In vitro fertilisation (IVF) is the best treatment for certain kinds of fertility problems. However, it can be demanding and doesn't always result in pregnancy. If you’re interested in fertility treatments, or if you’re about to start a course of IVF, find out as much as you can about the treatment. Knowing what to expect can make IVF easier to manage.
* What is IVF?
When a couple conceives naturally, sperm from the man and the egg from the woman meet in the woman’s fallopian tubes. These are the tubes that join the ovaries to the uterus (womb). One sperm penetrates the egg and fertilises it.
In IVF, this process of fertilisation happens outside the woman’s body. A woman’s eggs are surgically removed and fertilised in a laboratory using sperm that has been given as a sperm sample.
Next, the fertilised egg, called an embryo, is surgically implanted into the woman's womb. Typically, one cycle of IVF takes between four and seven weeks.
* How is IVF done?
IVF follows a series of steps, starting with fertility drugs to help you produce as many eggs as possible.
1. 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.
This is called down-regulation and usually involves drugs to suppress or stop your cycle. You take these daily for about two weeks by tablet or injection.
2. Hormone injections
You will then have hormone injections. These stimulate your ovaries to release a greater number of mature eggs than usual (ovulation induction).
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. This is for safety and to check when your eggs are mature.
3. Egg retrieval and sperm collection
Ultrasound is used to detect when your eggs are ready to be retrieved. Your doctor will then remove the eggs from your ovaries. Your doctor will use a fine, hollow needle attached to an ultrasound scan probe. The probe helps to locate the follicles that contain the eggs. You may feel mild discomfort during the procedure, but if you feel pain later on your specialist will prescribe painkillers.
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.
4. 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. This is especially the case if you are an older mum-to-be, using your own eggs.
5. 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.
Most clinics offer blastocyst transfer to all patients depending on quality and number of embryos available. However some clinics offer blastocyst transfer only if:
• you have had previous normal IVF with healthy embryos but they have not implanted
• you are under 40
• you have opted for eSET
You can be up and about quite soon after embryo transfer, as resting for more than 20 minutes immediately afterwards makes no difference to the outcome. In a successful cycle, one or more embryos will implant in your uterine wall and will continue to grow. You can take a pregnancy test in about two weeks. 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.
* Benefit of IVF
IVF is likely to be recommended for the following fertility problems:
• If you have blocked or damaged fallopian tubes or any other problem where IVF has been identified as the only treatment likely to help you get pregnancy.
• If your partner has a minor problem with his sperm. Major problems are better treated using ICSI.
• If you have tried fertility drugs or another fertility treatment such as IUI, without success.
• If you have been trying to conceive for at least two years and a cause hasn't been found to explain why you have not become pregnant.
There is health risks involved in IVF treatment. These include:
- Multiple pregnancies
There is an increased chance of multiple pregnancies with IVF. Multiple pregnancies has health risks for both the mother and children as twins or triplets are more likely to be born prematurely and to be underweight at birth.
- Ovarian hyper stimulation syndrome (OHSS)
Drugs used to stimulate the ovaries during IVF can lead to ovarian hyper stimulation syndrome (OHSS). In OHSS, the ovaries enlarge and become painful, causing abdominal discomfort. More severe cases can lead to shortness of breath, fluid retention in the abdominal cavity and formation of blood clots. In these cases, you may need a stay in hospital.
When eggs are removed from the woman, a fine needle is passed through the vagina and into the ovaries. There is a risk of introducing infection into the body, though antibiotics and surgical hygiene ensure that this rarely occurs.
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