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What is IVF?
Basically IVF involves collecting eggs from the ovary, putting them together with sperm in a dish and, if those sperms fertilise an egg, putting the embryo or embryos that result into the womb.
The Treatment
Every month women prepare several eggs in their ovaries, but usually only one is chosen by the body to be released into the fallopian tubes. With IVF, the ovaries are stimulated to produce more than one egg to give a better chance of collecting at least one which is healthy.
Combinations of drugs given by injection are used to stimulate egg production over a period of two to five weeks. The one drug (gonadotrophin) acts on the ovary to make it produce more eggs than it normally does and the other drug stops ovulation. On the day after the last injection of gonadotrophins, an injection of the hormone HCG (human Chorionic Gonadotrophin) is given. This matures the eggs, which should be ready for collection about 35 hours later (this may vary slightly between clinics).
Collecting and Fertilising the Eggs
The procedure to collect the eggs takes about half an hour and can be done under a general anaesthetic, although many clinics prefer to use sedation and painkillers. A fine needle is passed through the back of the vagina and into the ovary. The fluid from each follicle is sucked into tubes and examined by the embryologists who look for eggs. Each portion of fluid is examined in turn until every possible egg has been collected.
The next stage is to put the sperm with the eggs. The semen needs to be produced shortly before the eggs are collected. The sperm are then washed and prepared and put with the eggs. The specialists can usually tell if fertilization has taken place after twenty four hours.
Replacing the Eggs in the Womb
If the eggs have fertilised and are developing normally, they will be put back into the womb two to three days later. The procedure is simple. A plastic tube is passed through the cervix (the neck of the womb) and the embryos put high into the womb.
To give the best chance of pregnancy, most IVF units put more than one embryo into the womb. Transferring two or three embryos into the womb (the most allowed by law in the UK) gives a better chance of a baby than one embryo does, but also gives a chance of more than one baby developing. Recently, a couple who had triplets after fertility treatment won a compensation claim against the clinic which gave them three babies instead of the hoped-for one or two. Apart from the pressures involved in raising three children at once, triplet pregnancies are fraught with problems, from early pregnancy through to delivery. All this will add weight to the view that only two embryos should be transferred in order to reduce the risk of a triplet pregnancy. Your clinic will discuss these options with you.
Any healthy embryos that are not transferred can be frozen in liquid nitrogen for up to ten years but you must give your consent in writing for this.
About two weeks after the embryos have been put into your womb you can carry out a pregnancy test.
The Risks
Although IVF is a standard treatment it does carry some risks. 2 % of cycles may be complicated by infection, bleeding after the procedure or ovarian hyper-stimulation syndrome (OHSS). This occurs when the ovaries respond too well to the fertility drugs. OHSS can be mild and may only cause a bloated feeling, however, more severe cases need hospital treatment, to deal with the loss of fluid from the circulation.
Emotional Stress
You do need to be aware that IVF is emotionally stressful for both the man and the woman. Couples find it extremely disappointing if the treatment does not work and you may need emotional support while you’re having treatment. Your clinic may well offer counselling, hypnosis or training in relaxation techniques and possibly a support group. The stress that IVF treatment involves is hard to come to terms with but if a cycle of treatment fails, specialists can help plan another course, should you want it and feel able to cope emotionally as well as financially.
Tests
Discover the treatments available if you're having problems getting pregnant, with guidance from The Family Planning Association
Tests for a woman may involve
• Blood, urine and cervical mucus tests – to check hormone levels or ovulation.
• Ultrasound scans – to check if a follicle, which should contain an egg, is being produced. Treatment for ovulation problems usually involves drugs and has a high success rate.
• Sperm mucus crossover – this checks if the woman’s cervical mucus allows her partner’s sperm through.
• Endometrial biopsy – a sample of womb lining (endometrium) is removed to check that it is free from infection and that ovulation has occurred.
• Hysterosalpingogram – where dye is passed through the fallopian tubes to check they are not blocked.
• Laparoscopy (usually under general anaesthetic) – uses a thin telescopic instrument to view the reproductive organs through a small cut below the navel. It checks for scar tissue, endometriosis, fibroids or any abnormality in the shape or position of the womb, ovaries or fallopian tubes.
Tests for a man may involve
• Semen analysis to look at the number, shape and size of sperm, as well as the way they move.
• Blood or urine tests to check hormone levels.
• Testing the sperm in special solutions.
• Special X-rays/scans to find blockages or check the blood supply to the testes.
Assisted Conception Techniques include
• In-vitro fertilization (IVF) – the most well-known treatment. Eggs are removed from the woman, fertilised in the laboratory and the embryo is then placed in her womb. 80% of in-vitro fertilisation (IVF) treatment is carried out privately. Your GP, practice nurse or local Community Health Council (CHC) will tell you if you qualify for treatment on the NHS. You can also visit The Human Fertilisation and Embryology Authority website for more information.
• Donor insemination (DI) Egg donation may be an option if a woman is not producing eggs or has a genetic problem. If a man produces no or few normal sperm or has an inherited disease, insemination using sperm from an anonymous donor may be an option.
• Gamete Intra-Fallopian Transfer (GIFT) – a couple’s own eggs and sperm, or that of donors, are mixed together and placed in the woman’s fallopian tubes where they fertilise.
• Intra-cytoplasmic Sperm Injection (ICSI) – a single sperm is injected into the woman’s egg, which is then transferred to the womb after fertilization.
