In Vitro Fertilisation (IVF)

IVF is a common treatment for people who are unable to conceive naturally. Usually in IVF, the woman has medicines (fertility hormones) to stimulate the ovaries to produce several eggs. The eggs are then collected and mixed with sperm in a laboratory. 

IVF is carried out when the sperm quality is considered to be ‘normal’ If there are issues with the sperm quality such as low motility or numbers, a procedure called intracytoplasmic sperm injection-(ICSI) may instead be used – this is where a single sperm is injected into the egg by an embryologist. If fertilisation is successful, the embryos are allowed to develop for between two and six days. This helps the embryologist to select the strongest embryo, which is then transferred back to the woman’s womb to hopefully continue to a successful birth. 

Often several good quality embryos will be created. In these cases, it's normally best practice to freeze the remaining embryos because putting two embryos back in the womb increases your chance of having twins or triplets, which carries health risks. You can use your frozen embryos later on if your first cycle is unsuccessful or you want to try for another baby. 

Who is recommended to have IVF 

  • Women with blocked or damaged fallopian tubes. 

  • People with unexplained fertility problems, or who have tried other treatments that were unsuccessful. 

  • Men with low sperm counts or who have high numbers of sperm with an abnormal shape or movement. Where these problems are serious an additional procedure (intracytoplasmic sperm injection or ICSI) may be necessary. 

  • Women who have difficulty with ovulation and who haven’t been successful with other treatments. 

  • Older women who are less likely to be successful with less invasive treatments. 

  • People using surrogacy. 

Is there anyone IVF isn’t right for? 

Not everyone needs IVF. For example, some problems with ovulation may be corrected with drug treatment alone so it’s important you understand all your options before going ahead. 

IVF might not be suitable for some people because it’s very unlikely to succeed, particularly in the case of older women, or those who are at risk of premature menopause. You should talk to your doctor about your personal chances of success with IVF. 

How safe is IVF? 

IVF is generally very safe and most who have it experience no problems with their health or pregnancy. However, there are some risks to be aware of, which include: 

  • Ovarian Hyperstimulation Syndrome- a severe reaction to fertility drugs

  • Having a multiple pregnancy or birth (twins, triplets or more) which can cause serious health problems to both mum and babies 

  • Having an ectopic pregnancy 

  • Possible birth defects (these are rare and research is still ongoing). 

It’s very important you understand all the risks of IVF and know when to spot the symptoms of something serious. 

Can I have IVF on the NHS? 

It depends on where you live as decisions around who can have IVF on the NHS are made locally rather than nationally. Talk to your GP about what's available in your area. 

If you do need to pay for treatment, one cycle of IVF costs £5,000 on average, although this varies considerably. Bear in mind there may be additional costs such as the cost of storing your embryos or going for an initial appointment. 

Chana can help towards supporting a couple financially for IVF treatment for those that are not eligible to receive it on the NHS.

How long does IVF take? 

Before you have IVF, you’ll need various appointments with you doctor and/or tests and investigations, so be prepared for it to take some time. It’s not something to take lightly, so take your time to think things through, ask questions and make sure you’re clear on what’s involved and what to expect. 

IVF is referred to as a ‘cycle’ of treatment as it involves a number of stages: suppressing natural hormone production, hormone treatment to boost egg supply, egg collection, mixing the eggs and sperm and finally, embryo transfer (more information on the process below). How long it takes depends on your recommended treatment. 

 For most people, one cycle of IVF will take between four and six weeks. However, for medical reasons some women won’t have the first stage of treatment (suppressing hormone production) which brings their treatment time down to around three weeks. Your doctor will advise you on the most appropriate treatment for you. 

How successful is IVF? 

As with all fertility treatments, how successful IVF will be depends on the woman’s age and the cause of infertility. 

What does IVF involve? 

This process outlines a single cycle of IVF following the most commonly used procedure. You may find that your treatment is slightly different depending on your history and what your clinic thinks is best for you. 

 IVF involves four basic steps; 1-Ovarian stimulation, 2- Egg collection, 3- Insemination and 4- Embryo replacement. 

1-Ovarian stimulation- During a natural unstimulated cycle, a single follicle containing a single egg develops to maturity. It is possible to perform IVF using a single egg from a natural cycle, but the success rates with this are low. Hence, most IVF cycles involve stimulation of the ovaries with medicines known as gonadotrophins to produce multiple eggs. The clinic should give you written information about these drugs and their side effects. Your GP can also explain how the drugs work and discuss side effects.  

Ovarian hyperstimulation (OHSS) occurs when there is an excessive response to the drugs, and is a major and potentially life-threatening complication associated with gonadotrophins. Some women, particularly those with polycystic ovaries and those who have had hyperstimulation in the past, are at an increased risk of OHSS. Clinics monitor women using ultrasound scans and often hormone blood tests as well to judge their response to the gonadotrophins. By interpreting the results of ultrasound and blood tests, the specialist will determine the best time to perform the egg collection.  

About thirty-six hours before the egg collection is due, an injection of human chorionic gonadotrophin (hCG) is given to initiate the final process of egg maturation. Precise timing is necessary as the eggs will be suitable for recovery thirty four to thirty-six hours after the hCG injection.  

2- Egg collection -The eggs will be collected whilst under sedation or general anaesthetic. The procedure takes around half an hour and you may feel a little sore or bruised. Whilst the eggs are being collected, the man will be asked to come to the clinic to produce a sperm sample, or your donor sperm will be taken from the freezer, for mixing with your eggs. Medication will help to prepare the lining of the womb. This is usually taken as a pessary or gel which you can insert yourself into the vagina / rectum. 

3- Insemination and fertilisation - The eggs will be mixed with the sperm in a laboratory. The aim is for the eggs and sperm to fertilise to create an embryo. If the male partner has a significant reduction in sperm numbers, ICSI is likely to be advised. With ICSI a single sperm is selected by the embryologist and injected into the egg. Surgical sperm retrieval may also be necessary with ICSI in men whose tests have shown they don’t have any sperm in the ejaculate. It is important to remember that not all eggs will fertilise. This may be due to problems with either the egg or the sperm, or can be unexplained. When fertilisation takes place, the process takes about eighteen hours to complete and about twelve hours later the embryo starts to divide. 

4- Embryo replacement -The resulting embryo(s), will be monitored to check how it’s/they’re developing. At this stage, the embryo should form a blastocyst. The hope is for as many embryos as possible to progress successfully, but unfortunately not all the embryos will make it to the final stage.

Two to five days after fertilisation, the embryo(s) will be assessed, and those that have developed successfully will be ready to be transferred to the womb. The laboratory scientists will advise which to transfer, depending on the number of embryos that develop and their quality. Embryo transfer is an important step and is often performed under ultrasound guidance. The procedure is virtually painless. One embryo is usually transferred unless there are specific reasons to think that it may be necessary to transfer two. In some cases your doctor might recommend that you freeze your embryos to give your body a chance to recover from the egg collection, or to further prepare your body for the transfer procedure which would take place a later date. There is no evidence that bed rest after the embryo transfer makes a difference to the outcome and most units recommend resuming normal activities after the procedure. Luteal support Hormone supplementations in the form of progesterone pessaries, gel or injections are usually recommended after embryo transfer to support the womb lining. Sometimes hCG injections may be used for this purpose. 

Q & A’s

What is Embryo freezing?  

If you have more than one good quality embryo, you can freeze your remaining embryos for future use. Most IVF clinics offer embryo freezing and storage. Unfortunately not all embryos are suitable for freezing. Lower quality embryos may not survive the freeze/thaw process or may have a lower implantation rate after freezing than if used in a fresh transfer.

What if I can’t/don’t want to take fertility drugs? 

It’s possible to have IVF with no fertility drugs at all (natural cycle IVF) or with fewer drugs (mild stimulation IVF and in vitro maturation [IVM]). 

These may be appropriate for women who can’t take drugs because of an existing medical condition or who prefer not to for personal reasons. Success rates tend to be lower when you don’t use fertility drugs and, in the case of natural IVF are significantly lower. 

What can I do to boost my chances of successful IVF? 

Lifestyle factors can affect your chances of getting pregnant and having a healthy pregnancy. Making small changes may boost your chances of success. 

What else do I need to bear in mind? 

Before treatment can take place, you are required by law to give your informed consent (written permission) to ensure your sperm, eggs, embryos and personal information are only used in a way that you’re happy with. The paperwork can be lengthy and can seem overwhelming and it may help to remember that the forms are in your best interests, to ensure that your choices are respected. Some of the paperwork can be confusing and difficult to understand. If you are unsure of any of the details you can always ask the clinic to go through the forms with you and ensure that you understand everything clearly before you sign. Chana staff are very familiar with all these forms and will gladly go through the forms with you to ensure that you understand and agree with what you are signing.

There can be a high emotional toll with IVF treatment. It can be extremely helpful to get support from professionals and organisations who can relate to what you’re going through. Chana is here to support you through your journey.

You may be offered ‘treatment add-ons’ which are optional extras, often charged at an extra cost. To help you ask the right questions and make the right choices for you, visit HFEA treatment add-ons page to get the latest information about the evidence for the most commonly offered. The traffic light rating system helps you to easily identify which add-ons have been shown to be effective. 

Where can I find an IVF clinic? 

The HFEA have details of every licensed IVF clinic on our website, including their opening times, donor waiting times, success rates and ratings from both patients and our inspectors. It's a great place to start browsing for clinics or to find out a bit more about a clinic you've been referred to. 

I’ve had IVF and it didn’t work – what next? 

Many experts recommend that you wait for a couple of months after treatment before trying again. This gives you a break from the stress of treatment and a chance for your body to recover. 

It can also be an important time to think about your options and decide whether to continue treatment. 

If you’re planning on trying again after unsuccessful treatment, you will understandably want to feel that you’re doing everything you can to get pregnant. We know that this can be a situation in which some patients and clinics may discuss additional treatments, known as treatment add-ons, which often cost more. 

The fact is, there is no conclusive evidence that any of the commonly offered add-ons increase the chance of a pregnancy. 

References:

https://www.hfea.gov.uk/treatments/explore-all-treatments/ 

https://fertilitynetworkuk.org/trying-to-conceive/fertility-treatment/fertility-treatment-options/ 


The above content is for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your GP or Doctor if you have any questions regarding your health.