In vitro fertilisation (IVF)

What is IVF?

In vitro fertilisation (IVF) literally means ‘fertilisation in glass’ giving us the familiar term ‘test tube baby’.

During the IVF process, eggs are removed from the ovaries and fertilised with sperm in the laboratory. The fertilised egg (embryo) is later placed in the woman’s womb.

Is IVF for me?

IVF may be recommended as your best treatment option if:

• you have been diagnosed with unexplained infertility
• your fallopian tubes are blocked
• you have been unsuccessful with other techniques like using fertility drugs or intrauterine insemination (IUI)
• there is a minor degree of male subfertility – more severe problems are treated with intra-cytoplasmic sperm injection (ICSI).

What does IVF involve?  IVF involves taking daily fertility drugs to stimulate the ovaries to produce a high number of oocytes (eggs). The development of follicles, which contain the eggs, is tracked by regular transvaginal ultrasound scans and sometimes blood tests. When at least three follicles are mature (greater than 17mm in diameter) a hormone injection (hCG) is given to ripen the eggs. Eggs are collected vaginally under ultrasound guidance 34-36 hours later. The egg collection procedure takes about 20 minutes. The ovarian stimulation protocol is individualised to maximise the chances of success while reducing the risks, complications and possibly the costs of treatment.

What happens next? Once collected the eggs are placed in a laboratory dish, mixed with (IVF) or injecdted by the sperm (ICSI), and left overnight to fertilise. Following fertilisation, one or two embryos are transferred into the uterus through the cervix using a fine and thin tube called catheter. The healthy embryos can be transferred two to five days after fertilisation. Embryo transfer may be done under ultrasound guidance. Any good quality remaining embryos may be frozen for future use.

Risks and complications of IVF

Failure of treatment — this can result from cycle cancellation because of no response or over-response to drugs, failure to collect eggs, failure to fertilize eggs, failure of the embryos to develop normally and failure of implantation. Failure of treatment can result in emotional strain, psychological stress and depression, and some couples may require psychological counselling
Risks associated with egg collection — discomfort, slight bleeding and infection

Multiple pregnancy – mainly after the transfer of two or more embryos. This is the single greatest complication of IVF treatment. Although the prospect of twin or triplets may seem attractive to some couples, multiple pregnancies are associated with increased risks of maternal and fetal complications throughout pregnancy. In addition, multiple pregnancies place enormous pressure on the parents including financial difficulties and emotional distress

Ovarian hyperstimulation syndrome (OHSS) — is potentially serious condition, which result from over-response of the ovaries to fertility drugs. Several follicles develop in each of the ovaries and in severe cases, fluid collects in the abdomen and even around the lung. Severe OHSS requiring hospital admissions occur in 1-2% of IVF cycles. IVF treatment may be abandoned in that cycle. Occasionally, the cycle can be allowed to continue until egg collection, when all fertilised eggs are frozen

Ectopic pregnancy — when an embryo develops and implants outside the womb, generally into the fallopian tube. Women undergoing IVF treatment, because of problems with their tubes, have a greater risk of having an ectopic pregnancy.

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