What Is In Vitro Fertilisation (IVF)?
Fertility Treatments Explained
IVF is a first line treatment for some conditions including moderate to severe damage to the fallopian tubes and male factor infertility. When the tubes are damaged the eggs cannot travel through them to the site of fertilization. IVF avoids the tubes because the eggs are retrieved directly from the follicles and combined with the sperm. IVF is also used in cases where traditional therapy has been unsuccessful
IVF can be considered a 3 stage fertility treatment.
The 3 Main Stages of IVF:
IVF May Be A Fertility Treatment Option If There Are:
- Issues with the Fallopian tubes
- Endometriosis and pelvic adhesions
- Issues with ovulation
- Sperm quality is low
- Unexplained infertility reasons
As well as being a successful fertility treatment, in-vitro fertilisation also aids your clinical team to gather new information regarding the background of your infertility case.
IVF was successfully pioneered by Sir Robert Geoffrey Edwards, CBE, FRS. In 2010 he won the Nobel Prize in Physiology or Medicine for this achievement. IVF was developed initially as a treatment for fallopian tubes issues. On 25th July 1978 the first baby was born as a result of IVF was born, in Manchester, UK; her name is Louise Joy Brown.
In Vitro means in glass, which originates from Latin and was used as earlier experiments which entailed cultivating tissues in an environment outside the living organism, used glass vessels such as test tubes, petri dishes and beakers. Today in-vitro fertilisation is normally carried out in the shallow containers-petri dishes.
IVF | The Process Of In-Vitro Fertilisation
The aim of the stimulation stage of IVF is to stimulate the ovaries to produce a certain number of eggs. Some clinics will adhere to the best practice of stimulation which results in somewhere in the range of eight to fifteen eggs, over one or two cycles. (This practice varies and the average figures can be from ten to thirty eggs)
Hormonal treatment is administered to start the IVF cycle with the aim being to mature several follicles simultaneously in the ovaries. The maturing of the follicles will continue for about ten days, with hormonal injections. Women will respond differently to the treatment and this should be monitored by ultrasound scans, to see the response to the injections.
Although some IVF patients can be keen to have more eggs, as understandably they feel that they want to get the best amount of eggs for their buck, if you like, reproductive medical experts will advise strongly against this.
If too large a number of eggs are produced, this will result in there being too many eggs which havechromosomal abnormalities.
- Egg Retrieval
An injection of hCG (human chorionic gonadotropin) is given, which is the “trigger shot”, to induce the final maturation of the eggs.
Once the hCG has been administered ovulation would occur between 38 and 40 hours afterwards. However egg retrieval will take place just before the follicles are due to rupture, so it will be timed for about 34 to 36 hours after the injection.
Egg retrieval is performed using a technique called transvaginal oocyte retrieval, while the patient is under sedation. The procedure usually takes about twenty minutes. A needle is guided by ultrasound, which pierces the vaginal wall through to the ovaries, follicles are aspirated and the fluid is analysed by the IVF lab to identify the ova.
A sufficient amount of sperm is then added to the retrieved eggs to be fertilised on culture dishes, in a culture media. This process takes about 18 hours and next the fertilised egg will spend about 48 hours in a special growth medium.
Depending on the clinic protocol and the law of the country, a number of the best embryos will be selected for transfer. Best practice is to select one or two of the best embryos for transfer. The remaining good quality embryos will be frozen for later use, if required.
- Embryo Transfer
Laboratories have various methods to judge the quality of embryos and as technology develops more advanced embryo profiling methods will continue to become available.
Main criteria considered by an embryologist are the amount of cells the embryo has, how even the growth is and the degree of fragmentation.
In the UK and some other countries, the number of embryos which can be legally transferred will be higher for women over forty years of age. In the UK women over forty may have 3 embryos transferred, whereas women under 40 may have 2 embryos transferred. In the USA an individual fertility diagnosis may mean that a younger woman could have more embryos transferred.
The embryo transfer procedure is usually a pain free procedure. Similar to when you are having a cervical smear test done, a speculum is used to keep your vagina wall apart. The embryos are introduced into the uterine cavity using a soft thin plastic catheter, most often using ultrasound guidance. Some clinics may perform this guided embryo transfer before the actual cycle, like a test run. The reason for this is to familiarise the clinicians with the patient’s case and also it can help to make the procedure easier and more comfortable for patients.
IVF | In-Vitro Fertilisation Success v Risks
In the IVF cycle has been successful one or more embryos will implant in your uterine wall and should continue to grow.
Due to continued advancing technology the IVF success rates are significantly improved today as compared to a few years ago.
These stats below both refer to women using their own eggs and resulting in live births:
*The USA figure of 22.3% is for ages 38 to 40.
**The USA figure of 12.6% is for ages 41 to 42.
Remember that these success rates are only indicative, as they are nationwide and will vary from clinic to clinic.
Additionally these are hard facts and do not investigate other issues and implications such as the physical and emotional effects of treatment, both during cycles as well as any potential long term implications.
Reaction to Hormonal Treatment
The hormonal dosage will be decided according to factors such as age and body weight, how the ovaries appear during an ultrasound scan and also depending on previous treatments which may have been carried out.
In some cases patients will not react as expected and the dosages will need to be increased. In a small amount of cases, patients can have a very strong reaction to the treatment and in these cases ovaries may develop between thirty to forty follicles. This is known as ovarian hyperstimulation syndrome (OHSS) and the patient can experience pain and nausea, due to an accumulation of fluid in the abdomen as the ovaries have become swollen and large.
Ovarian hyperstimulation syndrome (OHSS) can be treated with enough fluid intake and rest, but in some of the more extreme cases the patients may require to be hospitalised.
Increased Risk of Multiple Pregnancies
Multiple pregnancies (twins, triplets etc.) account for 1% of naturally conceived pregnancies.
However IVF raises this risk percentage to 20-30%. Multiple pregnancies do increase risks such as complications at birth, low birth weight and a higher risk of premature birth.