IVF – or In Vitro Fertilisation stands for fertilisation taking place outside of a woman’s body, under controlled conditions e.g 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.
Why Just Women?
Infertility is a more common issue than we give sufficient credit for. It affects both men and women. For many couples, IVF is the only way possible they will be able to conceive their baby.
Most of us assume we will be able to conceive naturally and have children when we plan to and when we want them. But it is not always as straightforward as this.
When Should We See a Doctor?
The general recommendation is that if a couple has been trying to conceive for two years or 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:
- Stimulating the ovary to produce more eggs by the woman taking fertility drugs;
- Harvesting of the eggs from the ovarian follicles;
- Fertilisation of the eggs in a laboratory;
- Transferring the fertilised egg, the “embryo” or, the egg and sperm into the uterus;
- Hormonal treatment to prepare the uterus to receive the fertilised eggs.
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 estrogen. 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, 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.
When Will I Know If I’m Pregnant?
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.