Consultant Gynaecologist

IVF (In-Vitro Fertilisation)

This is the most used assisted conception technique worldwide. IVF literally means fertilisation “in-glass”, hence the origin of the name “test tube baby”. For IVF, eggs are collected from the ovaries and then put together with sperm to fertilise in a laboratory dish before being transferred into the uterus (womb).

Ovarian stimulation protocol

IVF involves taking daily fertility drugs (hMG or recombinant FSH or recombinant FSH/LH with or without GnRH agonist or antagonist) to stimulate the ovaries to produce a high number of oocytes (eggs). The recruitment and development of follicles, which contain the eggs, is tracked by regular transvaginal ultrasound scans and sometimes blood tests. When at least three follicles are mature (greater than 17mm in diameter) a hormone injection (hCG) is given to ripen the eggs. Egg collection is performed generally under ultrasound guidance, and very seldom using laparoscopy 34-36 hours later. The egg collection procedure takes about 20 minutes.

The ovarian stimulation protocol is individualised to maximise the chances of success while reducing the risks, complications and possibly the costs of treatment.

Natural cycle

Sometimes it is possible to proceed to IVF without using any drugs for ovarian stimulation. In most cases only one or two eggs are collected but immature eggs can be matured in vitro before being fertilised. In most cases only one healthy embryo is available for transfer. Usually there are not enough embryos to be stored. Some people argue that using “natural cycle IVF” the endometrium (lining of the womb) may be more receptive to the implanting embryos.

What is IVF?

Once collected the eggs are placed in a laboratory dish, mixed with the sperm, which in most cases has been produced on the same day, and left overnight to fertilise. Following fertilisation, one or two embryos are transferred into the uterus through the cervix using a fine and thin tube called catheter. The healthy embryos can be transferred two to five days after fertilisation. Embryo transfer may be done under ultrasound guidance. Any good quality suitable remaining embryos may be frozen for future use.

Who are the candidates for IVF?

• Women whose fallopian tubes are blocked, damaged or absent
• Men whose sperm is moderately abnormal (count and/or motility)
• Couples in which previous IUI treatment cycles have failed
• Couples who are known to be at risk of genetic disease or who have already had a child with a serious genetic disease and require preimplantation genetic diagnosis (PGD)
• Women with a history of severe pelvic endometriosis with altered pelvic anatomy because of scarring and adhesions
• Women who have hormone imbalance and require high doses of fertility drugs

The success rate of IVF measured as live birth rate can be as high as 40% per cycle with fresh embryos and up to 25% with frozen embryos.

Risks and complications of IVF

Failure of treatment

• This can result from cycle cancellation because of no response or over-response to stimulation drugs, failure to collect eggs, failure to fertilize eggs, failure of the embryos to develop normally and failure of implantation.
• Failure of treatment can result in emotional strain, psychological stress and depression, and some couples may require psychological counseling.

Risks associated with egg collection

• Discomfort, bleeding, infection and injury to organs (bladder and bowel).

Multiple pregnancy

• More than one fetus grows at any one time in the uterus (womb) after the transfer of two or more embryos. This is the single greatest complication of IVF treatment. Although the prospect of twin or triplets may seem attractive to some couples, high order of multiple pregnancies are associated with increased risks of maternal and fetal complications throughout pregnancy. In addition, multiple pregnancies place enormous strains for the parents including financial difficulties, emotional distress and physical exhaustion.

Ovarian hyperstimulation syndrome (OHSS)

• Potentially a very serious condition which result from over-stimulation of the ovaries following treatment with fertility drugs. Several follicles develop in each of the ovaries and fluid collects in the abdomen. In severe cases (1-2%) fluid may fill the entire abdominal cavity and the chest. Admission to the hospital may be required and IVF treatment abandoned in that cycle.

Ectopic pregnancy

• When an embryo develops and implants outside the womb, generally into the fallopian tube. Women undergoing IVF treatment because of problems with their tubes have a greater risk of having an ectopic pregnancy. This can be a serious condition and admission to the hospital may be required.

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