IVF

For all those couples who have been trying in vain to conceive for a year or more, science has brought hope in the form of in vitro fertilisation or IVF. A procedure first successfully attempted in 1978 in England, IVF has now become a boon for couples all over the world who have constantly been under the physical and mental trauma of infertility.

What is IVF?

In vitro literally means ‘in glass’. The dictionary explains it as a process made to occur outside the biological body, in an artificial environment. Thus, in vitro fertilisation simply means the fertilisation process that occurs under lab conditions and not inside the mother’s womb. Under natural conditions, for pregnancy to take place, the sperm from the male body unites with the egg inside the fallopian tube of the female body. However, a number of factors can contribute to this process not occurring naturally, including:

• Having damaged fallopian tubes
• Age
• Having had your fallopian tubes removed
• Male infertility issues
• Hostile cervical mucus

When a couple decides upon IVF, the woman will receive multiple injections of fertility drugs before having her eggs retrieved. Once collected, the eggs are combined with sperm, left to culture and then transferred back to woman’s womb for implantation.

The IVF Procedure

The IVF procedure is actually a combination of several steps that may take place over a period of approximately 20 – 25 days. Depending on the initial medical examination of the couple, in the standard process the first step involves the monitoring of the egg ripening process and the administration of fertility drugs. These drugs will not only help in the timing of the ripening, but will also help in collecting a considerable quantity of eggs from the female body as they help more eggs mature. In some IVF centres, the ovaries are examined using ultrasound to analyse the development of the eggs. The use of fertility drugs in recent times has helped in increasing the success rates of the procedure as they trigger super ovulation thereby allowing a greater number of embryos to develop. Collection of the egg takes place after the cycle has been closely monitored and prior to ovulation. This is a transvaginal process taking not more than 20 minutes and should be completely comfortable under proper sedation. Now comes the crucial part: mixing the eggs and sperms together. Under lab conditions, once the egg has been retrieved from the female body and the sperm processed, the two are brought together. In cases where sperm might not be able to naturally fertilise the eggs, Intracytoplasmic Sperm Injection (ICSI) is used to inject a single sperm cell into an egg using special, microscopic equipment. The resulting fertilised eggs are then left to incubate under controlled conditions and develop into embryos. Embryos are ready to be placed into the uterus in 4 to 5 days time, when they have reached the 6 to 8-cell stage. In the United Kingdom, the normal embryo transfer procedure involves the placing of 2 to 3 embryos into the woman’s womb. This is done using a catheter through the vagina and the cervix. The woman may also be given an additional progesterone dose to thicken the uterus walls and increase the chances of the embryos successfully implanting. After a waiting period of 2- 3 weeks, a blood pregnancy test as well as an ultrasound can reveal the success of the treatment and any possible pregnancy. Find out how alternative therapies like acupuncture can help with IVF treatments.

Success Rates

There has long been a debate regarding the success rates of in vitro fertilisation. While some find it the best possible infertility treatment, many are doubtful about its success rates and the complications following the failure. In reality, there are a number of factors that have to be taken into consideration to analyse the success or the failure of any IVF treatment. Possible reasons why a particular cycle treatment may fail include:

• Patient’s age
• Sperm and egg quality
• Failure to collect eggs
• Failure of implantation of the embryos

On an average, there is a 20% to 30% success rate associated with IVF. In general, women above 40 find it a little more difficult to conceive using IVF as the ovulation rate as well as quality of eggs decreases with age. Those who have had a normal delivery before or successful IVF births earlier have a greater chance of getting pregnant the second time over. The IVF centre where the treatment is done also influences the success rate. Factors like size of the clinic, technical expertise of the team, type of equipments used, protocols for ovary stimulation, and transferring of embryos play an important role in inferring the overall success rate.

Risk Factors

An important risk associated wtih IVF is the increased chance of having a multiple pregnancy. This is due to the high number of embryos transferred, which may result in the birth of twins, triplets, or, in certain rare cases, quadruplets. A woman may also experience complications arising due to over stimulation of the ovaries and has an increased risk of suffering an ectopic pregnancy. Learn more about the risk of ectopic pregnancy and IVF. Birth defects in children born through in vitro fertilisation have been studied and current data shows no significant difference from naturally born children. However, because IVF is a fairly new treatment, with most of its resulting offspring under the age of 20, it is important to regularly test these children to check their development patterns, psychological and mental growth, and genetic patterns. Regular testing will give experts a better idea what, if any, long-term effects this reproductive technique may have on offspring. Because not all embryos created during treatment will be used, some couples may plan to store these for future use. These are called frozen embryos and are usually kept in liquid nitrogen. Research has shown that the children born from these types of embryos also appear to develop normally and do not seem to have any increased risk of birth defects or genetic problems. Though this procedure is allowed in the UK some countries, like Sweden, do not allow such practice.

Cost of IVF Treatment

Although IVF is one of the most successful treatment procedures for those unable of becoming pregnant on their own, one crucial consideration to be made is the cost of the process. On average, it costs £1000 to £4000 per treatment cycle in the United Kingdom. This may vary from centre to centre and depends on a lot of factors, such as the number of IVF cycles performed; whether ICSI was used; if the couple is considering embryo freezing; and the cost of drugs. If the clinic is not close to home or in a different city, the accommodations and commuting will also need to be factored in. In the UK, if a woman is aged between 23 and 29 and the couple is facing infertility problems, then they should be offered up to 3 IVF cycles on the NHS, although the final decision rests with the local health authorities. A Finnish study has also suggested that instead of transferring multiple embryos, if a single good embryo is selected for implantation, the chances of pregnancy are equally good. This method offers two advantages. First, the cost of multiple embryo transfers and many IVF cycles are reduced drastically. Secondly, the risk of a multiple pregnancy occurring is virtually eliminated. For couples who have lost all hope of conceiving a baby naturally due to one or more fertility issues, IVF provides a chance. Successful treatment is a combination of a vast number of factors and IVF technology is improving every day. What was once considered impossible is now a regular procedure all over the world. Learn more about IVF on the medline plus government website.