In Vitro fertilisation (IVF)

What is In Vitro fertilisation (IVF)?

In Vitro Fertilisation (IVF) is a widely used form of assisted reproductive technology (ART) designed to help individuals and couples conceive when natural conception has not been successful.

In IVF, eggs are collected from the ovaries and fertilised with sperm in a specialised laboratory. Once fertilisation occurs and the embryo begins to develop, a single embryo is carefully transferred to the uterus. If implantation occurs, pregnancy follows in the same way as a naturally conceived pregnancy.

IVF has been used worldwide for several decades and has helped millions of people achieve pregnancy. It can be used with a partner’s sperm, donor sperm, donor eggs, or previously frozen eggs or embryos.

Who is Suitable for In Vitro Fertilisation?

IVF can be suitable for people with a wide range of fertility issues, including:

• Women with blocked or damaged fallopian tubes.
• Men with low sperm count or problems with sperm function.
• Couples with unexplained infertility, meaning no identifiable cause of infertility has been found.
• Women with ovulation disorders, premature ovarian failure, or uterine fibroids.
• Individuals with genetic disorders that they do not want to pass on to their children (in conjunction with preimplantation genetic testing).
• Women who have had their fallopian tubes removed.
• Individuals who have frozen eggs or sperm and want to use them to have children.

Benefits of In Vitro Fertilisation

• Overcoming infertility: IVF has proven to be a successful treatment option for couples who cannot conceive naturally due to various fertility issues.
• Use with other treatments: IVF can be combined with other treatments like ICSI to overcome severe male infertility or Preimplantation Genetic Diagnosis (PGD) to avoid genetic disorders.
• Donor eggs and sperm: Couples with serious genetic disorders or women who can't produce healthy eggs can use donor eggs or sperm.
• Control over timing: IVF allows some control over the timing of pregnancy. Embryos can be frozen and used in future cycles if the first transfer does not result in pregnancy or if the couple wishes to have more children later.
• Increased chances for older women: IVF can potentially allow older women, naturally having a lower fertility rate, to conceive.

Alternative Options to In Vitro Fertilisation

• Intrauterine Insemination (IUI)
• Medications
• Surgery
• Lifestyle changes
• Use of donor eggs or sperm
• Adoption or fostering

What to Do Before In Vitro Fertilisation?

Medical Preparations

• Initial Consultation: Meet with a gynaecologist to discuss your medical history, conduct necessary tests, and understand the IVF process.
• Fertility Testing: Both partners may undergo blood tests, ultrasounds, semen analysis, and hormone level checks.
• Health Assessment: General health checks to ensure you are in good health to undergo the treatment.
• Medications: Follow any prescribed medication regimens as your doctor advises to prepare your body for the procedure.
• Vaccinations: Ensure you are up to date with recommended vaccinations, including those for infectious diseases such as rubella.

Lifestyle Preparations

• Adopt a balanced diet of fruits, vegetables, lean proteins, and whole grains.
• Maintain a regular exercise routine to stay fit, but avoid overly strenuous activities.
• If you smoke, quitting can significantly improve your chances of success.
• Reduce or eliminate alcohol and caffeine intake.
• Achieving and maintaining a healthy weight, as both underweight and overweight, can affect fertility.

Emotional and Psychological Preparations

• Consider counselling or joining a support group to help manage the emotional stress associated with IVF.
• Practise stress-relief techniques such as yoga, meditation, or deep breathing exercises.
• Arrange for support from family and friends to help you through the process.

Financial Preparations

• Understand the costs involved in IVF, including medications, procedures, and any additional treatments.
• Check with your insurance provider to see if any part of the treatment is covered.
• Set a budget and explore financing options if needed.

Standard IVF Process

1. Ovarian Stimulation

Daily hormone injections stimulate the ovaries to produce multiple eggs. Monitoring with ultrasound and blood tests ensures safe and optimal response.

2. Egg Collection

A minor day-surgery procedure performed under light anaesthesia. A fine needle guided by ultrasound collects the eggs from the ovaries. The procedure takes approximately 15–20 minutes, and patients are discharged the same day.

3. Fertilisation

A sperm sample is provided on the day of egg collection. Fertilisation occurs either through conventional insemination or ICSI.

4. Embryo Culture

Embryos develop in specialised incubators for five days. Embryologists assess embryo quality during this period.

5. Embryo Transfer

Usually performed five days after egg collection. A thin catheter places the embryo into the uterus. The procedure takes 5–10 minutes and does not require anaesthesia. In some cases, embryos are frozen and transferred in a later cycle.

6. Pregnancy Test

A blood test is performed approximately two weeks after embryo transfer to confirm pregnancy.

What to Expect After In Vitro Fertilisation?

• Post-Transfer Care: The woman may be advised to rest briefly after the transfer. Light activities can be resumed after 24 hours.
• Progesterone: The woman may be prescribed progesterone to help prepare the uterus lining for implantation.
• Pregnancy Test: A blood test to measure the level of the hormone hCG (which indicates pregnancy) is typically performed about two weeks after embryo transfer.
• Rest: It's important to take some time to rest after the egg retrieval and embryo transfer procedures.
• Monitor for side effects: Some women experience side effects from fertility medications, such as bloating, abdominal pain, mood swings, or headaches. Severe or worsening symptoms should be reported to the doctor.
• Emotional support: IVF can be a physically and emotionally taxing process. Seek support from friends, family, a professional counsellor, or a support group if needed.
• Follow-up appointment: You'll have a follow-up appointment with your doctor to discuss the procedure results and next steps.
• Plan for the future: If the IVF cycle is unsuccessful, or if you wish to have more children, discuss the possibility of freezing any remaining viable embryos for future use. If the cycle is successful, prenatal care will begin.

IVF Success Rates

According to the Centres for Disease Control and Prevention (CDC), the percentage of IVF cycles resulting in a live birth (which is the most relevant measure of success) is about (the figures can vary from clinic to clinic):

• 40% for women under age 35
• 31% for women aged 35-37
• 21% for women aged 38-40
• 11% for women aged 41-42
• 5% for women aged 43-44
• 2% for women over 44

IVF Risks

IVF is generally safe, but possible risks include:

• Ovarian Hyperstimulation Syndrome (OHSS): Ovaries become swollen due to hormone stimulation. Modern protocols have significantly reduced this risk.
• Multiple pregnancy: Higher risk if more than one embryo is transferred.
• Ectopic pregnancy: Slightly increased risk compared to natural conception.
• Pelvic infection or bleeding: Rare complication of egg retrieval.
• Emotional stress: The process can be physically and emotionally demanding.

Careful monitoring reduces most risks significantly.

What if IVF is Delayed?

Age is a crucial factor in female fertility, so delaying IVF might result in a lower probability of success, especially if you are nearing your late 30s or early 40s. Conversations with your fertility specialist, who can provide guidance based on your health history and needs, are crucial.