In Vitro Fertilization

IVF explained

In Vitro Fertilisation (IVF) is the best treatment for certain kinds of fertility problems. But it can be demanding and doesn't always result in pregnancy.

If you’re about to start on a course of IVF or if you’re experiencing fertility problems and are interested in the treatments available to you, find out as much as you can.

Knowing what to expect and the problems you face can make this difficult process easier to manage.

What is it?

When a couple conceive naturally, sperm from the man and the egg from the woman meet in the woman’s fallopian tubes. One sperm penetrates the egg, and fertilises it.

In IVF, this process of fertilisation happens outside the woman’s body. Here, a woman’s eggs are surgically removed, and fertilised in a laboratory using a specimen of sperm (pictured). Next, the fertilised egg, called an embryo, is surgically implanted into the uterus of the woman with the intention of causing pregnancy.

Typically, this occurs as follows:

• Fertility drugs are given to the woman to stimulate egg production. These drugs are usually given by injection.
• A vaginal ultrasound scan helps staff at the fertility clinic monitor egg production.
• Eggs are collected by passing a fine needle through the vagina and into the ovaries. This is done under sedation, and sometimes general anaesthetic. Typically nine or 10 eggs are removed.
• The male partner provides a sperm sample. In some cases, sperm from a sperm donor is used.
• Sperm and eggs are mixed together in a laboratory. Any eggs that are subsequently fertilised by sperm are called embryos.
• The woman is given progesterone, which prepares the lining of the uterus for pregnancy.
• The healthiest embryos are selected and placed into the uterus using a tiny catheter, which is passed through the vagina. Typically, one or two embryos are transferred. This may rise to three if the woman is over 40. Embryo transfer usually happens around two to three days after the eggs have been collected.

Two to three weeks after embryo transfer, an ultrasound scan is used to find out if the woman is pregnant.

Risks

There are risks involved in IVF treatment. These include:

• Failure: IVF treatment does not always result in pregnancy. Nationally, around 20-25% of IVF treatment cycles result in a birth. In general, younger women have a greater chance of success. Success rates decrease dramatically in women over 40.
• Multiple pregnancy: there is an increased chance of multiple pregnancy through IVF. In September 2008 the British Fertility Society said that around 24% of IVF cycles result in multiple births. Multiple pregnancy is associated with health risks for both mother and child as twins or triplets are more likely to be born prematurely and be underweight at birth.
• OHSS: drugs used to stimulate the ovaries during IVF can lead to Ovarian Hyper Stimulation Syndrome (OHSS). In OHSS the ovaries enlarge and become painful, leading to abdominal discomfort. In more severe cases, there can be shortness of breath, fluid retention in the abdominal cavity, and formation of blood clots. In these cases OHSS can mean a stay in hospital.
• Infection: when eggs are removed from the woman a fine needle is passed through the vagina and to the ovaries. There is a risk of introducing infection into the body, though antibiotics and surgical hygiene ensure that this occurs rarely.
• Emotional and psychological problems: for all women and couples, IVF can be a stressful and emotionally demanding process. Some men and women suffer from anxiety or depression during or after IVF. Anyone undergoing IVF should be offered counselling to help with the emotional impact of the process and its result.