IVF can be a highly effective fertility treatment for some people, but it doesn’t guarantee a successful pregnancy. Here we cover what the IVF process entails, who could benefit from it and things to consider if you’re thinking about undergoing a cycle. 

Quick facts:

• IVF is one of the most common fertility treatments in the UK. 
• IVF is often explored by those who can’t or don’t want to conceive naturally. 
• An IVF cycle is an invasive procedure that can be physically and emotionally demanding. 
• IVF is covered by the NHS in certain instances or can be accessed at private clinics. 
• There are several things you can do to prepare for IVF, including testing your hormones to indicate your current ovarian reserve.

What is IVF?

In-vitro fertilisation (IVF) is a fertility treatment for those who can’t or don’t wish to conceive naturally. It’s one of the most common fertility treatments in the UK, with as many as 50,000 people undergoing IVF in the UK each year. 

IVF involves removing eggs from the ovaries, attempting to fertilise them with sperm in a lab and then transplanting any successfully fertilised eggs (embryos) into the uterus. This is called an IVF cycle. It’s an invasive procedure and doesn’t guarantee a successful pregnancy. 

Whether or not it’s right for you will depend on a range of personal and medical factors, as well as carefully considering the IVF cycle process.

Fresh cycle vs frozen cycle

IVF cycles can be fresh or frozen. Once an egg has been successfully fertilised by a sperm in the lab, it creates an embryo. This embryo is then typically incubated in the lab for 3-5 days. 

In a fresh cycle, it will then be transferred to the uterus. In a frozen cycle, the embryo will be frozen at this point and transferred to the uterus at another time. This might be done if your uterus isn’t prepared to receive an embryo, or if you had several embryos that were successfully fertilised, they will be frozen, rather than transferring more than 1 at time, which is associated with multiple pregnancies (expecting two or more babies from a pregnancy).

Who is IVF for?

IVF can benefit lots of different types of people. Some instances where IVF may be explored could be:

1. If you’re having problems conceiving naturally
2. If you’re in a same-sex female relationship
3. If you’re using donor sperm 
4. If you have a problem with ovulation

What happens in an IVF cycle?

There are four key stages involved in an IVF cycle—ovulation stimulation, egg retrieval, egg fertilisation and embryo transfer. The entire process may take between 4 to 6 weeks but will vary and depend on you.

Ovulation stimulation

Firstly, you’ll take a course of fertility medication to stimulate your ovaries to mature multiple eggs. Usually in one menstrual cycle, you’ll only release one egg for ovulation. But this medication stimulates many eggs to mature. 

During this time you’ll need to go to the clinic regularly for ultrasounds and blood tests to analyse your progress. The simulation period generally lasts for around 10 days. 

Egg retrieval and sperm collection

Once your eggs are mature, you’ll undergo a retrieval procedure. Egg retrieval is carried out under ultrasound guidance, where a small transvaginal needle is used to suck follicular fluid  that contains your mature eggs, out of your ovaries.

You’ll have the option to have the procedure done under general anaesthetic or mild sedation. Whilst your eggs are being retrieved, your partner or sperm donor will be required to go into the clinic and produce sperm cells which will be used to fertilise your eggs, unless your partner or donor sperm has previously been frozen.

Egg fertilisation

During the fertilisation step, your eggs and the sperm will be combined in a lab. The goal is for the sperm cells to break into and enter your egg cells where an embryo will be formed. 

There are multiple techniques in which your eggs can be fertilised. One technique is called conventional IVF which involves placing the mature eggs in a petri dish full of sperm.

Another technique is called intracytoplasmic sperm injection (ICSI), where one sperm cell is selected based on morphology and injected directly into your egg cell. The technique used depends on the sperm, clinic and whether or not you have attempted conventional IVF successfully or not before.  

Embryo transfer

If you undergo a fresh cycle, any successful embryos will be transferred 2-5 days later. If you have a frozen cycle, you will be given medication to prepare the uterus lining and depending on your progress, your doctor will determine a transfer date. 

However, this doesn’t guarantee a pregnancy. The embryo will still need to successfully implant to your uterus. You will be given a pregnancy test roughly 2 weeks later, which can confirm whether or not the IVF process has been successful. 

The process for an embryo to grow into a healthy baby and undergo live birth is a very complicated and precise journey. A certain number of chromosomes, which is our genetic information in the form of our DNA, is required for an embryo to develop into a baby. 

The test that is used to understand and analyse the number of chromosomes in the embryo before implantation is called Pre-implantation Genetic Screening. However, many other screening techniques can be used too depending on your clinic.

Is only one embryo transferred?

If more than one egg is fertilised, your doctor will choose one to transfer, based on trying to assure the maximum possibility of a pregnancy. There are multiple criteria that the clinics use to determine this, including: 

1. Morphological grading: this is when the clinicians interpret how regions of the embryo appear
2. How fast the particular embryo is dividing and how fast it has reached a certain stage of growth. 
3. Use of a pre-implantation technique to understand which embryo is euploid (has a “normal” number of chromosomes).

Sometimes you will be given the option to transfer more than one embryo. This may increase your chances of developing multiple pregnancies but again, doesn’t guarantee a pregnancy.

Can you get IVF on the NHS?

The NHS provides full funding for IVF for those who:

1. have tried to conceive for 2 years naturally, without success 
2. have had 12 or more cycles of unsuccessful artificial insemination
3. are carriers of certain genetic conditions. 

Whether or not you are eligible for IVF under the NHS also depends on where you live as different trusts have different requirements and funding availability. You must discuss thoroughly with your gynaecologist or GP and if you are not eligible, there are many private clinics available for IVF treatments. 

The cost for 1 cycle of treatment is roughly £5,000. This depends on the clinic you choose and the treatment protocol you follow. 

How effective is IVF?

Yes, IVF can be an effective fertility treatment and many women can successfully become pregnant and give birth to healthy babies via IVF. The success rate depends on a range of factors, including age, medical history, sperm quality and success rates of your clinic. 

As younger women have a higher quantity and quality of eggs, the chances of a successful IVF are also higher for them. According to the Human Fertilisation and Embryo Authority (HFEA), roughly 30% of women under 35 who had IVF treatment resulted in live births and as your age increases the percentage decreases. 

Women who are over the age of 42 are not recommended to undergo IVF treatment as the success rate is low. Exact success rates have been reported by HFEA.

Are there any risks with IVF?

As with any medical procedure, IVF does have risks. Some people are at risk of developing ovarian hyperstimulation syndrome which is a severe side-effect of the fertility medication used to stimulate the ovaries. 

If you have a successful IVF pregnancy, your pregnancy will carry the same risks as one conceived naturally, including ectopic pregnancy (where the embryo will implant itself elsewhere in your uterus like in the fallopian tube rather than the womb). Older women are generally at a higher risk of developing complications compared to younger women.

How to prepare for IVF? 

In addition to getting clued up on all of the specifics, testing your hormones, specifically your AMH levels, can give an insight into your ovarian reserve. You’ll also need to have a pelvic ultrasound scan to determine your Antral Follicle Count. 

Managing your lifestyle choices may also boost your success rates. Things like quitting smoking, decreasing your alcohol intake as well as exercising regularly and eating a healthy balanced diet can all increase your chances of a successful pregnancy.