A Guide to IVF
Many people have questions about what In Vitro Fertilisation involves, why it is a recommended treatment and its success rates. If you’re feeling a little bit confused about IVF, don’t worry. This form of assisted reproduction is less daunting to get your head around if you go step by step.
First developed in the 1970s, the basic IVF treatment is largely the same today. It is the process of surgically removing an egg from the woman’s ovaries and fertilising it with sperm in a laboratory. The fertilised egg – also known as an embryo – is placed back into the uterus in order to grow and develop. The transfer of the embryo back into the womb is a simple, painless procedure.
IVF treatment can be different depending on the individual situation. Prior to undergoing IVF, the woman (and the man in the case of a partnership) may need to take blood tests to screen for various illnesses, viruses and diseases. The success rate of IVF depends largely on the age of the woman and the corresponding health of her eggs. Statistics illustrate a significant gap in successful IVF cases between women aged under 30 and women around 45 years old. Generally speaking, the younger the patient, the higher the chances of success.
Upon visiting a fertility clinic, the complete fertility history of the woman will be documented and any required additional examinations carried out. Questions relating to medical and social history may also be posed.
In Vitro Fertilisation is a more invasive treatment for women than it is for men. IVF is carried out through the following process:
Controlling the female hormone cycle
Over a period of roughly two weeks, self- administered drug treatment will control a woman’s natural cycle in order to harness normal hormone production and place the body into a synthetic menstrual cycle. There are a number of hormone therapy regimes which a treating centre will have at its disposal and this should be tailored to the woman’s specific ovarian profile.
Boosting the egg supply
Once the cycle has been manipulated using medication, a natural fertility hormone called Follicle Stimulating Hormone (FSH) will be provided to take daily for 12 days that increases the number of eggs that the woman can use that month.
Vaginal ultrasounds and, in some cases, blood tests will monitor on-going progress during this time. The patient will receive a hormone injection between 34 and 38 hours prior to having eggs collected. This mimics natural ovulation conditions.
While sedated, the woman’s eggs will be collected trans-vaginally with ultrasound guidance. During this process, a hollow needle is fitted to the ultrasound probe so that it may collect the eggs from the follicles on each ovary. As this takes place, a small amount of bleeding from the vagina or some pain may occur, but these are often quite mild.
Preparing for embryo transfer
Following the collection of the eggs, the woman will be given medication to help prepare the lining of her womb for embryo transfer. This medication will come in the form of pessaries (small soluble inserts specifically designed for vaginal use), injection or a gel.
Fertilising the eggs
After being mixed with her partner’s or donor’s sperm, the woman’s eggs will be cultured in the laboratory for 16 to 20 hours, during which time they will be checked for signs of fertilisation. Embryos will be grown in an incubator for up to six days and monitored closely by a specialist with the best embryos chosen for transfer. Any additional embryos of suitable standard may be frozen for future use.
The transferring of embryos is a usually pain-free procedure. First, a small instrument known as a speculum is inserted into the vagina in a process similar to a cervical smear test. Next, a catheter is passed painlessly through the cervix before the embryos are passed down the tube and into the womb.
The amount of embryos that can be transferred will depend on how old the woman is. If under the age of 40, one or two may be used whereas if over that age, a maximum of three may be transferred. This restriction is due to the risks associated with multiple births.
A woman undergoing IVF treatment is around 11 times more likely to have a multiple pregnancy. About one in six IVF pregnancies result in a multiple birth, a significantly higher figure than that of a natural conception (around one in 80), and the health risks associated are of notable concern.
With IVF treatment there is a higher risk of encountering problems such as hypertension (induced high blood pressure), pre-eclampsia (a disorder characterised by high blood pressure and the presence of protein in urine) and gestational diabetes. Furthermore, there is an increased risk of issues such as haemorrhage and anaemia. The Institute of Obstetrics and Gynaecology in Ireland has an in-depth guide to management of multiple pregnancy which may be viewed here.
The possibility of early or late miscarriage is also higher in the circumstances of multiple births. Twins and triplets are more susceptible to health issues than a single baby as multiple babies may be born prematurely and underweight.
Does IVF apply to you?
Your clinic may recommend IVF treatment if the following circumstances apply:
• The woman has been diagnosed with unexplained infertility.
• Previous attempts to address infertility such as specific drugs or intrauterine insemination (IUI) proved unsuccessful.
• The fallopian tubes are blocked.
• The male partner has issues with infertility.
• The woman is using donated eggs or her own frozen eggs.
• The woman is testing embryos in a bid to avoid passing on a genetic issue.
This blog was written in partnership with Mr Declan Keane, founder and Senior Clinical Embryologist at ReproMed.