In Vitro Fertilization (IVF)

Author: MR RADWAN FARAJ - CONSULTANT OBSTETRICIAN AND GYNAECOLOGIST

Date: Mar 2017

IVF offers hope when other infertility treatments are unsuccessful. It eliminates any barriers between egg and sperm by combining them in a lab. The growing embryos are then placed inside the uterus. Undergoing IVF can be stressful and expensive, with an average cycle costing £3000. But success rates are growing every year. In general success rate is about 1 in 3 and could be higher in younger age (less than 35).

  • The first ‘test tube baby’, Louise Brown, was born in July 1978
  • By 1990, there had been 90,000 births resulting from fertility treatment

Five million babies have now been born by IVF – and HALF since 2007
More than 5 million babies have now been born through in vitro fertilization (IVF). Other therapies are successful, too — at least half of couples who seek treatment for infertility will get pregnant.
 
 
IVF With ICSI
 
When a man’s sperm count is extremely low or the sperm don’t move well, they may not be able to fertilize an egg without help. A procedure called intracytoplasmic sperm injection (ICSI) can overcome this problem by inserting a single sperm directly into an egg. The resulting embryos are then transferred to the uterus through the normal IVF procedure. The majority of IVF cycles now use ICSI. Sperms can also be obtained from the testes (TESE) if no sperms were found in the ejaculate and used for ICSI.
 
IVF and Multiples

To boost the odds of success with IVF, it’s common to transfer one to two embryos at a time. But this means the woman may become pregnant with twins or even, triplets. Carrying multiples raises the risk of miscarriage, anemia, high blood pressure, and other complications during pregnancy. It also makes premature birth more likely. We will discuss these issues with couples undergoing IVF in more details.
 
Tubal infertility

Investigations of tubal patency to ensure both fallopian tubes are open by either Hysterosalpingogram (dye test) or by Diagnostic laparoscopy (key hole operation)
Laparoscopic tubal surgery
Success rate depends on the severity of tubal disease and the cause. Most common causes are Pelvic infection like chlamydia, endometriosis or previous adhesions from pelvic surgery. In mild tubal damage success can be up to 80%.
Hysteroscopic tubal cannulation
This procedure will be offered if fallopian tube block was proximal (near the entrance into the womb) It can be done as a day case under laparoscopic control. Usually if at least one fallopian tube is open after operation, you stand a good chance of natural pregnancy.
Hysteroscopic surgery
In certain cases, women may have problems inside the cavity of the uterus like:
Fibroids and polyps: Can be treated by Hysteroscopic resection of the fibroid. It is a day case operation and will improve your chances of pregnancy.
 
Ovarian diathermy (laparoscopic ovarian drilling)

Used for women with PCOs (Polycystic Ovary Syndrome) who are resistant to ovulation with tablets (Clomiphine and Metformin).

It is a day case operation, using diathermy energy, 4-5 points in the ovary will be cauterised. This will improve response to ovulation drugs. Results are encouraging and is less likely to produce twin pregnancy and is cost effective.
 
How can a couple reduce IVF cost:

Most couples are eligible for NHS funded IVF. However, the number of IVF cycles funded by the NHS varies from area to area (1-3). Unfortunately, the NHS is unable to fund a large number of couples based on strict eligibility criteria. Example if either partner had a child before, women aged above 40 or has raised BMI over 30. Similar couples have to self  fund their IVF with an estimated cost of £3500-£4000/ cycle. There are ways to aim and cut down the IVF cost:

  1. Healthy life style and weight loss: The higher the weight (BMI over 30) the less success with IVF. Losing weight will also reduce the number of injectable hormones you need and that reduces cost.
  2. Explore the option of shared gamete IVF: By agreeing to donate half of your eggs, or your partner part of his sperm, that will significantly reduce your IVF cost. Be aware of future offspring implication and be sure you will be offered appropriate counselling.
  3. Search for an IVF unit with good reputation and success rate.
  4. Explore the option of (Satellite IVF) or shared care model: some consultants start the first part of IVF in one unit and when the eggs are ready, the women will go to the main Assisted Conception Unit for the second part (Egg collection and Embryo Transfer).

The idea is to have a personalised consultation during most of your IVF treatment, all under the care of your consultant. This includes an initial consultation with the same consultant. During this consultation you will have a transvaginal (internal) scan and the necessary hormonal tests.

The next part is the IVF stimulation protocol. This will start with hormonal injections and 3-4 follow up visits. 
Once your eggs are ready to ovulate, you will be booked for the second part of IVF/ICSI in the Assisted Conception Unit. Following that you will have the embryo transfer procedure. Further follow up for pregnancy scans is of your choice. For further information please visit:  www.faraj-gynaecology.co.uk

Article written by Mr Radwan Faraj - Consultant Obstetrician and Gynaecologist

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Last revised: 6 March 2017