Navigating IVF
In the UK, one in seven couples who are trying for a baby experience problems and delays in conceiving. Conception is a very complex process involving many factors. If one of these factors is impaired in some way, it may be very difficult to conceive naturally.
In-vitro fertilisation (IVF) is just one of several assisted conception techniques available to help people with fertility problems to have a baby. Originally founded in 1978, it involves an egg being surgically removed from the ovary and fertilised outside the body. "In vitro" is a Latin term meaning "in glass". It refers to the glass container in the laboratory where fertilisation takes place - hence the term "test tube baby", although in reality it is usually a culture dish.
Today, one in every 80 babies born in the UK is conceived through IVF.
Success rates of IVF
The success rate of IVF is determined to a large degree by the age of the woman undergoing the treatment. Younger women tend to have healthier eggs which may increase the chances of success.
IVF on the NHS
The National Institute for Clinical Excellence (NICE) guidelines that were published in 2004 recommend that suitable couples receive up to three cycles of IVF treatment on the NHS. The government added a priority condition that couples with a child, or children, from the current or previous relationship, should not have access to NHS treatment. However, there are many private clinics operating and sometimes the NHS waiting list is too long for couples to wait for their chances of conception. Some primary care trusts offer one free IVF cycle to couples experiencing fertility problems (where the woman is between 23 and 39), but NHS availability varies across the UK. The typical cost of one IVF cycle at a private clinic varies around £3,000.
Why IVF?
In one third of cases, infertility can be attributed to factors affecting women, such as problems connected to egg release, blockages in the fallopian tubes, or structural defects (congenital abnormalities) of the uterus. A third of cases involve factors affecting men, which may include a low sperm count (oligospermia), poor sperm motility or lifespan, or azoospermia where no sperm cells are produced. The remaining third of infertility cases can be attributed to fertility issues in both partners, or to reasons unknown.
When should I consider IVF?
Couples considering IVF are normally advised that before approaching their GPdoctor about assisted conception, they should have been trying for a baby, by having regular unprotected sex for at least one year. At this stage, a medical check up is required to determine the situation before any treatment begins. This may include physical examinations; tests to check blood hormone levels, ovarian function and sperm quality, X-rays of the reproductive organs, and perhaps a laparoscopy or hysterosalpingogram to pick up anything that an X-ray may miss, such as blockages or adhesions in the pelvic cavity.
One of the main factors influencing the outcome of IVF treatment is the age of the woman whose eggs are used, as the quality of the eggs normally declines as the woman gets older. The rate of birth defects, chromosome abnormality or miscarriage also rises with maternal age.
Couples considering IVF must undergo an assessment at a fertility clinic before any treatment begins. A full lifestyle check-up can help people with fertility problems to optimise their health before treatment starts.
How is IVF performed?
'Traditional IVF'
The main IVF technique was developed in the 1970s. This involves giving the woman certain fertility drugs to help stimulate her egg production, and then surgically removing the eggs from the ovaries. She is then given hormones to help prepare her uterus for a pregnancy, during which time, the eggs are fertilised with the sperm in a laboratory. The embryos are then implanted into the woman's uterus, and if all goes well, a normal pregnancy is achieved.
Intra-cytoplasmic Sperm Injection
IVF procedures developed more recently include Intra-cytoplasmic Sperm Injection (ICSI). This helps those men for whom the standard IVF technique would fail, for example if their sperm are unable to penetrate the egg, to achieve pregnancy with their partner.
Intrauterine Insemination
Intrauterine insemination (IUI) is an alternative procedure which involves the introduction of washed sperm directly into the uterus to maximise the number of healthy sperm reaching the fallopian tubes and fertilising an egg. Procedures such as sperm washing can also be carried out in order to only retrieve sperm strong and healthy enough for inclusion in IVF techniques. This is particularly successful with men who have a low sperm count.
IUI often takes place alongside ovarian stimulation to increase egg production and improve the rate of success. In some cases, egg selection may be suggested. It enables only the healthiest eggs to be taken from the ovaries for fertilisation outside the body. It can be useful for women with a diminished number and quality of eggs.
New assisted conception techniques are being developed and existing procedures improved and refined. Nowadays for example, a 3D ultrasound can now detect pre-pregnancy fertility problems, such as blocked fallopian tubes.
What are the risks of IVF?
As with any medical procedure, there are several risks involved with assisted conception. The diagnostic and treatment procedures can involve discomfort, particularly for the woman undergoing IVF, who may experience side effects from the fertility drugs, and may find the egg removal very uncomfortable.
Ectopic pregnancy and multiple births
Some assisted conception techniques carry an increased risk of ectopic pregnancy, where the fertilised egg implants in the fallopian tubes instead of the uterus.
There is an increased chance of producing twins or triplets, as the chances of IVF success are maximised by more than one embryo being put back into the womb. This has associated dangers, such as an increased risk of problems occurring during the pregnancy or labour and the increased possibility of the babies being born prematurely.
Ovarian hyper-stimulation syndrome
Ovarian hyper-stimulation syndrome (OHSS) is a rare but known side effect of IVF. It can occur when the fertility drugs given to stimulate egg production in the woman are so successful that the ovaries cannot cope with the increased number of eggs.
A mild incidence can cause pain and bloating. If the overstimulation is severe, blood clots, kidney damage and twisting of the ovaries may occur, and monitoring in hospital will be required. OHSS can hinder the progress of the treatment cycle.
What support will I get through IVF?
Counselling
Having IVF or other assisted conception procedures can be and emotional and physical rollercoaster. It is important that couples are take up counselling opportunities if appropriate, to either understand the implications of treatment, or to get support at a certain time (if IVF fails or if the treatment is stopped).
NICE recommends that counselling should be offered before, during and after assisted conception treatment (regardless of the outcome of the procedures) by someone who is not directly involved in the management of the couple's fertility problems.
Becoming a parent
It is not uncommon for couples who have been successful in their attempts to start a family to find it difficult to adjust to their new life. It is important to seek help from health professionals - your fertility clinic, doctor, health visitor or midwife. Contacting a fertility support group and talking with others who can empathise with your experiences can also be helpful.
NICE - National Institute for Clinical Excellence www.nice.org.uk
www.nhs.co.uk
www.hfea.gov.uk
www.ivf.net
www.ivfworld.com
