In vitro fertilization (IVF) is a procedure in which your egg is fertilized by sperm outside of your body—in the lab.
After a few days to allow the resulting embryos to grow, the best quality embryo is transferred back into your uterus.
IVF is the gold standard for couples who have problems conceiving naturally.
Who needs IVF?
You may need to seek help for infertility issues if you have been trying to conceive naturally for over a year, with no success. If you are over the age of 35 years, you should approach the doctor if you haven’t been able to conceive naturally in six months.
IVF is useful for couples with either female or male infertility factors.
However, in many cases it is not considered as a first line treatment for infertility. Other treatments may be offered to you that are less invasive and are usually less expensive option.
To get an honest evaluation of your infertility and seek the best possible treatment options, get in touch via the form on the right.
Am I a candidate for IVF?
IVF can help you if you have:
- Age-related infertility
- Anovulation – although there are less invasive fertility treatments that you can try first to stimulate ovulation
- Blocked fallopian tubes
- Poor egg quality – in this situation an egg donor may be considered
- Male infertility (problems with either sperm count or motility) – in this situation ICSI may be the best treatment option
- Unexplained infertility
To be a suitable candidate for IVF, you should be healthy enough to support a pregnancy once it is established.
What’s the recommended age for IVF?
The age of a patient can influence how successful IVF treatment may be. A study, published in Fertility and Sterility in 2003, shows that increasing maternal age correlates with a reduced implantation and pregnancy success rate.
IVF over the age of 40 has lower chances of success as both egg quantity and egg quality have usually declined by then. For this reason, fertility clinics have an age limit for performing IVF. This age limit varies depending on the clinic but it is usually around 50 years.
If you are in your 40s and have been found to have poor quality eggs, you may be offered IVF with donor eggs.
How is IVF performed?
If you are referred for IVF treatment, you will be prescribed either an Agonist treatment cycle or an Antagonist treatment cycle, which is quicker. An agonist cycle slowly down-regulates your hormones prior to starting the treatment. Whereas, with an antagonist cycle you will be injected with drugs that stop the release of certain hormones after only a few days.
Both treatment options have similar success rates. The Antagonist treatment cycle is usually offered in most cases.
A cycle of IVF is performed in distinct, key phases, as described below:
At the start of your period
You will need to make an appointment to see your fertility doctor on day one or two of your period. Your doctor will be able to prescribe medications to stimulate a period if you do not have any or if they are irregular.
Suppression of your hormones
Agonist cycle: At around day 21 of your cycle, your doctor will take a sample of blood from you and start you on a course of drugs to suppress your hormones.
These drugs will be GnRH analogues, which suppress FSH (follicle stimulating hormone) and LH (luteinising hormone) production and prevent premature ovulation. They will be prescribed to you for 12-28 days in the form of either an injection or a nasal spray. You will probably be able to administer your own injections at home.
This treatment will temporarily make your ovaries dormant, so that they do not release eggs. This is necessary to prepare your body for the stimulation of ovulation.
Be aware: The timings of these treatments may be changed by your doctor, in order to optimise your treatment based on how your body responds.
Side Effects of GnRH analogues:
Some women report that they experience headaches, hot flushes, night sweats and mood swings when taking these drugs.
For the antagonist cycle, you will start from the next stage of treatment.
A course of FSH injections will be prescribed to you over 5-12 days to stimulate the ovaries to make multiple follicles and eggs. You will also continue with the GnRH analogue during this time, unless otherwise advised.
Antagonist cycle: If the GnRH analogue drugs are not needed, you may be prescribed an LH antagonist, after stimulation has started, to prevent ovulation.
The doctor will perform an ultrasound after 5 days of stimulation, to check for follicular number and growth and the lining of your uterus.
A mature follicle, in which an egg will grow, measures 18-30mm. It is normal to see 10-12 follicles, although this can vary. At least 3-4 mature follicles are needed for egg collection.
The uterus lining needs to be at least 7mm for a healthy transfer.
The doctor may also take a blood sample to carry out some checks on your hormone levels, including progesterone and oestrogen levels.
Side effects of FSH drugs:
Some women report bloating and discomfort as the eggs mature.
Once the follicles have reached the appropriate size, the doctor will prescribe you a HCG (human chorionic gonadotrophin) injection. This causes the eggs to mature and loosen their attachment to the follicle, to enable collection.
All other drugs are stopped at this point.
You will normally then wait 34-38 hours before egg retrieval.
You will be sedated for this step. A small, hollow needle will be passed through the vagina and into the ovaries where the eggs will be collected, using an ultrasound to locate them.
As many eggs as possible will be collected and stored in an incubator until fertilisation. This procedure normally takes around 30 minutes.
Following this procedure, you may experience some mild period-like pains and a small amount of bleeding from the vagina.
Following this you will be given some medication to help optimise the lining of your womb, ready for transfer of the embryo.
Also, at this point, the sperm will be collected and prepared.
The eggs and sperm will be combined in a dish and left for 16-20 hours under controlled conditions to enable fertilisation. The eggs will be checked the following day to determine if fertilisation has occurred.
The ICSI protocol may be used here in cases of poor sperm quantity or quality to optimise results.
Successfully fertilised eggs are assessed 2-3 days later for growth and quality. Doctors can transfer the zygotes at this stage or wait until day 5, when they reach blastocyst stage. Transferring blastocyst is associated with higher chances of success.
The best quality embryos will be picked by the doctor for transfer to the uterus.
This procedure does not require sedation. It is similar to a smear test and may cause slight discomfort during the procedure.
After this, the embryos are left to implant into the uterus wall, which can take anywhere between 1-10 days.
You may be advised to follow some simple guidelines to improve the chance of successful implantation, for example:
- Avoid long baths
- No sex for 2 weeks
- Limit activity for the day of transfer and take it easy for a few days afterwards
- Take recommended pregnancy vitamin supplements and eat a balanced diet
(Related read: IVF procedure – step by step)
IVF success rates
The success of IVF depends on many different factors, which include:
- Maternal age and quality of eggs
- Uterine lining
- Reproductive health of both partners
- Infertility cause
- Lifestyle factors
IVF success rates for the US, published by the Society for Assisted Reproductive Technology for 2015, were reported to be as below:
- Under 35 years– 48.2%
- 35-37 years– 35.3%
- 38-40 years– 22.4%
- 41-42 years– 10.6%
- >42years – 3.2%
IVF success decreases significantly over the age of 40 years, which is why women over this age may be advised to use donor eggs.
Cost of IVF
IVF is an expensive treatment, with no guarantee of success. The cost of IVF can vary greatly depending on what country and clinic you have it performed at and what type of treatment you require.
You also have to consider that several cycles of IVF may be required for a successful outcome.
Typical price for 1 cycle of IVF in:
- the UK: £12,000 (on NHS)
- the USA: $20,000
- India: $3,500
- Europe: $6,000
- Australia: $8,000
- Thailand: 7,000
- Malaysia: $5,000
These costs include medications, but do not include additional factors, such as, embryo freezing, the use of donor eggs or genetic testing.
IVF risks and side effects
Medication side effects
As discussed above, there are certain side effects that you may experience when taking the fertility medications. These are usually mild, but speak to your doctor if you are concerned about any of these.
Ovarian hyper stimulation syndrome
This is a rare but serious complication of IVF. It occurs when the fertility medications cause too many follicles to be produced in the ovaries. This can occur if you are very sensitive to the medications and will usually develop a week after egg collection.
OHSS is more likely in patients of PCOS, so you have to be more careful if you have polycystic ovaries.
- bloating and discomfort in the abdomen
- nausea and vomiting
- shortness of breath
You may require lower doses of fertility medication if this occurs; please consult your doctor.
With IVF treatment, you may have a slightly increased risk of ectopic pregnancy. This is where the embryo implants somewhere outside of the womb. A simple ultrasound scan is done after your pregnancy is confirmed, to rule this out.
The risk of multiple pregnancies is increased if more than one embryo is transferred to the uterus. This carries additional risks to you and your baby, hence why the number of embryos transferred is carefully considered.
How many embryos should be transferred in IVF?
Whilst transferring more than one embryo can increase the pregnancy rate with IVF, it can also increase the chances of a multiple pregnancy. Multiple pregnancies carry additional risks.
The main goal of IVF treatment is to provide you with a single, healthy baby.
However, each case is different and your doctors will look at your age and health to weigh up the risks and benefits for multiple embryo transfer.
Research has shown that older women may benefit from transferring two embryos instead of one, as the benefits outweigh the risks.
Transferring three or more embryos is usually not recommended.
What happens to leftover embryos after IVF?
There are a number of options available to couples, including:
Storing for future use
If you believe that you will want to expand your family in the future and infertility may still be an issue, you may opt to store your frozen embryos for use in the future.
You may wish to donate your embryos to other couple who are struggling with infertility. This is a very personal choice and it is important to think this through fully first.
Donate embryos to medical research
Embryos can be used not only to better understand and to improve fertility treatments, but also to understand genetic conditions. This could make a vital contribution to medical understanding and treatment.
Dispose of embryos
Again this is a decision that should be well thought through, but should you wish to, your fertility clinic can organise for the appropriate disposal of the leftover embryos.
What if IVF fails?
You may be asking yourself the question, what happens if my IVF fails? This is a possibility that needs to be considered, as IVF success is not guaranteed. There are several options that may be considered if this happens:
Try further cycles of IVF
There could be several reasons for failure of IVF, and if your doctor is able to figure out a certain cause in your case, it may be addressed in subsequent cycles. Preimplantation genetic testing may also be a viable option in future cycles, as it has been proven that PGS improves IVF success.
Some couples feel that they are unable to go through the process of IVF again as it poses risk to the health of the mother. Also, if your IVF failure was due to implantation failure, you may need to hire a surrogate.
Consider donor eggs
Poor egg quality is the main reason for IVF failure in majority of the cases; healthier eggs from a donor may be recommended (especially if you are over 35 years of age)
This may be your choice, if your doctor tells you that your chances of conceiving are very low. You may also consider this if several cycles have failed, as the emotional and financial burden can be overwhelming.
IVF failure is something that will need to be discussed carefully, both with your partner and with your medical team.
IVF involves a large commitment of time, money and emotional upheaval. It is important for you to learn as much as possible about the procedure, before starting it.
Hopefully this information has answered a lot of your questions. However, if you have any further questions at all about the process, make sure that you get these answered. Being well prepared will stand you in good stead for facing the hurdles ahead.
Write to us to plan your affordable IVF with an honest, reliable doctor.