IVF – or In Vitro Fertilisation stands for fertilisation taking place outside of a woman’s body, under controlled conditions such as in a laboratory. There have been over 1 million babies born as a result of using IVF technology; the first was a little girl called Louise Brown in 1978.
Infertility is a more common issue than we give sufficient credit for. For the average couple with no fertility issues, there is only a 20-25% chance of successfully conceiving each month. Around 5% of couples are considered completely infertile. In New Zealand at the present time, we know that females account for around 30% of the cause for infertility problems and males another 30%. Infertility affecting both the male and female constitutes another 20% and the remaining 20% doesn’t have a clear reason at all. For many of these couples, IVF is the only way possible they will be able to conceive their baby.
Most of us assume we’ll be able to conceive naturally and have children when we plan to and when we want them. But it’s not always as straightforward as this. In truth, around one in every six couples will experience some degree of infertility, which is about 15% of the population.
The general recommendation is that if a couple has been trying to conceive for two years of more and are having no success, then investigations into the cause may be appropriate. An initial consultation with a general practitioner and then referral to an obstetrician and gynaecologist who specialises in fertility problems is the usual management.
IVF involves a number of steps and although individual fertility clinics may vary in their techniques, the general principles and processes are the same. Five steps are usually undertaken, and these include:
There are a range of medications which are designed to stimulate the ovarian follicles to produce more eggs. The more eggs which are assisted to maturity, the greater the likelihood of successful fertilisation and successful pregnancy. Collecting several eggs maximises the chances of one being fertilised. The aim is to artificially bring 5-12 eggs to a state of maturity under controlled and monitored conditions. This takes around 12 days of injections, which many women learn to give to themselves. Alternatively their partner may take on this role.
The growth of the follicles is monitored closely by ultrasounds and blood tests, specifically levels of oestrogen. When the follicles containing the eggs are ripe and ready to be collected, an injection of hCG (human chorionic growth) hormone is given. One of the actions of this hormone is to stimulate the follicles to release its egg.
Harvesting is around a day and a half later and is done in hospital when the woman is placed under a light anaesthetic. A very narrow, fine needle is injected into the ripe follicle and the eggs are aspirated (sucked) gently out.
This is the time when your partner needs to do his bit and provide the scientists with a fresh sample of semen. With every ejaculation there are around 250 million sperm released, though this number varies on a number of factors. Age, hormones, frequency of ejaculation, environmental factors, diet and general health all play a role.
With standard IVF treatment, the eggs and sperm are mixed together in a plastic dish. If the quality of the sperm is not sound, then a sperm is injected directly into an egg and this is then transferred directly into the woman’s uterus. This is known as intra cytoplasmic sperm injection (ICSI). An alternative is when sperm are sorted and selected to be the most viable and are transferred directly into the woman’s uterus.
There have been some changes in fertility clinic practice, regarding the number of fertilized eggs which are transferred into the uterus. Currently many clinics will only transfer one or two back, so that the chances of having a multiple pregnancy are reduced.
Any excess embryos can be frozen for future use if a current cycle of IVF is unsuccessful or the uterus is not favourable enough for transfer to go ahead.
Pregnancy tests are usually conducted just over fortnight after the IVF procedure was done. This can seem like an endless waiting game for a couple who are desperate to have a baby.
This series of articles on IVF is designed to help you navigate your way through a range of information and choices. Your own gynaecologist and fertility clinic will be able to provide you with more individually tailored advice.