In Vitro Fertilisation

IVF– or in vitro fertilisation, stands for fertilisation taking place outside a woman’s body under controlled laboratory conditions. A woman’s eggs are collected and fertilised by sperm. The fertilised egg/s are then implanted into the woman’s uterus.

IVF treatment is an option when natural conception isn’t possible.

Why IVF?

Infertility is a more common issue than we give credit for. On average, a healthy 30 year old woman has around a 20% chance of conceiving each month. By the time she reaches 40 years of age, her chances have dropped to around 5%. Fertility for women decreases as they get older, because of changes in the menstrual cycles and the number and quality of her eggs. Older men do not produce sperm are which are as healthy or mobile as younger men do.

Most of us assume we’ll be able to conceive naturally and have children when we plan a pregnancy. But it’s not always as straightforward as this. Around 1/3 of fertility issues are due to women, 1/3 due to men and the remainder due to a combination or unknown causes.

When to get IVF treatment

The general recommendation is that if a heterosexual couple, having regular sex have been trying to conceive for one year (or six months if you are over 35), and are having no success, then it’s time to be checked. A consultation with a general practitioner and then referral to an obstetrician and gynaecologist specialising in fertility problems is the usual management.

Reasons for IVF

There are a range of reasons why IVF can become necessary. Generally it’s used when natural conception isn’t possible or, there is a high risk of genetic abnormalities being passed on to the baby.

  • Endometriosis
  • Blocked fallopian tubes
  • Fallopian tube damage
  • Uterine fibroids
  • Male infertility
  • Recurrent miscarriage
  • Unexplained infertility
  • For single women
  • For same sex couples, using a donor egg or sperm or both.

IVF treatment

IVFinvolves a number of steps. Although individual fertility clinics may vary in their techniques, the general principles and proc esses are the same.

After taking a careful history, having a counselling session and basic screening tests from the couple these are the usual IVF steps:

  1. Medication is taken to suppress the woman’s usual cycle. This is so the IVF cycle can be monitored and controlled.
  2. Stimulation of the ovaries to produce eggs, Follicle Stimulating Hormone (FSH) injections are used to help this process. Often, the woman and/or her partner give these infections.
  3. Monitoring with blood tests and ultrasounds, to measure the thickening of the uterine layer and the number of follicles on each ovary.
  4. Trigger injection given once the number and size of the follicles is right. This is usually given 37 hours before the eggs are collected.
  5. Removing the eggs surgically. This is called egg collection or egg retrieval.
  6. On the same day as the egg retrieval, the partner provides a sperm sample or, donor sperm is prepared.
  7. In the laboratory, the eggs and sperm are mixed together. The aim is to produce as many embryos as possible to ensure the ones which are used are healthy.
  8. Around five days later, the fertilised eggs (embryos) are transferred into the uterus. This is called embryo transfer.
  9. Any remaining embryos are frozen for later use.
  10. A wait of two weeks is necessary to see if the embryo implants and there is a positive pregnancy.
  11. A blood test is done to assess for pregnancy and the success of having an IVF baby.

Partner’s Role in IVF

This is 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. Age, hormones, frequency of ejaculation, diet and general health all play a role.

With standardIVFtreatment, the eggs and sperm are mixed together in a Petri dish. If the egg is fertilised, the embryo is cultured in the laboratory for around five days and monitored carefully before being transferred into the woman’s uterus.

If the quality or quantity of the sperm is not sound, then a single sperm may be injected into an egg and then transferred directly into the woman’s uterus.

An alternative is when sperm are sorted and the healthiest are selected to for transfer directly into the woman’s uterus. This can happen when the risk of genetically inherited disease from the father is high.

After IVF

Pregnancy tests are usually done around ten days after the embryo transfer. Medication used in IVF treatment can affect a urine pregnancy test, which is why a blood test is more accurate.

Success of IVF

Clinics in Australia aren’t required to publish their success rates of IVF. And the way they do treatments and interpret their successes varies. As a general rule, the younger the woman the higher the chances of success.

Cost of IVF

The cost of IVF can be considerable, not just in money terms but emotionally as well. Some couples need several rounds or cycles of IVF before they have a successful pregnancy. Before you start IVF, speak with Medicare and your private health insurer so you understand the costs.

The cost of IVF varies between individual clinics and treatments. Only some of the cost of IVF is covered by Medicare and private health insurers, and there are generally out of pocket expenses.

  • For an initial simulated IVF cycle the out of pocket expense is around $4,700.00
  • For a subsequent stimulated IVF cycle out of pocket expense is around $4,100.00.
  • For an initial stimulated IVF cycle with ICSI out of pocket cost is around $5,300.00.
  • For a subsequent stimulated IVF cycle with ICSI out of pocket cost is around $4,700.00
  • Frozen embryo transfer is around $1,650.00.
  • For intrauterine insemination (IUI) cycle out of pocket cost is around $1,390.00.

Chances of success with IVF

The chances of success with IVF are dependent on many factors however, there’s generally a 1 in 5 chance of becoming pregnant and having a baby after successful IVF. The younger the woman, the greater the chances of her having IVF success.

FAQ

How many fertilised eggs will I have transferred back?

There have been some changes in fertility clinic practice around the numbers. Currently many clinics will only transfer one or two back, so that the chances of having a multiple pregnancy are reduced.

Are there any free IVF clinics?

There are some bulk billing IVF clinics, though these are outnumbered by the number of private companies.

Written for Huggies by Jane Barry Midwife and Child Health Nurse on 4/05/20.