In vitro fertilization (IVF) is the most common and most effective type of Assisted Reproductive Technology (ART) to help women become pregnant. The procedure involves fertilizing an egg outside the body, in a laboratory dish, and then implanting it in a woman's uterus.
In a normal pregnancy a male sperm penetrates a woman's egg and fertilizes it inside her body after ovulation - when a mature egg has been released from the ovaries. The fertilized egg (now an embryo) then attaches itself to the wall of the uterus (womb) and begins developing into a baby. This is known as natural conception. However, some women are unable to become pregnant through natural or unassisted conception and have to undergo fertility treatment to become pregnant.
When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:
» Low sperm counts
» Problems with the uterus or fallopian tubes
» Problems with ovulation
» Antibody problems that harm sperm or eggs
» The inability of sperm to penetrate or survive in the cervical mucus
» An unexplained fertility problem
IVF is never the first step in the treatment of infertility. Instead, it's reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven't worked.If you think that IVF might make sense for you, carefully assess any treatment center before undergoing the procedure. Here are some questions to ask the staff at the fertility clinic:
» What is your pregnancy ratio per embryo transfer?
» What is your pregnancy rate for couples in our age group and with our fertility problem?
» What is the live birth rate for all couples who undergo this procedure each year at your facility?
» How many of those deliveries are twins or other multiple births?
» How much will the procedure cost, including the cost of the hormone treatments?
» How much does it cost to store embryos and how long can we store them?
» Do you participate in an egg donation program?
The procedure IVF techniques may differ depending on the clinic, but usually involves the following steps:
Step 1. Suppressing the natural monthly hormone cycle, as a first step of the IVF process you may be given a drug to suppress your natural cycle. Treatment is given either as a daily injection (which is normally self-administered unless you are not able to do this yourself) or a nasal spray. This continues for about two weeks.
Step 2. Boosting the egg supply; after the natural cycle is suppressed you are given a fertility hormone called FSH (or Follicle Stimulating Hormone). This is usually taken as a daily injection for around 12 days. This hormone will increase the number of eggs you produce - meaning that more eggs can be fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.
Step 3. Checking on progress; throughout the drug treatment, the clinic will monitor your progress. This is done by vaginal ultrasound scans and, possibly, blood tests. 34–38 hours before your eggs are due to be collected you have a hormone injection to help your eggs mature.
Step 4. Collecting the eggs; In the IVF process eggs are usually collected by ultrasound guidance under sedation. This involves a needle being inserted into the scanning probe and into each ovary. The eggs are, in turn, collected through the needle. Cramping and a small amount of vaginal bleeding can occur after the procedure.
Step 5. Fertilising the eggs; Clinician picking up a Petri dish – IVF your eggs are mixed with your partner’s or the donor’s sperm and cultured in the laboratory for 16–20 hours. They are then checked to see if any have fertilised. Those that have been fertilised (now called embryos) are grown in the laboratory incubator for another one - two days before being checked again. The best one or two embryos will then be chosen for transfer.
After egg collection, you are given medication to help prepare the lining of the womb for embryo transfer.
Step 6. Embryo transfer; for women under the age of 40, one or two embryos can be transferred. If you are 40, or over, a maximum of three can be used. The number of embryos is restricted because of the risks associated with multiple births. Remaining embryos may be frozen for future IVF attempts, if they are suitable.
» Risks of fertility treatment
» Freezing and storing embryos
Step 7. Other treatments; Some clinics may also offer Blastocyst transfer, where the fertilised eggs are left to mature for five to six days and then transferred. For information about embryo transfer, and the different methods used see:
» Embryo transfer
» Blastocyst transfer
» Assisted hatching