If you have been trying for a baby for a long time and your doctor feels all other possible options have been explored, you might wish to consider some form of ‘assisted conception’ and even begin to think about IVF treatment.
We hear a lot about IVF here at MFM HQ - but it's not always clear what exactly the term IVF means, what IVF actually is, and how it works exactly.
Here's what you need to know about IVF and how it happens...
What is IVF treatment?
IVF, or In Vitro Fertilisation, is a fertility treatment used to help couples achieve a pregnancy – by taking the tricky part of the baby-making process outside of the body. In Vitro, a Latin term, literally means ‘outside the organism’.
IVF is probably the most high profile treatment for couples having difficulty getting pregnant and it stands for in vitro fertilisation.
Eggs are taken from the woman’s ovaries (or the eggs are taken from a donor) by surgery and then allowed to fertilise in a laboratory with sperm (from the woman's partner or, again, a donor), and then placed directly into the woman’s uterus by surgery. The woman is then made pregnant. The risk of then losing the pregnancy through early miscarriage is usually only the same as that of a couple conceiving naturally.
Perhaps if you're struggling to get pregnant after a long period of trying, or you feel you've exhausted all other infertility treatment options, then IVF might be the right option to help you have a baby.
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Instead of your egg being fertilised by sperm in your body, the egg and sperm are brought together in a petri dish.
Depending on the quality/quantity of your partner's sperm, your egg will either remain in the dish with the sperm, where they will hopefully begin to fertilise (IVF), or you'll have the sperm directly injected into the egg (IVF with ICSI).
Fertilisation then takes place in the lab – before the embryo is 'transferred' into your uterus, where your baby will grow and develop over the next 9 months.
Before you get to that stage, though, there's a lot of prep involved in making sure your body is primed for the transfer, including a series of drug injections that suppress and then boot your menstrual cycle.
Having the fertilisation take place outside of the body gives docs and fertility specialists a chance to pick the healthiest eggs and sperm for fertilisation, monitor the growth of the resultant embryos, select the one(s) with the best chance of survival, and make sure your body's as ready as possible for your pregnancy to stick.
Each IVF cycle is usually a fairly short, but complicated process - we have a full guide to what to expect from every step of having IVF here.
Can I use a donor egg/sperm for IVF?
Yep, you can have IVF treatment using your eggs or donor eggs. Likewise, you can also have IVF using your partner’s sperm, or donor sperm.
Who is IVF best suited to?
IVF is an option that women with unexplained fertility may like to go for. This is when tests on both the man and the woman in the couple have not produced any specific reason why trying for a baby naturally has not resulted in pregnancy.
Other women who may benefit from IVF as opposed to other forms of assisted conception included those who have blocked fallopian tubes (where the eggs are fine but are unable to make there way from the ovaries to be fertilised by the sperm).
Where treatments such as fertility drugs or IUI (Intrauterine insemination) have not been successful.
Is it possible to get IVF treatment on the NHS?
The National Institute for Clinical Excellence (NICE) have advised the Government that all couples where the woman is aged 23 to 39 years, who have an established caused of infertility or who have been trying to conceive without success for three years, should be allowed up to three cycles of IVF treatment on the NHS. However, the government only say that one cycle should be definitely free and that further cycles are a matter for individual health authorities.
Read more: IVF costs and NHS availability
It is possible to ‘go private’ and some clinics now offer good deals for certain patients who are willing to donate eggs. You can find out more about clinics near you and what to consider and expect from IVF treatment at the HFEA’s website, www.hfea.gov.uk
Could different types of IVF work for you?
Conventional methods of IVF, where high doses of drugs force the ovaries to overproduce eggs, can be physically gruelling and mentally draining. Now more clinics are starting to offer lower level and even drug-free alternatives.
Natural cycle IVF
This is where the egg naturally released by your ovary is collected, fertilised, and returned to your womb at the right point in the month for implantation. The theory is that since your body has selected this as the most capable egg, it should be most likely to win the race to conceive.
Geeta Nargund, medical director of Create Health Clinic in London and a pioneer in this field, says, “It isn’t a new phenomenon – the first test tube baby was conceived by this method. But it has fewer side effects, it cheaper and recent advances have improved success rates.”
Mild stimulation IVF
This is a recently developed method where low-dose hormones are given for just five to nine days in a natural cycle, rather than four to five weeks, to mature eggs. the idea is that extra eggs are released but they are healthy, whereas the larger amount of eggs produced by stimulated cycle IVF are not always viable. Most importantly, it reduces the risk of Ovarian Hyperstimulation Syndrome (OHSS) and symptoms such as abdominal pain.
“Natural and Mild IVF are aimed at quality not quantity,” explains Geeta.
What are the alternatives to IVF?
Before you go for IVF treatment, it’s good to look at what the other options are. Your doctor will be able to explain these to you and advise you on what is a good option given your individual circumstances or specific fertility problem.
‘Assisted conception’ is when any means are used to help a woman conceive who is not able to or is having trouble getting pregnant just through sexual intercourse.
This can simply be giving the whole process a bit of a nudge or anything up to full-on medical involvement with the conception. Drugs will be used to help 'ripen' the eggs and make them more receptive to fertilisation.
This is used as a precursor to other courses of action like IVF but can be used on its own if the difficulty arises due to the woman's egg production.
The woman is prescribed clomiphene (or clomid) to take for a series of days each month in order to stimulate egg production.
This is when semen is gathered from the male and treated so that the sperm count is highly concentrated in the fluid which is then placed in the woman's uterus. This is quite non-invasive and is a useful method used when a man's sperm count is low. (That is, the semen he produces normally does not include a great number of motile or healthy sperm. It is possible to use a donor's sperm for this.)
ICSI (intra-cytoplasmic sperm injection)
ICSI is like IVF but here the sperm is actively injected into the eggs under laboratory conditions, rather than simply put together with the eggs, and they are left to fertilize. If the eggs are successfully fertlised through the ICSI process, they are placed into the uterus by surgery. ICSI is regarded by some doctors as preferable to IVF in instances where the male sperm is deemed to be particularly ‘subfertile’.
GIFT (gamete intra-fallopian tube transfer)
GIFT is when the woman's eggs (one or possibly more) are taken from an ovary and a mixture of the egg and sperm is then placed directly into the fallopian tubes in the hope that fertilisation will occur. Unlike IVF, this process does require surgery under general anasthetic. When the eggs and sperm are left to fertilise in a laboratory, this process is called ZIFT (zygote intra-fallopian tube transfer). Both of these procedures will be carried out only if the fallopian tubes are found to be healthy and working effectively.
IUI (Intrauterine insemination)
This is when the sperm are sorted to ensure that the healthiest have been selected, and then that sperm is inserted directed into the womb at the point when the woman is most fertile. This procedure does not take very long and is preferred where the problems appears to be that the male has a low sperm count or if his sperm appears to have difficulty surviving the journey into the womb. This process may also be used where the woman is using a sperm donor.