In-vitro fertilisation (IVF)

What is In-vitro fertilisation (IVF)?

In-vitro fertilisation (IVF) is designed to help people that are struggling to conceive naturally. It is a procedure in which fertilised eggs are transferred into the womb.

Am I a candidate for IVF?

The best way to determine if you are a candidate for IVF is to discuss the infertility difficulties you are facing with your doctor.

 However, you may be a candidate if you have experienced one of the following:

• Unexplained infertility

• Endometriosis

• Blocked or diseased fallopian tubes

• Polycysytic Ovary Syndrome (PCOS) 

• Low sperm count

• Antisperm antibodies (these occur when the body becomes sensitised to sperm, causing an immune system response that destroys the sperm)

• Cervical mucous hostility (inability of sperm to penetrate the cervical mucus)

• Failed alternative treatments.

What are the risks involved?

The predominant risk involved in IVF is that it may not lead to a successful pregnancy. In the UK, only 20-25% of IVF treatments lead to birth.*

*NHS Choices

Additional risks include:

 A multiple pregnancy – There is an increased chance of having multiple pregnancy (this includes twins, triplets etc.) with IVF. Multiple pregnancy can put a significant mental and physical strain on the mother and increase the chance of pregnancy complications.

 Ovarian hyperstimulation syndrome – This is a rare complication of IVF. It usually occurs if the woman is sensitive to the fertility drugs taken to increase egg production. This leads to too many eggs developing, which can become very painful. 

 Ectopic pregnancy – There is a slight increase risk of having an ectopic pregnancy while undergoing IVF treatment. This is when the embryo grows in the fallopian tubes instead of the womb. 

• IVF Drug Side Effects – The drugs prescribed as part of IVF treatment may have some side effects. These can differ for each patient but common symptoms include – hot flashes, nausea, migraines and shortness of breath. 

How does IVF Work?

These are the main seven stages of IVF:

1. Down regulation

Before beginning fertility treatment drugs are given to suppress the natural hormones produced in a normal menstrual cycle. This results in the ovaries responding more effectively to fertility drugs.

Possible complications:

If the treatment is not successful, you may find your periods are irregular for a couple of months before returning to normal.

2. Stimulation of the ovaries

In an IVF cycle fertility drugs are given in order to control the growth of follicles to produce between 10-15 eggs. Sometimes the ovaries respond inadequately to the drugs and the treatment cycle may be cancelled. A further attempt can then be arranged and the amount of stimulating drugs may be increased.

Possible complications:

Ovarian hyperstimulation syndrome (OHSS) may occur if the ovaries over stimulate and produce large numbers of eggs or high levels of oestrogen, but this is rare. Symptoms include abdominal discomfort, but this should settle with rest and mild painkillers.

3. Monitoring egg development

The growth of the follicles is monitored by vaginal ultrasound scans regularly from approximately the sixth day of injections. When the follicles are the best size, a different hormone injection is given to induce the final stages of egg maturation. This injection is given 34 to 36 hours before the eggs are collected.

4. Ultrasound guided egg collection

The most common technique is by using an ultrasound-guided needle, carried out under a light general anaesthetic or intravenous sedation. The procedure, which takes about 30 minutes, is carried out using vaginal ultrasound. Remember, you will not be able to drive after this procedure. A needle is guided along the probe through the vaginal wall and into the ovary. Each follicle in turn is punctured and drained of the fluid it contains. The embryologist examines this to determine whether an egg is present.

On average eggs are retrieved from about 80 per cent of mature follicles. The eggs recovered will be inseminated using sperm provided by the recipient’s partner. Those that fertilise will be cultured in the embryology lab. In some cases no eggs will be collected, but this is very rare.

5. Sperm collection

Your partner will be asked to produce a sample of sperm either before or after the egg collection depending on the time of the procedure. He shouldn’t have sex for 72 hours before the egg collection. Usually only one sample is needed. If donor sperm <link> is being used, the sample will be taken from frozen storage. When donor sperm is used in any assisted conception technique recommendations from the Human Fertilisation and Embryology Authority (HFEA) and the Royal College of Gynaecologists are followed.

6. Fertilisation

After egg collection, eggs are incubated in a special culture medium. At the time of insemination, prepared sperm will be added to the eggs and about 16-20 hours later the first signs of fertilisation become visible under the microscope. The fertilised eggs then remain in culture until the second or third day after egg collection when they will have become embryos and will be ready for transfer back into the uterus.

7. Embryo transfer

Embryos are transferred through the cervix into the uterus using a catheter. Usually two to three embryos are transferred to increase the chance of having a baby. No more than three embryos may be transferred, under HFEA guidelines.

For more information, and if you have any queries, speak to your consultant.

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