In vitro fertilisation (IVF) – BabyCentre

IVF is the process by which eggs are removed from your ovaries and mixed with sperm in a laboratory culture dish. Fertilisation takes place in this dish, "in vitro", which means "in glass".

Thousands of IVF babies have been born since the first in 1978. In 2009, nearly two per cent of all the babies born in the UK were conceived as a result of IVF treatment (HFEA 2011a).

The National Institute of Clinical Excellence (NICE) recommends that:

Fertility drugs

You will probably need to take fertility drugs to stimulate your ovaries to develop mature eggs ready for fertilisation. During your normal menstrual cycle you release one egg per month. Your odds of getting pregnant are better with more eggs and using fertility drugs increases the number of mature eggs that are released. It's recommended that IVF be offered with fertility drugs to stimulate your ovaries as you have a better chance of pregnancy as a result (NCCWCH 2013: 329).

This is called down-regulation and in the UK usually involves drugs called gonadotrophin-releasing hormone (GnRH) analogues (pituitary agonists) to suppress or stop your cycle. You take these daily for about two weeks by tablet or injection.

Other shorter methods of taking control are available. Some involve the use of GnRH antagonists. These drugs can be taken over a few days, usually after pre-treatment with the contraception pill and at the start of ovulation stimulation. This method is not common in the UK but is suitable for women who are at higher risk of severe side effects of fertility drugs (NCCWCH 2013:292).

If you have endometriosis you may take the GnRH agonist Cetrotide for several months to help improve your egg quality and chances of success (Sallam et al 2006).

Hormone injections

You will then have daily hormone injections for about 12 days (NHS Choices 2011). These stimulate your ovaries to release a greater number of mature eggs than usual (ovulation induction). The hormones used are gonadotrophins follicle stimulating hormone (FSH) and luteinising hormone (LH).

Women respond to these fertility drugs in different ways, and they may have strong side-effects. Your doctor will closely monitor you to make sure that you are cared for if this happens.

Ultrasound scans and possibly blood hormone tests will be offered to monitor how many and how well your eggs are responding (NCCWCH 2013:329). This is for safety and to check when your eggs are mature.

Egg retrieval and sperm collection

Ultrasound is used to detect when your eggs are ready to be retrieved.

While your eggs are being collected, your partner will need to provide a fresh sample of semen. If donated sperm or frozen sperm are being used, the sample is taken from the freezer. The sperm is washed and the best-quality sperm extracted ready to fertilise the eggs. The sperm is then combined with the eggs in a dish and left to culture in an incubator.

Fertilisation and embryo transfer

Within one day of combining the eggs and sperm, the dish is checked to see if any eggs have been fertilised. If they have, they'll be kept for between two days and five days before being transferred back into your uterus.

Any fertilised eggs will each have become a ball of cells called an embryo. They may also be referred to by your specialist as blastocysts, if the embryos are being transferred at the later blastocyst stage, at about day five. The healthiest embryos are chosen to be inserted into your uterus.

Some clinics offer a pre-implantation test called comprehensive chromosome screening (CCS). This screens embryos before they are transferred at the blastocyst stage. Only the embryos that are predicted to have a full set of chromosomes are selected.

CCS may boost your chances of getting pregnant and may also reduce your risk of miscarriage when a single embryo is transferred (Forman et al 2012, Yang et al 2012). This is especially the case if you are an older mum-to-be, using your own eggs.

By now you will have been helping your uterus (womb) to prepare for the embryo by taking progesterone, which helps thicken its lining. You receive this by injection, pessary or gel. If your uterus lining (endometrium) is too thin, the embryos are unlikely to implant (NCCWCH 2013:365). If this is the case, the IVF cycle will unfortunately be abandoned.

Usually, one or two embryos are transferred with a thin catheter (tube) through your cervix into your uterus. Your fertility specialist may use ultrasound to guide him.

To avoid the risk of a high order multiple pregnancy, no more than three embryos can be legally transferred. The number of embryos that are transferred will depend on your age and your chances of success. This in turn depends on your particular fertility problem.

NICE recommends a maximum of two embryos transferred to your uterus whatever your age (NCCWCH 2013:365). If you are 39 years old or under and a suitable candidate, you may be recommended for elective Single Embryo Transfer (eSET) in your first and second cycles. If you have one or more top quality embryos, eSET can increase your chance of having a healthy single baby at term, and improve your and your baby's health (HFEA 2011c, NCCWCH 2013:365).

If you are 40 years or over NICE supports the transfer of two embryos per cycle, because you have a smaller chance of conceiving with your own eggs (NCCWCH 2013:365).

If the eggs are donated, again only one or two can be transferred depending on the age of the donor and the quality of the embryos.

Repeated cycles

If there are any extra embryos, these may be frozen for future use. This is in case the first cycle doesn't succeed, or you want another baby after your successful treatment.

IVF normally involves transferring embryos at about two to three days after fertilisation. Another option is to wait until about five days after fertilisation when the ball of cells has developed into a blastocyst. Only the healthiest embryos will reach the blastocyst stage in vitro. You may have a better chance of having a healthy pregnancy after blastocyst transfer (Blake et al 2007).

Most clinics offer blastocyst transfer to all patients depending on quality and number of embryos available. However some clinics offer blastocyst transfer only if:

Once your pregnancy has been confirmed following IVF, you should have an early ultrasound scan at about six weeks. This is to check that the embryo has implanted in your uterus.

Based on figures from 2010, the percentage of cycles for women using their own fresh eggs which result in a live birth are:

You can improve your chances of success by:

IVF can offer you a chance of having a baby if you are unable to conceive naturally, for example if you have blocked, damaged or missing fallopian tubes.

And you can talk to other women going through IVF treatment in our BabyCentre community.

Last reviewed:May 2013

Basatemur E, Sutcliffe A. 2008. Follow-up of children born after ART. Placenta Oct 29 (Suppl B): 135-40

Glujovsky D, Blake D, Farquhar C, et al. 2012. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database of Systematic Reviews (7): CD002118 onlinelibrary.wiley.com [pdf file, accessed April 2013]

Forman EJ, Tao C, Ferry KM, et al. 2012. Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates. Hum Reprod 27(4): 12171222

Fortunato A, Tosti E. 2011. The impact of in vitro fertilization on health of the children: an update. Eur J Obstet Gynecol Reprod Biol 154(2): 125-9

HFEA. 2009. Risks of fertility treatment. Human Fertilisation and Embyrology Authority. http://www.hfea.gov.uk [Accessed January 2012]

HFEA. 2012. Fertility treatment in 2011: trends and figures. Human Fertilisation and Embyrology Authority. http://www.hfea.gov.uk [pdf file, accessed April 2013]

HFEA. 2011b. IVF: what is in vitro fertilisation (IVF) and how does it work? Human Fertilisation and Embyrology Authority. http://www.hfea.gov.uk [Accessed January 2012]

HFEA. 2011c. Improving outcomes for fertility patients: multiple births. A statistical report. Human Fertilisation and Embyrology Authority. http://www.hfea.gov.uk [pdf file, accessed January 2012]

NCCWCH. 2013. Fertility: assessment and treatment for people with fertility problems. National Collaborating Centre for Women's and Children's Health, NICE Clinical Guideline. London: RCOG Press. guidance.nice.org.uk [pdf file, accessed April 2013]

NHS Choices. 2011. IVF. NHS Choices Health A-Z. http://www.nhs.uk [Accessed January 2012]

Sala P, Ferrero S, Buffi D, et al. 2011. Congenital defects in assisted reproductive technology pregnancies. Minerva Ginecol 63(3): 227-35

Sallam HN, Garcia-Velasco JA, Dias S, et al. 2006. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database of Systematic Reviews (1): CD004635. http://www.onlinelibrary.wiley.com [pdf file, accessed January 2012]

Wen J, Jiang J, Ding C, et al. 2012. Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: a meta-analysis. Fertil Steril 97(6):1331-7.

Yang Z, Liu J, Collins GS, et al. 2012. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Molecular Cytogenetics 5:24

Read more from the original source:
In vitro fertilisation (IVF) - BabyCentre