What is IVF?
IVF involves 6 main stages: suppressing your natural cycle (your menstrual cycle is suppressed with medicine); helping your ovaries produce extra eggs (medicine is used to encourage your ovaries to produce more than 1 egg at a time); monitoring your progress and maturing your eggs (an ultrasound scan is carried out to check the development of the eggs, and medicine is used to help them mature); collecting the eggs (a needle is inserted through your vagina and into your ovaries to remove the eggs); fertilising the eggs (the eggs are mixed with the sperm for a few days to allow them to be fertilised); and transferring the embryo(s) (1 or 2 fertilised eggs (embryos) are placed into your womb). Once the embryo(s) has been transferred into your womb, you’ll need to wait 2 weeks before taking a pregnancy test to see if the treatment has worked.
Chances of Success
The success rate of IVF depends on the age of the woman having treatment, as well as the cause of the infertility (if it’s known). Younger women are more likely to have a successful pregnancy. IVF isn’t usually recommended for women over the age of 43 because the chances of a successful pregnancy are thought to be too low. In 2019, the percentage of IVF treatments that resulted in a live birth was:
Infertility
Infertility is when a couple cannot get pregnant (conceive) despite having regular unprotected sex during a year. Around 1 in 7 couples may have difficulty conceiving.
About 84% of couples will conceive naturally within a year if they have regular unprotected sex (every 2 or 3 days). For couples who have been trying to conceive for more than 3 years without success, the likelihood of getting pregnant naturally within the next year is 1 in 4, or less.
Some people get pregnant quickly, but for others it can take longer. It’s a good idea to see a gynecologists if you have not conceived after a year of trying.
Women aged 36 and over, and anyone who’s already aware they may have fertility problems, should see their gynecologists sooner. They can check for common causes of fertility problems and suggest treatments that could help.
Infertility is usually only diagnosed when a couple have not managed to conceive after a year of trying.
There are 2 types of infertility:
- Primary infertility – where someone who’s never conceived a child in the past has difficulty conceiving
- Secondary infertility – where someone has had 1 or more pregnancies in the past, but is having difficulty conceiving again
Fertility treatments include:
- Medical treatment for lack of regular ovulation
- Surgical procedures such as treatment for endometriosis, repair of the fallopian tubes, or removal of scarring (adhesions) within the womb or abdominal cavity
- Assisted conception such as intrauterine insemination (IUI) or IVF
The treatment offered will depend on what’s causing the fertility problems. Some treatments for infertility, such as IVF, can cause complications. For example, if more than 1 embryo is placed in the womb as part of IVF treatment there’s an increased chance of having twins; this may not seem like a bad thing, but it significantly increases the risk of complications for you and your babies. The risk of having an ectopic pregnancy is slightly increased if you have IVF.
What Causes Infertility?
There are many possible causes of infertility, and fertility problems can affect either partner. But in a quarter of cases it is not possible to identify the cause.
- Lack of regular ovulation (the monthly release of an egg)
- Poor quality semen
- Blocked or damaged fallopian tubes
- Endometriosis – where tissue that behaves like the lining of the womb (the endometrium) is found outside the womb
- Age – fertility declines with age
- Weight – being overweight or obese (having a BMI of 30 or over) reduces fertility; in women, being overweight or severely underweight can affect ovulation
- Sexually transmitted infections (STIs) – several STIs, including chlamydia, can affect fertility
- Smoking – smoking (including passive smoking) affects your chance of conceiving and can reduce semen quality
- Alcohol – the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum. Drinking too much alcohol can also affect the quality of sperm (the chief medical officers for the UK recommend adults should drink no more than 14 units of alcohol a week, which should be spread evenly over 3 days or more)
- Environmental factors – exposure to certain pesticides, solvents and metals has been shown to affect fertility, particularly in men
- Stress – can affect your relationship with your partner and cause a loss of sex drive; in severe cases, stress may also affect ovulation and sperm production
There’s no evidence to suggest caffeinated drinks, such as tea, coffee and colas, are associated with fertility problems.
Diagnosis of Infertility
More than 8 in 10 couples, where the woman is under 40, will conceive naturally within a year of having regular unprotected sex. Regular unprotected sex means having sex every 2 to 3 days without using contraception. See your doctor if you have not conceived after a year of trying. You should see a doctor sooner if you are female and are aged 36 or over, or have any other reason to be concerned about your fertility, for example if you’ve had treatment for cancer or you think you might have had a sexually transmitted infection (STI). Fertility tests can take time and female fertility decreases with age, so it’s best to make an appointment early. It’s always best for both partners to visit the Doctor as fertility problems can affect either or both partners. Trying to conceive can be an emotional process, so it’s important to support each other as much as possible. Stress is just one factor that can affect fertility.
The Doctor will ask you about your medical and sexual history.
Previous pregnancies and children: If you’re a woman, the Doctor will discuss any previous births and any complications with previous pregnancies. They’ll also ask about any miscarriages you’ve had. If you’re a man, you’ll be asked whether you’ve had any children from previous relationships.
Length of time trying to conceive: The Doctor will ask how long you’ve been trying to conceive. About 84% of people will conceive within 1 year if they have regular unprotected sex (every 2 to 3 days). Of those who do not conceive in the first year, about half will conceive in the second year. If you’re under 40 and have not been trying for a baby for very long, you may be advised to keep trying for a little longer.
Sex: You’ll be asked how often you have sex and whether you have any difficulties during sex. You may feel uncomfortable or embarrassed discussing your sex life with the Doctor, but it’s best to be open and honest. If the fertility problem is related to sex, it might be overcome easily.
Length of time since stopping contraception: You’ll be asked about the type of contraception you previously used and when you stopped using it. It can sometimes take a while for some types of contraception to stop working and this may be affecting your fertility.
Medical history and symptoms: The Doctor will discuss any medical conditions you have or had in the past, including sexually transmitted infections (STIs). If you’re a woman, the Doctor may ask if you have regular periods and whether you experience any bleeding between periods or after sex.
Medicine: Some medicines can affect your fertility. The Doctor will ask you about any medicine you’re taking and might discuss alternative treatments with you. You should mention any non-prescription medicine you’re taking, including herbal remedies and supplements.
Lifestyle: Several lifestyle factors can affect your fertility. The Doctor will want to know if you smoke, how much you weigh, how much alcohol you drink, whether you take any illegal drugs, and if you’re stressed. They may recommend making changes to your lifestyle to increase your chances of conceiving.
If you are female, the doctor may weigh you to see if you have a healthy body mass index (BMI), and examine your pelvic area to check for infection, lumps or tenderness, which could be a sign of fibroids, ovarian tumours, endometriosis or pelvic inflammatory disease (PID).
If you are male, the doctor may check your testicles to look for any lumps or deformities, and your penis to look at its shape, structure and any obvious abnormalities.
- Blood tests – samples of your blood can be tested for a hormone called progesterone to check whether you’re ovulating. The timing of the test is based on how regular your periods are. If you have irregular periods, you’ll be offered a test to measure hormones called gonadotrophins, which stimulate the ovaries to produce eggs. A urine test may be used as an alternative. You’ll be prescribed antibiotics if you have chlamydia.
- Ultrasound scan – an ultrasound scan can be used to check your ovaries, womb (uterus) and fallopian tubes. Certain conditions that can affect the womb, such as endometriosis and fibroids, can prevent pregnancy. A scan can also be used to look for signs that your fallopian tubes may be blocked, which may be stopping eggs from travelling along the tubes and into the womb. If the ultrasound suggests a possible blockage, your doctor will refer you to a specialist to discuss further checks, such as a laparoscopy. During a transvaginal ultrasound scan, an ultrasound probe is placed in your vagina. The scan can be used to check the health of your womb and ovaries and for any blockages in your fallopian tubes. A hysterosalpingo-contrast-ultrasonography is a special type of ultrasound scan sometimes used to check the fallopian tubes. A small amount of fluid is injected into your womb through a tube put into the neck of your womb (the cervix). Ultrasound is used to look at the fluid as it passes through the fallopian tubes to check for any blockages or abnormalities. If the test suggests a possible blockage, your doctor will refer you to a specialist to discuss further checks, such as laparoscopy.
- X-ray (hysterosalpingogram) – a hysterosalpingogram is an X-ray of your womb and fallopian tubes after a special dye has been injected. It can be used to find blockages in your fallopian tubes, which may be stopping eggs travelling along the tubes and into your womb.
- Laparoscopy – laparoscopy (keyhole surgery) involves making a small cut in your lower tummy so a thin tube with a camera at the end (a laparoscope) can be inserted to examine your womb, fallopian tubes and ovaries. Dye may be injected into your fallopian tubes through your cervix to highlight any blockages in them. Laparoscopy is usually only used if it’s likely that you have a problem, for example, if you’ve had an episode of pelvic inflammatory disease (PID) in the past, or if scans suggest a possible blockage of one or both of your tubes.
- Semen analysis – this is to check for problems with sperm, such as a low sperm count or sperm that are not moving properly.
- Chlamydia test – a sample of your urine will be tested to check for chlamydia, as it can affect fertility. Your doctor will prescribe antibiotics if you have chlamydia.
Treatment of Infertility
If you have fertility problems, the treatment you’re offered will depend on what’s causing the problem. There are 3 main types of fertility treatment: medicines, surgical procedures, and assisted conception, including intrauterine insemination (IUI) and in vitro fertilisation (IVF).
Common fertility medicines include: clomifene (encourages the monthly release of an egg in women who do not ovulate regularly or cannot ovulate at all); tamoxifen (an alternative to clomifene that may be offered if you have ovulation problems); metformin (particularly beneficial for women who have polycystic ovary syndrome (PCOS)); gonadotrophins (can help stimulate ovulation in women, and may also improve fertility in men); and gonadotrophin-releasing hormone and dopamine agonists (other types of medicine prescribed to encourage ovulation in women). Some of these medicines may cause side effects, such as nausea, vomiting, headaches and hot flushes. Medicine that stimulates the ovaries is not recommended for women with unexplained infertility because it has not been found to increase their chances of getting pregnant.
Options include fallopian tube surgery (surgery can be used to break up the scar tissue in your fallopian tubes, making it easier for eggs to pass through; possible complications include an ectopic pregnancy); laparoscopic surgery to treat endometriosis by destroying or removing fluid-filled sacs called cysts, or to remove submucosal fibroids; and correcting an epididymal blockage or surgically extracting sperm (an option if you have an obstruction that prevents the release of sperm, were born without the vas deferens, or have had a vasectomy or a failed vasectomy reversal). Both sperm extraction operations take a few hours and are done under local anaesthetic as outpatient procedures. You’ll be advised on the same day about the quality of the tissue or sperm collected. Any sperm will be frozen and placed in storage for use at a later stage.
Intrauterine insemination (IUI), also known as artificial insemination, involves inserting sperm into the womb via a thin plastic tube passed through the cervix. Sperm is first collected and washed in a fluid. The best quality specimens (the fastest moving) are selected. In vitro fertilisation (IVF) is when an egg is fertilised outside the body. Fertility medicine is taken to encourage the ovaries to produce more eggs than usual. Eggs are removed from the ovaries and fertilised with sperm in a laboratory. A fertilised egg (embryo) is then returned to the womb to grow and develop.
Getting Started with IVF
If you’re having problems getting pregnant, see your doctor. They will look at your medical history and give you a physical examination. They may also recommend some lifestyle changes to help increase your chances of getting pregnant. Unless there are reasons that may put you at high risk of infertility, such as cancer treatment, you’ll usually only be considered for infertility investigations and treatment if you’ve been trying for a baby for at least a year without becoming pregnant. If appropriate, your doctor can refer you to a fertility specialist at an NHS hospital or fertility clinic.
The specialist will ask about your fertility history, and may carry out a physical examination. Women may have tests to check the levels of hormones in their blood and how well their ovaries are working. They may also have an ultrasound scan or X-ray to see if there are any blockages or structural problems. Men may be asked for a semen sample to test sperm quality. If IVF is the best treatment for you, the specialist will refer you to an assisted conception unit.
Once you’re accepted for treatment at the assisted conception unit, you and your partner will have blood tests, including tests for HIV, hepatitis B and hepatitis C. Your cervical screening tests should also be up-to-date. This can be assessed by measuring a substance called anti-mullerian hormone (AMH) in your blood, or by counting the number of egg-containing follicles, known as your antral follicle count (AFC), using a vaginal ultrasound scan. Your specialist will then discuss your treatment plan with you in detail and talk to you about any support or guidance you may find helpful.
Risks of IVF
Before starting IVF, it’s important to be aware of the potential problems you could experience.
Many women will have some reaction to the medicines used during IVF. Some of the side effects can be mild. Side effects can include hot flushes, feeling down or irritable, headaches, restlessness, and ovarian hyperstimulation syndrome. Contact the fertility clinic if you experience persistent or worrying side effects during treatment.
If more than 1 embryo is replaced in the womb as part of IVF treatment, there’s an increased chance of producing twins. Having more than 1 baby may not seem like a bad thing, but it significantly increases the risk of complications for you and your babies. Problems more commonly associated with multiple births include:
- Miscarriage
- Pregnancy-related high blood pressure and pre-eclampsia
- Gestational diabetes
- Anaemia and heavy bleeding
- Needing a caesarean section
- Your babies are also more likely to be born prematurely or with a low birth weight, and are at an increased risk of developing life-threatening complications such as newborn respiratory distress syndrome (NRDS) or long-term disabilities, such as cerebral palsy
Ovarian hyperstimulation syndrome (OHSS) is a rare complication of IVF. It happens in women who are very sensitive to the fertility medicine taken to increase egg production. Too many eggs develop in the ovaries, which become very large and painful. OHSS generally develops in the week after egg collection. The symptoms can include pain and bloating low down in your tummy, feeling and being sick, shortness of breath, and feeling faint. Severe OHSS can be dangerous. Contact your clinic as soon as possible if you have any of these symptoms. It may be necessary to cancel your current treatment cycle and start again with a lower dose of fertility medicine.
If you have IVF, you have a slightly higher risk of having an ectopic pregnancy, where the embryo implants in a fallopian tube rather than in the womb. This can cause pain in the tummy, followed by vaginal bleeding or dark vaginal discharge. If you have a positive pregnancy test after IVF, you’ll have a scan at 6 weeks to make sure the embryo is growing properly and that your pregnancy is normal. Tell your doctor if you experience vaginal bleeding or stomach pain after having IVF and a positive pregnancy test.
IVF treatment becomes less successful with age. In addition, the risk of miscarriage and birth defects increases with the age of the woman. Your doctor will discuss the increased risks that come with age and can answer any questions you may have.
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