In vitro fertilisation (IVF)

What is IVF?

Commonly known as IVF, in vitro fertilisation is one of several fertility treatments designed to help people with fertility issues to conceive.

In vitro means ‘in glass’, which is why IVF is also sometimes called a ‘test tube baby’ procedure.

This treatment involves a series of steps, starting with the retrieval of mature eggs from your ovaries. The eggs are then fertilised with sperm in a laboratory before an embryo is transferred to your uterus (womb). In total, an IVF cycle takes about three weeks.

IVF is considered one of the most effective fertility treatments and can be done using your and your partner’s egg and sperm or using an egg or sperm that has been provided by a donor. The donor can be known or anonymous.

Who is eligible for IVF?

IVF can be recommended for:

• women under the age of 43 who have been trying to get pregnant for two years but can’t
• women who have damaged or blocked fallopian tubes
• women with endometriosis (when the tissue that usually lines the inside of your uterus grows outside of it)
• women with ovulation disorders who haven’t responded well to other treatments
• men who have a low sperm count
• men with sperm that has poor motility
• men with sperm that are abnormally shaped
• people who aren’t able to conceive and wish to use surrogacy

If you are unable to have a child, another woman known as a gestational carrier (a woman with no biological link to the baby) or surrogate mother (a woman who shares a biological link to the baby) can be used to have the baby with IVF treatment.

If you are struggling to get pregnant and are interested in fertility treatment, the first step is to talk to your GP. They will be able to advise you on the best way to increase your chances of having a baby and refer you to a fertility specialist if necessary.

When should you seek IVF treatment?

IVF treatment is used in cases of:

• female infertility, including:
  • tubal damage
  • bilateral salpingectomy (both tubes were surgically removed)
  • endometriosis
• male infertility
• idiopathic infertility
• immunological infertility
• failure of IUI treatment

Stages in the IVF treatment process

Step 1: Fertility medication

To stimulate your ovaries to produce multiple eggs at a time, you will take daily hormone injections for 10 to 12 days. During this stage, you will also be seen regularly by your consultant or medical team for ultrasound scans and possible blood tests to monitor how quickly your ovaries have adapted to the hormone injections.

Step 2: Egg collection

Firstly, your doctor will decide which day will be most suitable for your egg collection. This will be determined by your ultrasound results, your medical history and your response to the fertility medicines.

You will have an injection 36 hours before your planned egg collection. This hormonal medicine is called a ‘trigger injection’ and encourages the eggs to mature before collection.

On the day of the procedure, the eggs will be collected through a small needle which is inserted into your ovaries via your vagina. Attached to the needle is a small ultrasound probe. The needle is passed through the vaginal wall into the ovary. The fluid containing the eggs within the ovaries will be extracted. This process takes approximately 10 minutes.

During this time, we will provide you with a sedative which will be administered through a small plastic tube. This is to ensure that you do not feel any pain and you feel relaxed throughout the procedure. We will also provide oxygen to help with your breathing.

Step 3: Sperm collection

On the day of your egg collection, a semen sample will be collected from your partner. This is carried out in a private room at our assisted conception unit at Guy’s Hospital. The sperm sample will be assessed in a laboratory to ensure the sperm cells are healthy. If donated or frozen sperm is being used, the sample will be prepared after the egg collection.

Step 4: Egg fertilisation

Once retrieved, your eggs can be mixed with sperm in a laboratory so they can develop into an embryo. This process will take 3-5 days. Each dish, where the sperm and eggs are combined, is electronically tagged and labelled.

Step 5: Embryo transfer

One or two of the best-fertilised eggs will be placed into your uterus – usually on the second, third or fifth day after egg collection, when the fertilised egg has divided and contains two to eight cells. A day-five transfer is known as blastocyst transfer.

This is done using a fine catheter (a thin tube) and ultrasound for guidance. Usually, just one egg will be transferred, but in some cases, two can be transferred – this would typically be if you are over the age of 40, to increase your chances of having a baby. Embryo transfer doesn’t require sedation therefore you should not feel any pain. This process takes around 15 to 20 minutes.

Step 6: Results – pregnancy test

You will need to take a pregnancy test 16 days after the date of your egg collection.  We will provide you with a pregnancy test kit and advise you on how to use it.

It is important to stay patient and wait until the given date to take a pregnancy test. This is because the hormones in the trigger injection can stay in your body for over a week and interfere with the results.

The success rate of IVF

The chances of success from IVF treatment can depend on the age of the woman having treatment.

If you are a younger woman, you have a better chance of having a successful pregnancy. For this reason, IVF may not be advised for women over the age of 42 as there is a low chance of getting pregnant.

For women who use their own eggs and the sperm of their partner, the expected percentage of a successful birth is:

• women under 35 – 38%
• women aged 35 to 37 – 25%
• women aged 38 to 39 – 22%
• women aged 40 to 42 – 19%
• women aged 43 to 44 – 3-5%
• women aged over 44 – <1%

Lifestyle choices such as avoiding alcohol and smoking can improve your chances of having successful IVF treatment. Weight is also a factor, as having a high body mass index can harm fertility.

If IVF doesn’t work for you the first time, you shouldn’t get discouraged. Usually, you can try the treatment multiple times.

IVF success factors that influence outcome

A variety of factors can influence the outcome of IVF treatment. These include:

• quantity of the eggs or embryo (fertilised egg)
• quality of the eggs or embryo
• quantity of the sperm
• quality of the sperm
• how the ovary stimulation stage is carried out
• how receptive the endometrium (tissue that lines the uterus) is during implantation
• how easy it is to transfer the embryo into your uterus

IVF risks

There are various risks of IVF which should be understood before choosing to have the treatment. These include:

• having multiple births, especially if more than one fertilised egg has been implanted in your uterus. Multiple fetuses mean there is a higher risk of premature delivery and low birth weight
• complications arising from egg collection, such as pain, bleeding or infection which are very rare
• ovarian hyperstimulation syndrome, an exaggerated response to the hormone injections taken for ovary stimulation as part of IVF treatment
• ectopic pregnancy, when the embryo is implanted outside the uterus and cannot survive