If a couple decides to use artificial fertilisation, a new phase of family planning begins. The process can be financially, physically, and mentally demanding on both partners – but the ultimate reward is near.
Women may struggle with the hormones they need to take, and these can result in strong mood swings, stomach pains and nausea. This period can be difficult for men as they often feel completely helpless. (Morales; Bravo, Tapia, Alvarez, & Mendez: 2003). (Scibona, Meschini, Capparelli, Pecori, Rossi, & Fabris: 1994) In addition, the financial costs can be a big burden on the household, as a couple often bears a great deal of expense for fertility treatments.
Indications for IVF
In vitro fertilisation (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, the woman and her partner might be able to try less-invasive treatment options before attempting IVF, including fertility drugs to increase the production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in your uterus near the time of ovulation.
- Uterine 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, fewer eggs are available for fertilisation.
- Endometriosis – Occurs when the uterine tissue implants and grows outside of the uterus, often affecting the function of the ovaries, uterus, and fallopian tubes.
- Uterine fibroids are benign tumours in the wall of the uterus can interfere with the implantation of the fertilised egg.
- Previous tubal sterilisation or removal
- Impaired sperm production or function
- Unexplained infertility – this means no cause of infertility has been found despite evaluation for common causes.
- A genetic disorder
- Fertility preservation for cancer or other health conditions. Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk.
- Multiple births –IVF increases the risk of multiple births if more than one embryo is transferred to your uterus.
- 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 hyper stimulation syndrome – 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 like that of women who conceive naturally — about 15% to 25% — but the rate increases with maternal age.
- Egg-retrieval procedure complications –Use of an aspirating needle to collect eggs could cause bleeding, infection or damage to the bowel, bladder, or a blood vessel.
- 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.
- Birth defects –The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived.
- Cancer –Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumour, more recent studies do not support these findings.
- Stress –Use of IVF can be financially, physically and emotionally draining. Support from counsellors and family is needed.
How to Prepare
When choosing an IVF clinic, keep in mind that a clinic’s success rate depends on many factors, such as patients’ ages and medical issues, as well as the clinic’s treatment population and treatment approaches. Ask for detailed information about the costs associated with each step of the procedure.
Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screenings, including:
- 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.
- Semen analysis.If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.
- Infectious disease screening.You and your partner will both be screened for infectious diseases, including HIV.
- Practice (mock) embryo transfer.Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.
- Uterine exam.Your doctor will examine the inside lining of the uterus before you start IVF. This might involve a sonohysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.
Before beginning a cycle of IVF, consider important questions, including:
- How many embryos will be transferred?
The number of embryos transferred is typically based on age and the number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs or genetically tested embryos.
- What will you do with any extra embryos?
Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will.
- How will you handle a multiple pregnancy?
If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, foetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing foetal reduction, however, is a major decision with ethical, emotional, and psychological consequences.
- Have you considered the potential complications associated with using donor eggs, sperm or embryos, or a gestational carrier?
A trained counsellor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You may also need an attorney to file court papers to help you become legal parents of an implanted embryo.
What Can You Expect?
IVF involves several steps — ovarian stimulation, egg retrieval, sperm retrieval, fertilisation and embryo transfer. One cycle of IVF can take about two to three weeks, and more than one cycle may be required.
If you’re using your own eggs during IVF, at the start of a cycle you’ll begin treatment with synthetic hormones to stimulate your ovaries to produce multiple eggs — rather than the single egg that normally develops each month. Multiple eggs are needed because some eggs won’t fertilise or develop normally after fertilisation. You may need several different medications, such as:
Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinising hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.
Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally after eight to 14 days — you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.
Medications for oocyte maturation. These medications prevent your body from releasing the developing eggs too soon. Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.
In part one an introduction was presented on what IVF is, the indications, the possible risks, how to prepare and what to expect. Part two will focus on the processes of ovulation stimulation, egg and sperm retrieval, embryo transfer and aftercare.