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Infertility

IVF: a route to pregnancy

In vitro fertilization – a real chance of pregnancy.

Throughout history, infertility has been one of the biggest problems a woman could encounter on the path of life. According to the World Health Organization data more than 180 million couples in the world in developing countries suffer from infertility1.

Infertility is common — approximately 1 in every 10 couples has difficulty conceiving a child2.

What is IVF?

In vitro fertilization (IVF) is a complex series of procedures used to help infertility or prevent genetic problems and assist with the conception of a child3.

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One complete cycle of IVF takes about three weeks. Sometimes these steps are split into different parts, and the process can take longer3.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using a couple’s own eggs and sperm or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — someone who has an embryo implanted in the uterus — can be used3.

Indications for the procedure

In vitro fertilization (IVF) is a treatment for infertility or genetic problems3. 

Sometimes, IVF is offered as a primary treatment for infertility in women aged over 40. IVF can also be undertaken if you have certain health conditions. For example, IVF may be an option if you or your partner has3:

  • Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilised or for an embryo to travel to the uterus.
  • Ovulation disorders. If ovulation is infrequent or absent there are fewer eggs available for fertilisation.
  • Endometriosis. Endometriosis occurs when tissue similar to the lining of the uterus implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
  • Uterine fibroids. Fibroids are benign tumours in the uterus. They are common in women in their 30s and 40s. Fibroids can interfere with the implantation of the fertilized egg.
  • Previous tubal sterilization or removal. Tubal ligation is a type of sterilization in which the fallopian tubes are cut or blocked to prevent pregnancy permanently.
  • Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor motility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilise an egg.
  • Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
  • A genetic disorder. If you or your partner are at risk of passing on a genetic disorder to your child, you may be candidates for pre-implantation genetic testing — a procedure that involves IVF.

Preparation for IVF

Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely undergo various screenings, including3:

  • Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone in your blood during the first few days of your menstrual cycle. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.
  • Semen analysis. If not completed as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before an IVF treatment cycle starts.
  • Infectious disease screening. You and your partner will be screened for infectious diseases, including HIV.
  • Practice embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to place the embryos into your uterus successfully.
  • Uterine exam. Your doctor will examine the inside lining of the uterus before you start IVF.

Risks

Risks of IVF include3:

  • Multiple births. IVF increases the risk of multiple births if more than one embryo is transferred to your uterus. A pregnancy with multiple fetuses carries a higher risk of early labour and low birth weight than a pregnancy with a single fetus.
  • Premature delivery and low birth weight. Research suggests that IVF slightly increases the risk that the baby will be born early or with low birth weight.
  • Ovarian hyperstimulation syndrome. The use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful.
  • Miscarriage. The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15% to 25% — but the rate increases with maternal age.
  • Egg-retrieval procedure complications. Using an aspirating needle to collect eggs could cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also associated with sedation and general anaesthesia if used.
  • Ectopic pregnancy. About 2% to 5% of women who use IVF will have an ectopic pregnancy — when the fertilised egg implants outside the uterus, usually in a fallopian tube. The fertilised egg can’t survive outside the uterus, and there is no way to continue the pregnancy.
  • Stress. The use of IVF can be financially, physically and emotionally draining. Support from counsellors, family and friends can help you and your partner through the ups and downs of infertility treatment.

Results

Between 12 and 14 days after egg retrieval, your doctor will test a sample of your blood to detect whether you are pregnant3.

If you are pregnant, your doctor will refer you to an obstetrician or other pregnancy specialist for prenatal care3.

If you are not pregnant, you will stop taking progesterone and your period is likely to return within a week. Contact your doctor if you don’t get your period or have unusual bleeding. If you are interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF3.

The chances of giving birth to a healthy baby after using IVF depend on various factors, including3:

Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women aged 41 and older are often counselled to consider using donor eggs during IVF to increase the chances of success.

Embryo status. Transfer of more developed embryos is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk to your doctor about your specific situation.

Reproductive history. Women who have previously given birth are more likely to be able to get pregnant using IVF than are women who have never given birth. Success rates are lower for women who have previously used IVF multiple times but failed to get pregnant.

Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than women who have unexplained infertility.

Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman’s chance of success using IVF by 50%. Obesity can decrease your chances of getting pregnant and having a baby. The use of alcohol, recreational drugs, excessive caffeine and certain medications can also be harmful.

References

  1. Ombelet W. Global access to infertility care in developing countries: a case of human rights, equity and social justice. Facts Views Vis Obgyn. 2011;3(4):257-66.
  2. Van Voorhis, B. J. (2007). In Vitro Fertilization. New England Journal of Medicine, 356(4), 379–386. doi:10.1056/nejmcp065743. 
  3. In vitro fertilization (IVF). https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 (Last access 17.06.2022).