IVF treatment, costs and what is involved
In vitro fertilisation (IVF) is a fertility treatment that has helped millions of women to conceive. You may be offered it because of a fertility issue that makes conceiving naturally difficult or impossible, or because you have been trying for a baby without success for a long time and other methods of assisted conception have failed.
What is IVF treatment?
IVF simply means that the process of fertilisation takes place outside the womb. Eggs are taken from the mother (or a donor) and fertilised with sperm in a glass dish – “in vitro” literally means “in glass”. Once the egg is fertilised and has developed into a ball of cells, it's transferred to the uterus. Eggs and sperm can be from you and your partner, or either can come from a donor. The IVF process was first used in 1978.
What does IVF treatment involve?
The process of IVF happens in several stages and you'll need to go into the clinic or hospital several times at various points. Before you begin you'll be advised to start taking folic acid and you and your partner may be given blood tests to check for things like HIV and hepatitis, just to ensure you both have a clean bill of health before you begin.
Suppressing your cycle
Also known as “down-regulation”, this is the start of the IVF process where you're given drugs to essentially “turn off” ovulation. On about day 21 of your cycle, you'll start taking medication to suppress your hormones – either as a nasal spray or a daily injection that you can do yourself at home. Down-regulation usually takes about two weeks.
Stimulating your ovaries
Once your natural hormones are “turned off” you'll start a course of injections that will encourage your ovaries to produce lots of eggs (as opposed to the usual one they cough up per month). This is to give the doctors lots of eggs to work with so they can create several embryos and pick the best to implant. Again, you can do this injection yourself. You usually have the injections for 10-12 days.
Monitoring the follicles
While the eggs are getting ready to be released from their follicles, you'll be carefully monitored with transvaginal ultrasounds to check on their progress. When they look ready to go, you'll be given an injection, which will release the eggs around 36 hours later.
Egg and sperm collection
Approximately 36 hours after the injection to release the eggs, you'll go in to the clinic to have your eggs collected. This is the really clever bit. The doctor will use a very fine, hollow tube attached to an ultrasound probe to go in, through the vagina and up into each ovary. This is done using an ultrasound scan so they can see exactly what they're doing.
They usually manage to extract an egg from 80% of the ripe follicles. The number of eggs collected varies enormously. It can be as many as 30 but they would hope to get at least 15. You'll be awake during the procedure, but sedated. It's not usually painful but can feel a bit strange and uncomfortable. You should be able to take painkillers later on at home if you need them.
At the same appointment, your partner will be asked to give a sample of sperm. Obviously he has the less uncomfortable end of the deal, but understandably, lots of men feel a bit of pressure and performance anxiety, too.
Sometimes they can use frozen sperm and obviously if you are using donor sperm, at this point they will simply defrost the sample.
The sperm will be “washed” – this is nothing to do with Imperial Leather and Marigolds, don't worry. It's the process by which individual sperm cells are separated from the semen. They pick out the best looking specimens, leaving any ropey-looking ones behind.
The collected eggs and the lucky few sperm selected are combined in a glass dish and put in an incubator to, well… “get it on”. The dish is checked 24 hours on and if any eggs have been fertilised they're then incubated for two to five days to allow them to develop into blastocysts of four or eight cells each. Usually between 60 and 70% of the eggs will be fertilised.
If you're having ICSI (intra-cytoplasmic sperm injection) then a single sperm is injected into a single egg at this point. ICSI is a type of IVF that is usually done if there's a male fertility problem, such as a very low count or the sperm being of poor quality. ICSI is also sometimes used if you've had IVF previously and fertilisation wasn't successful.
Transferring the embryo
While the embryos were developing, you'll have been given hormone medication (progesterone) to take to thicken the lining of the womb in preparation for the embryo to be implanted. This could be either a pessary, a gel or an injection.
The embryologists will keep in touch with you and let you know when the embryos are ready to be transferred. They’ll then pick the best looking embryo or embryos to implant.
Some clinics will offer chromosomal screening at this point to ensure the best embryos are used, which reduces the chances of miscarriage. Transfer is done with a thin tube, a bit like when you had the eggs collected, but this is a simpler process and less uncomfortable – more like having a smear test – so you shouldn't need sedation. They use the tube to place the embryo (or embryos) through the vagina and cervix into the womb.
Any embryos left over will be frozen so you can use them another time if you wish.
The two-week wait
This is the agonising bit – waiting to find out if the embryo has bedded in. You'll be advised to wait two weeks after embryo transfer to take a pregnancy test. Some clinics suggest you do a simple urine test at home, while others like you to come in for a blood test, which is more accurate.I need to get prepared by cutting out caffeine etc but I'm finding it hard. I also know lots of people announcing their pregnancies – I'm trying not to be jealous of how easy procreation is for some.
You don't need to do anything “special” during this time but keep yourself busy if possible, or it can seem like a very long wait indeed. Obviously follow any instructions your medical team have given you though. You'll probably be advised to abstain from sex, cigarettes and alcohol and to avoid doing anything too strenuous. Don't forget to keep taking your medication, too.
Other than that, this is a time just to look after yourself both physically and mentally. Get early nights, eat well and relax as much as is possible. It's easier said than done but try to avoid agonising over every last sign and symptom and wondering if it means you're pregnant – it will only drive you mad.
You might like to speak to a counsellor during this time, which your clinic can usually help with. The stress of trying to conceive is bad enough when you aren't going the IVF route, so don't feel silly if you need some extra support – everyone understands that it's a really anxious time.
Sadly, IVF is quite often not successful so while it's good to think positively, it's worth keeping that in the back of your mind so it's slightly less of a devastating blow if it isn't successful this time.
If your pregnancy test is positive, you're likely to have one or perhaps more ultrasounds over the following weeks just to check that the embryo has implanted in the womb and nowhere else. You'll then start the journey of standard antenatal care, midwife appointments and scans just like everyone else. It can feel weirdly like the end of a long journey, getting to this point, when it's really the start of a much bigger journey.
How many embryos are implanted with IVF?
The number of embryos transferred will depend on your age. NICE guidelines state that the maximum number of transfers should be two. There are also guidelines about how many embryos should be transferred, depending on your circumstances:
- If you're under 37 – in your first IVF cycle, you should only have a single embryo transfer. On your second cycle you should only have one if at least one top-quality embryo is available. If no top-quality embryos are available, they may implant two. In the third IVF cycle, you should have up to two embryos.
- If you're aged 37-39 – for your first and second IVF cycles one embryo is recommended if there is at least one top-quality embryo, and two if there are no top-quality embryos. In the third cycle, you should have up to two.
- If you're aged 40-42 – you can have a double embryo transfer at any point.
Are there any risks with IVF?
IVF is a very safe and regularly used process but there are a few slightly increased risk factors to be aware of:
- You're more likely to have twins (if you have more than one egg transferred). Obviously for many women this would be a boon rather than a disappointment. But it's worth remembering that multiple pregnancies always carry greater risks than a single pregnancy.
- Slightly increased risk of ectopic pregnancy. For this reason, you’ll be given a scan once you get a positive pregnancy test to confirm that the embryo has implanted in the uterus and not the fallopian tubes.
- Rarely, women having IVF develop Ovarian Hyperstimulation Syndrome in the week after egg collection. This is where the medication you have to encourage the production of more eggs sends your ovaries into overdrive and they become large and swollen. Symptoms include faintness, shortness of breath, sickness and pain and bloating low in your abdomen. This can be dangerous if severe, so if you experience any of these symptoms you should contact your clinic straight away.
What are the side effects of IVF?
The process of IVF has become easier and smoother over the years but you may experience a few problems along the way. None of them are anything you won't be able to cope with, however, and you'll get lots of support along the way from your clinic. You may experience some of the following during the IVF process due to the drugs you're taking:
- Feeling irritable
- Hot flushes
Does having IVF hurt?
The minor procedures you'll have as part of IVF can be uncomfortable, but most women say they aren't painful. Retrieving the eggs tends to be the worst bit. Putting the embryos back in is usually a simpler and smoother process.
Can I have IVF on the NHS?
You have to meet specific criteria to be offered IVF on the NHS. NICE guidelines recommend that:
- Women under 40 should be offered up to three cycles of IVF if they've been trying to conceive for more than two years without success or they have had 12 cycles of artificial insemination and this hasn't worked.
- Women trying to get pregnant at 40 o 42 years of age should be offered one cycle of IVF if, as above, they've have 12 cycles of unsuccessful insemination or have been trying for two years and they have never had IVF before and they don't seem to have low ovarian reserves (very few eggs) and they've been informed of the risks of IVF at 40 plus.
- Additionally if fertility testing has shown that IVF is likely to be the only method via which you will ever conceive you should be offered it straight away too.
It's worth remembering, however, that local Clinical Commissioning Groups (CCGs) will also have their own criteria to add to this, so you may find that in your area, you won't receive treatment if you are overweight, smoke, are over 35 or one of you has children from a previous relationship, for example. You can contact your local CCG or ask your GP what the situation is in your area.I'm currently in the middle of the two-week wait after having a frozen embryo transferred. I'm trying my hardest not to think about it – but I'm constantly checking for every/any sign.
What does IVF cost?
If you aren't eligible for IVF on the NHS, you can of course go privately. Costs will vary from one clinic to another but are usually somewhere in the region of £5,000 per cycle. You can find details of your local IVF clinics on the Human Fertilisation and Embryology Authority's website.
What is the success rate of IVF?
The younger you are, the higher your chances of success with IVF. Data from 2010 on IVF (including ICSI) shows the percentage of IVF cycles that resulted in a live birth by mother's age:
Under 35 years – 32.2%
Age 35-37 – 27.7%
Age 38-39 – 20.8%
Age 40-42 – 13.6%
Age 43-44 – 5%
Over 44 – 1.9%
Unfortunately, your chances of success do statistically decrease with each cycle of IVF you undertake so if you've had several cycles with no success, it's worth bearing that in mind when considering whether to continue or not.
Can I improve my chances of IVF working?
For the most part, it's in the lap of the gods, but obviously you will want to ensure you've done all you can to maximise your chances of success. Being a healthy weight, not smoking, limiting alcohol to a unit per day and keeping caffeine intake very low will all help. It might also help you to try things like positive visualisation or yoga to help stay in a good frame of mind and keep relaxed. There's no way of saying whether this will have any discernible impact on your chances of success but there's certainly nothing to be lost.