing. If your period starts, please contact us on the first day of your period to discuss the next step. If your period does not start and the test is negative, we would also like to hear from you, particularly in connection with stopping the medication. If you still have frozen embryos, you will discuss the policy for the next transfer with a doctor. If there are no embryos left, we can discuss the options for a new IVF treatment.