In-Vitro Fertilisation (IVF)

In-Vitro Fertilisation (IVF) is one of the techniques available to help couples with fertility issues have a baby.

Not all couples will need IVF to have a baby, and there could be many reasons why IVF may be a suitable option. Some of these include:

• Difficulty in conceiving for at least 2 years, with no underlying medical reason (unexplained in-fertility)
• Known fertility problems such as damaged / blocked Fallopian tubes, endometriosis, abnormal sperm counts, failure to ovulate regularly and reduced egg reserves
• Previous unsuccessful reproductive techniques like intrauterine insemination (IUI) – the placement of sperm inside the womb

Your doctor will advise you on whether IVF is a good option to help assist or speed up pregnancy.

What are the steps to IVF?

1. Controlled stimulation of the ovaries to recruit and mature eggs
2. Harvesting of matured eggs
3. Fertilisation of eggs with sperm
4. Culturing and grading of the resulting embryos
5. Transfer of embryos
6. Supporting the pregnancy
7. Freezing of excess embryos not transferred

Stimulation of ovaries

Eggs present in the ovaries are immature, and not ready to be fertilized. They need to be stimulated to mature, before they are ready for collection and fertilization. In a natural pregnancy, only one mature egg is released monthly. In IVF, medications are given by self-injections daily to encourage the ovaries to produce more eggs than usual. The type and amount of medications used is tailored for each individual woman. During this time, it is crucial to monitor the egg growth with regular ultrasound scans.

Harvesting of eggs

When the eggs are mature, collection of eggs is done with the guidance of ultrasound scans. A needle is inserted via the vagina, into the ovaries, to remove the eggs. You will be given some sedation medication to sleep, so that you do not feel any discomfort or pain. Eggs collected are then processed in the laboratory.

Fertilization of eggs

Fertilization is when the sperm enters the egg, to combine and form an embryo (fertilized egg). The partner’s sperm is processed to select suitable sperm for fertilization. The eggs and sperm are then mixed together in the laboratory and left for a few days to allow fertilization to take place. Resulting embryos are then selected to identify the embryos with the best chance of pregnancy.

Transfer of embryos

Selected embryos (usually the best 1-2 embryos) will be transferred into the womb for implantation (attachment of embryo to the womb lining, resulting in pregnancy). This is usually done in the clinic where you will be awake. A device called a speculum is inserted into the vagina, and the embryos are placed into your womb under ultrasound guidance. This process is painless, but if you feel discomfort, tell your doctor and adjustments can be made to make you more comfortable.

If you have remaining good embryos that were not transferred, they can be frozen and kept for future transfer, without going through the whole IVF process from the start.

Supporting the pregnancy

After embryo transfer, hormones are given (either in the form of oral tablets, vaginal pessaries, topical gels or in combination) to support the womb lining and encourage implantation. A pregnancy test is performed 2 to 3 weeks later to see if IVF was successful.

What are the risks?

Some risks include:

• Side effects from medications used during the IVF process
• Multiple pregnancies (twins, triplets) due to more than one embryo successfully implanting
• Ectopic pregnancy – embryo implanting somewhere else other than the womb lining, such as in the fallopian tubes
• Ovarian Hyperstimulation Syndrome (OHSS) – a condition where too many eggs develop in the ovaries in response to stimulation. This may result in excessive fluid accumulation in parts of the body such as the abdomen (tummy), and in severe cases, the lungs, kidneys, and liver. Mild cases can resolve spontaneously, while severe cases are rare and may need admission to the hospital.