In-vitro fertilisation (IVF) is the process by which an egg is fertilised outside the body in a petri dish. Indications for IVF are severe pelvic disease (for example, endometriosis that has scarred the fallopian tubes, absent fallopian tubes due to previous ectopic pregnancies, egg quality or ovulation problems that would prevent fertilisation, sperm antibodies and sperm quality problems).
The first IVF procedure was carried out by physicians Patrick Steptoe and Robert Edwards on 10th November 1977 for Mrs Lesley Brown and her husband John. They had tried unsuccessfully to conceive for nine years before agreeing to try the experimental new treatment. On the 25th July, 1978, baby Louise Joy Brown was born by caesarean at Oldham General Hospital. She weighed a small but perfect 5lbs, 12ozs and had the awe-inspiring title of being the world’s very first IVF baby.
The Human Fertilisation and Embryology Authority (HFEA) now say that 2% of all babies born in the UK were conceived by IVF.
Due to its complexity and expense, IVF is usually reserved as a last resort treatment when other options are impossible or haven’t worked. Other forms of assisted reproductive techniques that may be tried are fertility drugs (Clomid, for instance, can induce ovulation in women who have irregular ovulation), surgery to remove blockages or scar tissue and intra-uterine insemination (IUI) where sperm is placed into the uterus via a fine catheter.
If the woman is using her own eggs for IVF, the first stage of the process is to take injectable stimulation drugs that encourage the ovaries to produce multiple eggs instead of just one. ‘Shut down’ medications will stop full ovulation from occurring and keep the eggs just inside the follicles (because eggs that have already been released cannot be retrieved). Every woman is taught how to self-inject so she can do this at home.
Regular ultrasound scans are performed on the ovaries to check how the eggs are maturing and how many follicles there are. Towards the end of the treatment cycle, she will have to visit the clinic for a scan daily. This is to make sure the ideal time for retrieval isn’t missed and to monitor her for ovarian hyperstimulation syndrome – a condition that results from the use of ovulatory stimulation drugs and causes swollen ovaries, abdominal pain and shortness of breath. OHSS may require hospitalisation but it can be prevented by stopping the medication which is why ultrasounds are so important during IVF.
Egg retrieval is done via a hollow needle through the vaginal wall into the ovary. This is carried out with pain medications and mild sedation or a full general anaesthetic if the woman would prefer to be asleep. It can take up to an hour to remove the eggs.
The eggs and sperm are mixed – or one single sperm is injected directly into an egg – and the fertilised eggs are placed in a growth medium to help it mature. If the woman has asked for time lapsed embryo imaging a video camera will be added to film the maturation of her embryos to enable the doctor to decide on the best embryo or embryos to transfer. If not, they will be checked on day three and day four or five for fragmentation and the number of cells present.
A catheter is inserted into the vagina and through the cervix and the embryos are deposited into the uterus. The woman should stay still for several hours afterwards and is usually kept in a hospital bed for four hours or more.
Once she is discharged home, she will have to have progesterone supplementation to maintain the potential pregnancy. This is administered either via injection, as a gel, oral tablet or vaginal pessary and is usually taken every day until around 10 weeks of pregnancy, when the placenta takes over supportive functions for the baby.
Two weeks after embryo transfer, a pregnancy test is taken via blood test to confirm pregnancy or disprove it.
Nationally, the average success rate for women under the age of 35 who use their own fresh eggs is 32.2%. This rate is 27.7% for women aged 35-37 and 20.8% for women aged 38-39.