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In Vitro Fertilisation (IVF)

In-vitro fertilisation (IVF) is a fertility treatment available through fertility clinics. Here we explain what IVF is, who might need it and the procedure, embryo transfers and efficacy rates.

What is IVF? 

In vitro fertilitisation (IVF) means fertilisation outside of the human body. During IVF, a woman’s eggs are removed from the ovaries and fertilised with a sperm sample in a laboratory1. The fertilised egg, an embryo, is transferred to the uterus in order to develop and grow into a baby. This treatment is now used effectively to treat a range of fertility related conditions. 

When is IVF most suitable? 

IVF is a recommended treatment option for those who can not conceive through having intercourse2, for example due to a medical condition, for those with a known infertility diagnosis or for those who have tried to conceive through intercourse for 2 years where no diagnosis has been established3

Image shows an egg and four sperm cells in a petri dish, as part of the IVF (in vitro fertilisation)
In Vitro Fertilisation

How is IVF performed?

The IVF process consists of many steps, which we outline below so you know what to expect:

NHS or private treatment

Your GP may refer you for treatment on the NHS after they’ve reviewed the results of your infertility investigations. In some cases you may not be eligible for funded treatment and would be advised of any adjustments you could make or if you should consider private treatment. You may also choose to have and pay for treatment privately at a fertility clinic of your choice. 

Consultation and consents

A first step within your fertility clinic is to have a medical consultation with a fertility specialist. They will review the results of your fertility investigations and order more tests if necessary. The results of your investigations will help create a plan for treatment and determine the best hormone stimulation protocol for you. You will also be required to sign consents for your treatment4. This is an important step as the consents are there to protect you, your sperm, your eggs and the embryos created from them. You will have a lot of paperwork from the clinic and be sure to ask your doctor or nurse if there is anything that doesn’t make sense. 

Hormone stimulation and monitoring

The hormone stimulation stage of the IVF process involves daily injections of medication called gonadotropins. These drugs encourage your ovaries to produce multiple eggs5. During the stimulation, you will attend the clinic for ultrasound monitoring to ensure that your ovaries are responding well to the medication. It’s possible to have blood tests during this time as well. The dosage of the medication is subject to change based on how your ovaries are responding. Once the follicles in your ovaries have reached an appropriate size, you’ll be given a trigger injection (the final injection to help the eggs mature) and your egg collection will be scheduled. 

Egg collection 

The egg collection takes place under sedation and you will need to fast in advance of the procedure. Your clinic will inform you of when to stop eating, what medications to take and when to arrive at the clinic. The eggs are aspirated from the follicles in your ovaries using a long needle and transvaginal ultrasound6. The fluid from the follicles is collected in test tubes that are passed to the embryologist in the laboratory and they will notify when eggs have been found under a microscope. A final number of eggs is given once all follicles have been emptied and all test tubes have been checked. Your doctor or embryologist will inform you how many eggs have been collected once you’ve woken up after your procedure and will confirm the treatment plan with you. You will also be informed of when to expect updates from the laboratory and when an embryo transfer may take place. It is recommended to take the day off from work and give yourself some recovery time. Your nurse should let you know what medication to be taking for pain relief if you need and explain when to take your progesterone, which you might be prescribed to prepare the lining in your uterus for an embryo transfer.

Fertilisation

A fresh sperm sample should be produced at the clinic during the egg collection or a frozen sperm sample could be thawed and used for treatment. The eggs are fertilised with the sperm sample

either with IVF, where sperm are allowed to swim and attempt to fertilise the eggs, or with intracytoplasmic injection (ICSI) where sperm are injected individually into any mature eggs.

Embryo culture

The fertilised eggs, called embryos, are cultured in heated incubators in the laboratory and their development is monitored by embryologists. Embryologists will be in touch with you to inform you of how your embryos are developing. This may include the stage of development, the quality of the embryos and the grades. The number of developing embryos and quality will help determine a suitable day for embryo transfer. This could take place on day 2 of development (2 days after your egg collection), day 3 (3 days after your egg collection) or day 5 (5 days after your egg collection). When your embryos reach day 5, they may be referred to as blastocysts. 

Embryo transfer 

Most clinics have an embryo transfer policy in place, which means they have their own recommendations on how many embryos are suitable to transfer. The majority of embryo transfers are performed with a single embryo, adhering to the Human Fertility and Embryology Authority (HFEA) guidance and recommendation for elective single embryo transfers7. In some cases a double embryo transfer may be recommended, but this will be discussed with your doctor prior to any transfer. Your fertility clinic will schedule you in for your embryo transfer and give you any relevant information you need to know to prepare for the procedure. This will most commonly involve you drinking extra fluids on the day, in order to have a full bladder. Having a full bladder helps the doctor gain easier access to your uterus. Once you’re in position, the embryologist will load your embryo into a thin, soft catheter in the laboratory and pass it to the doctor who will place it through your cervix. The doctor may sometimes visualise the position with the help of an abdominal ultrasound and the embryo gets inserted into your uterus. The catheter is passed back to the embryologist who will verify that the catheter is empty. After the transfer procedure is completed, you will be instructed when to take a pregnancy test. Some clinics will recommend taking a urine pregnancy test at home, and others may ask you to come into the clinic and have a blood test taken.

Embryo freezing

When an embryo transfer has taken place, in some cases there will be surplus good quality embryos that could be suitable for freezing. Your embryologist or doctor should discuss the quality of the embryos and explain any additional costs you may incur for the freezing and storage of the embryos. 

Additional fertilisation method

IVF was the standard fertilisation method for a number of years, but in 1992 a new treatment called ICSI was introduced in clinical practice to help overcome male factor infertility issues8. With ICSI, only a small number of sperm are required. Embryologists use specialist equipment to inject sperm individually into each egg under a microscope with high magnification9. The indications for ICSI treatment include low sperm count (how many there are), low sperm motility (how they move), low sperm morphology (how they look) and previous failed fertilisation with IVF10.

Are there any risks of IVF? 

Risks with IVF procedures include side effects to the hormone stimulation medication, like headaches, nausea and hot flushes, and ovarian hyperstimulation syndrome (OHSS).11 OHSS, while rare, is a serious complication in IVF. It can develop when too many follicles grow during the hormone stimulation and can cause bloating, swelling and fluid retention in nearby organs if not treated12.  

Other risks include:

  • Not responding to the hormone stimulation medication which may lead to a cancelled cycle
  • No eggs collected during your egg collection procedure
  • No eggs fertilised after IVF or ICSI
  • No embryos available for transfer

While the above risks are small, it’s important to know that they exist and the doctor at your clinic should explain what the chances may be for you during your treatment. 

How effective is IVF?

The chances of success of IVF largely depends on the specific circumstance you are in when you receive treatment. The age of the woman having treatment, any known cause of infertility, previous pregnancy history and certain lifestyle factors can all have an impact on how likely the treatment is to be effective 13. As many factors are involved, it’s best to speak to your doctor about your individual chances of success before starting any treatment procedure. The most recent data from the HFEA shows that the percentage of live births following IVF treatment was1:

  • 32% for women under 35
  • 25% for women aged 35 to 37
  • 19% for women aged 38 to 39
  • 11% for women aged 40 to 42
  • 5% for women aged 43 to 44
  • 4% for women aged over 44

How can I access IVF? 

If you fulfill the eligibility criteria set out by your Clinical Commissioning Group (CCG) you may be able to access IVF one or more procedures through the NHS. Your GP should discuss whether or not IVF is a funded treatment in your area and if you fulfill the criteria. If you fulfill the eligibility criteria you would be referred to the NHS IVF clinic in your area. 

IVF is also widely available at private fertility clinics. You do not need a referral to attend a private clinic, you can schedule an initial consultation and discuss treatment options with a fertility specialist there. Prices can vary so be sure to get a cost estimate before proceeding with any treatment.

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