In vitro fertilisation (IVF)
The information on this page explains briefly the procedures of In Vitro Fertilisation (IVF). This will give you an understanding of the treatments and an outline of methods we use. We will be happy to discuss any questions you may have about the treatments.
What is IVF?
IVF is the technique of mixing the women’s eggs (ova) with sperm from her partner in a small dish or test-tube in the laboratory to allow fertilisation to occur. Once the ova are fertilised, one or more fertilised eggs (pre-embryos) or developing embryos are replaced into the woman’s womb through the cervix.
Who needs IVF?
Many cases of infertility can be helped with IVF. However, the chances of pregnancy are very variable and depend on the cause of your infertility. When you are seen at the clinic we will discuss the most suitable type of treatment for you and give you an estimate of your chances of becoming pregnant.
For most couples, IVF treatment involves using your own sperm and eggs. Rarely we may recommend using donated eggs or sperm but of course this would never be done without your consent.
What does IVF involve?
The precise details of your treatment will be sent separately and below is a short outline of the steps involved in IVF. These include:
- Stimulation of the ovaries
- Monitoring of egg development
- Egg collection
- Sperm preparation
- Embryo replacement
- Pregnancy test and scan
Stimulation of the ovaries
In a natural menstrual cycle, a woman produces only one egg, but to increase the chances of pregnancy in IVF it is useful to stimulate the ovary to produce several eggs. This is done by giving you medication as a nasal spray or injection for about three weeks to control your natural cycle. Then additional injections are given for about 12 days to make the eggs grow. The eggs need to be exactly “ripe” when they are collected, so their development must be carefully monitored. The drug treatment varies slightly to suit your circumstances but this will be fully discussed with you beforehand.
Monitoring of egg development
Development of the eggs is monitored by two methods. First, the size and number of egg follicles growing in the ovary are observed by ultrasound scanning. The scan is obtained by passing a small device (called a transducer) into the vagina to provide a clear picture of the ovaries on a television screen.
The second method of monitoring is by measuring the hormones produced in the ovary. This is done by a blood test. The blood test may sometimes be needed during the two weeks before egg collection. At least three eggs must be growing before we can proceed to egg collection, so sometimes treatment will fail at this stage.
If the simulation treatment has been successful, the eggs will be ripe at the right time and a final, different injection will be given to complete the ripening. Egg collection will be planned for about 38 hours after this injection.
On rare occasions a complication of this treatment can occur (Hyperstimulation Syndrome). The ovaries may become large and painful and if severe, admission to hospital may be necessary. This usually only occurs if you become pregnant, and gets better within a few weeks.
Eggs are collected from the ovary by suction through a fine needle. This needle is inserted into the ovary through the vagina using the ultrasound picture as a guide. Only a mild sedative is needed and you can go home a few hours later.
We hope to obtain at least three eggs, but usually larger numbers are obtained.
A fresh sperm sample is needed for IVF so that the sperm are of good quality. The sperm are specially prepared so that only the best, cleaned sperm are put with the eggs.
After collection, the eggs will be put into an incubator for a short time. A relatively small number of sperm are then added to each egg. They will then be kept in the incubator for about two days. We monitor them daily and we will keep in touch with you to let you know when to attend for embryo replacement.
We will have previously discussed with patients how many embryos should be replaced. The chances of pregnancy increases with the number of embryos replaced, but so does the risk of multiple pregnancy. There is an increased chance of losing one or all of the babies in a multiple pregnancy, so we would like to avoid this complication. A maximum of two embryos are replaced except in exceptional circumstances in women over the age of 40 years. The procedure for replacement of the embryos is virtually painless and is little more than an internal examination. You will not need to lie down afterwards and you can return to normal (but not too strenuous) activity.
In some circumstances, it may be possible to consider freezing and storing embryos.
After IVF, further injections or pessaries may be needed to support the lining of the womb. We will see you about two weeks after egg collection, and a pregnancy test will be done. If this is positive, a scan will be performed five weeks after egg collection to confirm that this is a good pregnancy and that a baby is growing.
Remember that if two embryos are replaced, there is a significant risk (over 25%) of twins. More problems occur with babies from multiple pregnancies and the risk to the mother is also higher.
Miscarriages can occur in any pregnancy but there is also no increased or decreased risk after IVF/GIFT. There is a small chance (7%) that the pregnancy may stick in the tube (ectopic pregnancy). If this occurs an operation is required to remove the pregnancy and possibly the tube as well.
We see everyone who becomes pregnant regularly at the hospital until we are sure that the pregnancy is growing normally.
Will the baby be normal?
Sadly some babies are born with abnormalities however they are conceived. Many studies throughout the world have looked at babies born after IVF and ICSI. Recently published reviews of these studies show that the risk of abnormality is the same with both IVF and ICSI treatment. In the UK, about two to three babies in every 100 who are conceived naturally will have a major abnormality. After IVF or ICSI, this risk is increased and we expect that about three to four babies in every 100 will have a major abnormality. At present we do not know whether this is due to the treatment or is related to the causes of infertility, but further studies are continuing.
Clearly, these methods of treatment are complicated and stressful and they may fail at any stage. Sometimes we can explain why it has failed but often it is for reasons which we don’t understand. If you are not successful we will arrange for you both to come back to the hospital to discuss what happened in detail.
If you have any further questions about these treatments, the medical and nursing staff at the Fertility Centre are available to answer them. You will be asked to attend for a further counselling/information session at the centre before treatment begins, which will give you both an opportunity to discuss any problems.
For more information on our services, please contact us.