In vitro fertilisation (IVF): an overview

In vitro fertilisation (IVF) has now become a phrase in such common use that it is rare for anyone to talk about ‘test tube babies’ any more. Babies born as a result of in vitro fertilisation are born after being fertilised outside the mother’s body. In vitro means literally ‘in glass’ but most IVF cycles take place in laboratory-grade plastic these days.

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Why have in vitro fertilisation?

This is the most commonly performed infertility treatment in the world. It can help the hundreds of thousands of couples worldwide who are unable to conceive naturally. Reasons for infertility vary, but IVF can help couples with both male and female infertility issues:

  • In vitro fertilisation is the standard technique for women who have blocked fallopian tubes.
  • It is used in cases of male infertility, in which the man’s sperm is unable to fertilise his partner’s egg naturally, either because he has a very low sperm count, or his sperm are very poor swimmers.
  • In vitro fertilisation can be used in conjunction with other techniques, such as intracytoplasmic sperm injection, if a man produces no sperm in his ejaculation. The sperm are surgically retrieved from his testes using one of several techniques.
  • IVF can be used to treat unexplained infertility. Even if no reason can be found to explain why a couple cannot have a baby naturally, a cycle of in vitro fertilisation can still result in a successful pregnancy.

The main process of in vitro fertilisation

Procedures differ both between different countries, where regulations may not be the same, and between fertility clinics in the same country. There are also several types of in vitro fertilisation that may increase success rates.

The entire in vitro fertilisation cycle takes about 25 days to complete, and it usually commences on the third day of a natural period. It involves:

  • Two weeks of hormone treatment for the female partner to stop her going through her own normal menstrual cycle, as this would interfere with the preparations for in vitro fertilisation. This involves having a daily injection or a nose spray of a hormone that acts on the pituitary gland to stop it producing sex hormones.
  • Hormone treatment with follicle stimulating hormone: this stimulates the ovaries to produce several eggs at once so that several embryos can be produced from the in vitro fertilisation. This involves an injection each day, for 12 days.
  • Constant monitoring using blood tests and ultrasound: it is vital to check on the stage of egg production so they can be collected at their best. A different injection is given to mature the eggs about 36 hours before egg collection.
  • Sperm collection: the male partner will be asked to provide some fresh ejaculate about three hours before the eggs are collected. The sperm sample is washed and put in a high speed centrifuge to help select the sperm that are active and healthy.
  • Egg collection: the female partner will be sedated while a needle, guided by ultrasound, is use to collect as many eggs as possible from both ovaries.
  • In vitro fertilisation: the eggs are mixed with the sperm in special culture fluid; fertilisation usually occurs within 24 hours.
  • Embryo culture: any eggs that have been fertilised are cultured for another 1–2 days and then checked. At that point, either the 2–3 day old embryos will be transferred into the woman’s uterus, or they will be cultured until day 5 or day 6 to see if any become blastocysts. Blastocyst embryo transfer can have a slightly higher success rate. Some fertility clinics favour assisted hatching before implanting the embryos.
  • Embryo or blastocyst transfer: depending on the woman’s age, between one and three embryos or blastocysts will be transferred.

A pregnancy test carried out about two weeks after embryo or blastocyst transfer reveals whether the cycle of in vitro fertilisation has been successful.

Success rates of in vitro fertilisation

Success rates have been increasing and may be a little higher if techniques such as blastocyst transfer or assisted hatching are used. Typically, though, the main factor that impacts on the success of in vitro fertilisation is the age of the female partner. If she is under 35, each cycle of in vitro fertilisation has a 32.3 % chance of achieving pregnancy. This declines to 27.2 % if she is between 35 and 37, to 19.2 % if she is a year older, between 38 and 39, and goes down to 1.5 % in women who are 45 or more.

What if in vitro fertilisation fails?

If you have one failed cycle, then you can try again after waiting for a month or so; the deciding factor in how many cycles of in vitro fertilisation most couples can have is the financial cost. For couples in countries where the cost of private infertility treatment is high, many consider the options available in fertility clinics abroad, where the cost of an IVF cycle can be much lower.

Sadly, some couples go through the trauma of many failed cycles, spending all their savings, only to find that they are still unable to have a child. In this case, other options such as fostering, adoption or surrogacy may become important.

The emotional impact of in vitro fertilisation

By the time you embark on your first cycle of in vitro fertilisation you may well have been trying for a baby for several years, and you may already have had other infertility treatments. By this stage, couples can become quite obsessed with the need to get pregnant, and this can lead to relationship strain and isolation. It is important to understand the risks of in vitro fertilisation, such as the potential for a multiple pregnancy, and to realise what the success rate statistics mean. Having in vitro fertilisation can never be stress-free, but it helps to have a realistic and flexible perspective.

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