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In vitro fertilisation (IVF) is one of several techniques available to help couples with fertility problems to have a baby.
During IVF, an egg is surgically removed from the woman's ovaries and fertilised with sperm in a laboratory. The fertilised egg, now called an embryo, is then returned to the woman's womb to grow and develop.
For more information read IVF - How it is performed.
IVF doesn't always result in pregnancy and it can be both physically and emotionally demanding. If you're going through IVF, you should be offered counselling to help you through the process. Read more about the support available during IVF.
Who can have IVF?
According to guidelines, couples may be eligible for IVF treatment on the NHS if:
However, the decision about who receives treatment is made by local healthcare trusts. Priority is often given to couples who don't already have children.
IVF isn't usually recommended for women above the age of 42 because the chances of a successful pregnancy are thought to be too low (see below).
For more information read IVF - Getting started.
The success rate of IVF depends on the age of the woman undergoing treatment as well as the cause of the infertility (if it's known). Younger women are more likely to have healthier eggs, which increases the chances of success.
In 2008, the percentage IVF treatments that resulted in a birth (the success rate) was:
For more information read IVF - Risks.
Funding and payment
In 2004, National Institute for Health and Clinical Excellence National Institute for Health and Clinical Excellence (NICE) published guidelines recommending that suitable couples receive up to three cycles of IVF treatment on the NHS.
NHS trusts/Health boards across England and Wales are working to provide the same levels of service. However, the provision of IVF treatment varies across the country and it often depends on local trust/Health board policies.
If you're not eligible for NHS funding or you decide to pay for IVF, you can approach a private fertility clinic directly. On average, one cycle of IVF costs about £5000. However, this varies from clinic to clinic and there may be additional costs for medicines, consultations and tests.
Some clinics may offer a ‘package’ of treatment. During your discussions with the clinic, make sure you find out exactly what's included in the price. You may also be able to reduce the cost of IVF by donating some of your eggs for others to use.
For more information go to HFEA: private fertility treatment.
If you're thinking about having IVF abroad, there are a number of issues that you may need to consider, including your safety and the standards of care that you'll receive. The HFEA licenses and regulates clinics in the UK only. Clinics in other countries may or may not be regulated to local standards and regulations.
For more information go to HFEA: considering fertility treatment abroad: issues and risks.
If you're having problems getting pregnant, see your GP.
Your GP will look at your medical history and give you a physical examination. They may also recommend some lifestyle changes to help fertility.
Unless there are reasons that may put you at high risk of infertility, such as treatment for cancer in the past, you'll only be considered for infertility investigations and treatment after you've been trying for a baby for at least a year without becoming pregnant.
Your GP will be able to refer you to an infertility specialist at an NHS hospital or fertility clinic.
Referral to an infertility specialist
The specialist will ask about your fertility history, and they may carry out a physical examination.
For women, you may have tests to check the levels of hormones in the blood as well how well the ovaries are working. You may also have an ultrasound or X-ray, to see if there are any blockages or structural problems.
Men may be asked for a sperm sample to test sperm quality.
If the specialist thinks that your infertility could be treated by IVF, or if you've been unable to conceive for at least three years, you may qualify for funding for IVF treatment.
The specialist will advise your GP whether IVF is the best treatment for you. If it is, they will refer you to an assisted conception unit (see below).
For more information, see the A-Z topic on Diagnosing infertility.
The assisted conception unit
Once you're accepted for treatment at the assisted conception unit, you and your partner will have a blood test for HIV, hepatitis B, hepatitis C and syphilis, and to check that you're immune to rubella (German measles). Also, your cervical screening tests should be up to date.
The specialist will investigate the amount of eggs in your body and their quality (your ovarian reserve). It will be assessed by measuring your anti-mullerian hormone (AMH) level. This is a blood test that can be done on any day of your cycle. It will show if there's likely to be any difficulty in obtaining eggs.
Additional semen samples may be required.
The specialist will then discuss your treatment plan with you in full detail.
For more information see IVF - How it is performed.
You will need to sign consent forms giving permission for the use or storage of your eggs, sperm or embryos throughout the procedure.
You may find that you need support and guidance while going through this process. Some people find counselling helpful. For more information, go to HFEA: benefits of counselling and how to access it.
The IVF technique was developed in the 1970s. It may differ slightly from clinic to clinic but a typical treatment is as follows.
Step one: suppressing the natural monthly cycle
You are given a drug that will suppress your natural menstrual cycle. This is given either as a daily injection (which you'll be taught to give yourself) or as a nasal spray. You continue this for about two weeks.
Step two: boosting the egg supply
Once your natural cycle is suppressed, you take a fertility hormone called FSH (follicle stimulating hormone). These fertility hormones are known as gonadotrophins. This is another daily injection that you give yourself, usually for about 12 days, but it can vary depending on your response.
FSH increases the number of eggs your ovaries produce. This means that more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.
Step three: checking on progress
The clinic will keep an eye on you throughout the drug treatment. You will have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests. About 34-36 hours before your eggs are due to be collected, you'll have a final hormone injection that helps your eggs to mature.
Step four: collecting the eggs
For the egg collection, you'll be sedated and your eggs will be collected under ultrasound guidance. This involves a needle being inserted through the vagina and into each ovary. The eggs are then collected through the needle.
Some women experience cramps or a small amount of vaginal bleeding after the procedure.
Step five: fertilising the eggs
The eggs that have been collected are mixed with your partner's or the donor's sperm in the laboratory. After 16-20 hours they're checked to see if any have been fertilised.
If the sperm are few or weak, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI (see below). In 2008, over 40% of all IVF procedures used the ICSI technique.
The cells that have been fertilised (embryos) continue to grow in the laboratory for one to five days before being transferred into the womb. The best one or two embryos will be chosen for transfer.
After egg collection, you will be given medicines, either progesterone or hCG (chorionic gonadotrophin), to help prepare the lining of the womb to receive the embryo. This is given either as a pessary (which is placed inside the vagina) or an injection.
Step six: embryo transfer
The number of embryos to be replaced should have been discussed before treatment starts. Couples should think carefully about the replacement of a single embryo, especially when the female is under 35 and when five or more embryos have been produced. If you're 40 or over, a maximum of three embryos may be transferred.
All multiple embryo replacements carry the risk of a multiple pregnancy and birth.
Multiple pregnancies are associated with a significantly increased risk of premature labour, resulting in a three- to five-fold increased risk of blindness, deafness and cerebral palsy.
Read more about the risks associated with multiple births.
If any embryos are left over, and they're suitable, they may be frozen for future IVF attempts (see HFEA: freezing and storing embryos).
Some clinics may also offer a process called blastocyst transfer. This is where the fertilised eggs are left to mature for five to six days before being transferred. For more information about embryo transfer, read the HFEA factsheets on:
Around the time your partner's eggs are collected, you'll be asked to produce a fresh sample of sperm. The sperm are washed and spun at a high speed, so the healthiest and most active sperm can be selected.
If you're using donated sperm, it is removed from frozen storage, thawed and prepared in the same way.
Information on other techniques
There are many alternative methods to help a couple conceive. For more information, see the HFEA factsheets on:
The potential problems associated with IVF are outlined below.
Most women will have some reaction to the drugs. Most of the time the side effects are mild and include:
If you have these symptoms, see your doctor immediately, especially if you have abdominal pain and swelling.
If more than one embryo is replaced in the womb as part of IVF treatment, there's an increased chance of producing twins or triplets.
Having more than one baby may not seem like a bad thing, but it significantly increases the risk of complications for you and your babies:
The Human Fertilisation and Embryology Authority (HFEA) recommends that a maximum of two embryos may be replaced in the womb, and that consideration be given to the transfer of a single embryo during treatment in women under the age of 40.
The HFEA encourages a single embryo transfer in women who are at most risk of having twins (for example, younger women who have produced a lot of embryos).
Ovarian hyper-stimulation syndrome
The ovarian hyper-stimulation syndrome (OHSS) is a rare complication of IVF. It occurs in women who are very sensitive to the fertility drugs that are taken to increase egg production. Too many eggs develop in the ovaries, which become very large and painful.
OHSS is more common in women under 30 and in women who have polycystic ovary syndrome. OHSS generally develops in the week after egg collection.
The symptoms of OHSS are pain and bloating low down in your abdomen, nausea or vomiting. Severe cases can be dangerous. Contact your clinic if you have any of these symptoms.
If you have IVF, you have a slightly higher risk of an ectopic pregnancy, where the fertilised egg implants in the fallopian tubes rather than in the womb. This can cause vaginal bleeding or bleeding into your abdomen.
If you have a positive pregnancy test, you'll have a series of hormone tests and a scan at six weeks to make sure that the embryo is growing properly.
Tell your doctor if you experience vaginal bleeding or stomach pain after having IVF and a positive pregnancy test.
Risks for older women
IVF treatment becomes less successful with age. In addition, the risk of miscarriage and birth defects increases with the age of the woman having IVF treatment. Your doctor will discuss the increased risks that come with age, and can answer any questions you may have.
Undergoing IVF can be emotionally and physically draining. It's important that couples are offered counselling when they need it. For example, to understand the implications of treatment or for support at a critical time, e.g. when an IVF cycle has been unsuccessful.
The National Institute for Health and Clinical Excellence (NICE) recommends that counselling should be offered before, during and after IVF treatment (regardless of the outcome) by someone who's not directly involved in the management of the couple's fertility problems.
For more information, see HFEA: benefits of counselling and how to access it.
Unsuccessful IVF treatment
In many instances, IVF treatment is unsuccessful. Under these circumstances it's a good idea to have a break from treatment and give your body time to recover. A break of two months is often recommended.
This time can give you a chance to talk with the clinic about the reasons the IVF was unsuccessful, to talk to your partner about how you both feel and consider your options going forward.
It can help to talk to other people who have been through IVF. A support group or online forum may be helpful.
For more information, see HFEA: When fertility treatment fails, what next?
Adapting to parenthood
Some couples who have successfully started a family with IVF can find it difficult to adjust to their new life. It's important to seek help from health professionals (e.g. your fertility consultant, GP, midwife or health visitor).
Contacting a fertility support group and talking with others who can empathise with your experiences can also be helpful.
Infertility Network UK and Fertility Friends both have online forums where you can find other people who have dealt with the same issues.
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