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Fertility 101: IVF - how it works

Fertility 101: IVF - how it works

What is IVF?

In IVF (in vitro fertilisation), an egg is removed from a woman’s ovaries and fertilised, in a laboratory, with sperm.  The ‘in vitro’ bit literally means ‘in glass’, so-named because the hoped-for fertilisation takes place outside the body, in a petri dish.

The goal is to cultivate a viable embryo that can then be placed back inside the woman’s uterus to develop into a healthy baby.

IVF can be carried out using:

  • Your own eggs and partner’s sperm; 
  • Donor eggs and your partner’s sperm;
  • Your own eggs and donor sperm;
  • Both donor eggs and sperm.    

Is IVF for me?

We are all different and some of us take longer than others to get pregnant.

If you’re experiencing difficulties conceiving and have been trying for some time – and the general rule of thumb is two years if you’re under 35 and six months if your over 35 - then the best first step is to see your GP.  

They can do some basic tests (including blood tests, ultrasounds to look at the condition of the womb) to help rule out any underlying, but often treatable, medical conditions which may be a factor.  They can also talk you through the various fertility treatment options (also see our guides for more) and might recommend IVF if:

  • You’re female, under 40, and have been struggling to conceive naturally after two years of regular sex
  • You’ve been diagnosed with a condition affecting your fertility such as blocked or damaged fallopian tubes, or you’ve had to have them removed
  • You suffer from endometriosis; polycystic ovarian syndrome (PCOS); fibroids etc
  • Your menstrual cycles are irregular
  • You’re no longer ovulating - if you’ve gone through early menopause for example
  • You or your partner have undergone cancer treatment which may have affected your fertility
  • Your partner is experiencing male factor infertility such as low sperm count 
  • Either you or your partner has a known genetic condition
  • You’re in a same-sex couple
  • You’re a single woman wanting to start a family
  • You’ve tried some other fertility treatments e.g. fertility drugs to regulate ovulation or you’ve tried artificial insemination without success
  • You’re experiencing ‘unexplained infertility’ ie there’s no apparent medical reason why you’re having difficulties conceiving

What’s the process?

The prospect of IVF can seem like a BIG THING and very ‘medical’ so understanding what happens at each stage of the process can help it feel a bit more approachable.  Here’s a quick breakdown so you know what to expect in a typical cycle: 

  1.  Cycle management. You might be put on the contraceptive pill for the month before you start your IVF cycle.  Although this sounds counter-intuitive, this is just so your doctor can control the timing of ovulation in preparation for your treatment. 
  2. Stimulation.  You’ll be given drugs which are usually self-injected daily and taken for around 10 to 14 days.  Usually, in a natural cycle, your body only releases one egg per month at ovulation time. The IVF medicine (usually known as Gonadotrophins) stimulates your ovaries into producing multiple eggs which can then be retrieved from your ovaries once they’ve had chance to ripen or ‘mature’. The average number of eggs retrieved is between 8-15 but you’re looking for quality not quantity so don’t be disheartened if you only produce a couple of eggs, especially in your first cycle. IVF is not a precise science and response to treatment can vary from one person to another.  Your doctor can tweak subsequent rounds of IVF based on your response to the drugs. Plus, remember it only takes one good embryo to get you pregnant. 
  3. Monitoring. You’ll be booked in for regular scans and blood tests during the stimulation phase – normally every few days.  The ultrasound scans are to check how many follicles you're producing in response to the medication, how quickly they are growing and how big they are.  Your doctor will use this information to estimate when the eggs are likely to be ‘ripe’ and therefore when ovulation might occur. Timing is key in IVF: the doctors don’t want you to ovulate too soon – they need to be able to remove the eggs when they are ready, during the egg collection procedure (see step 5, below).  
  4. Trigger shot. Two days before your eggs are due to be collected, you will be told to take another hormone injection, usually referred to as the ‘trigger shot’ as it triggers the final maturation of the eggs.  
  5. Egg collection. You’ll be given a light general anaesthetic so your doctor can retrieve the eggs that have been developing over the last couple of weeks.  It’s a short, straight-forward procedure using guided ultrasound and you’ll be able to go home the same day (though it’s important to have someone to collect you because you’ll be unfit to drive with the anaesthetic).  When you wake up you’ll be told how many eggs they collected. Your eggs will be taken straight to the lab where the embryologists will start put them with the sperm collected in a sperm sample from your partner that day (via masturbation) or using donor sperm.   
  6. Fertilisation and embryo development. Hopefully some of the eggs fertilise and the embryos begin to develop. Your eggs will be monitored daily in the lab and you’ll be kept updated on their progress, usually by phone. The embryologist will judge when it’s best to transfer the developing embryo or embryos back into your uterus.  If egg quantity and quality is good, the embryologist will usually try to let the eggs mature in the lab for as long as possible, ideally to blastocyst stage, but your eggs might be transferred any time from day 1 to day 6 after retrieval. 
  7. Embryo transfer. You’ll be fully awake for this quick, simple procedure and it’s fascinating to watch on the ultrasound screen as your embryo or embryos are guided into your uterus via a very thin catheter.  You’re able to get up off the bed straightaway (there’s no scientific evidence to suggest lying down has any effect on implantation whatsoever) and carry on your day. 
  8. Embryo freezing. If you have any embryos left over from your IVF cycle that are suitable for freezing, they can be stored for future transfers.
  9. The two week wait. You’ve made it through the injections and medical procedures, and now…nothing. Possibly the hardest part of any IVF cycle, this last 10-14 day phase sees you counting down the days until you can take a pregnancy test and/or have a blood test back at the hospital to determine whether or not the treatment has been successful.  If so, you’ll have your first pregnancy scan two weeks later. If it hasn’t worked, you can discuss next steps and options with your doctor. 

Will I need to pay for IVF?

The short answer? It depends.

Somewhat unfairly, the availability of NHS funding for your IVF and how many free ‘cycles’ or ‘rounds’ you’re entitled to largely comes down to where you live (you may have seen headlines in the press highlighting this unfortunate ‘postcode lottery’ affecting many UK IVF patients).

Guidelines have been set by NICE - the National Institute for Health and Care Excellence - recommending all women in England and Wales aged under 40 should be offered 3 free cycles of IVF treatment on the NHS.

They also say women aged 40-42 should be offered one free IVF cycle provided certain criteria are met. Go here to see the NICE Guidelines in full.

However, since funding is controlled at a local level (by Clinical Commissioning Groups, or CCGs) and not all CCGs provide the full 3 funded cycles, you might have to pay a private clinic if you are only offered one cycle on the NHS and need further treatment or if you are not eligible for any funded cycles at all.

You can find out how many cycles your local CCG currently offers by going to Fertility Fairness.

If you’re not eligible for NHS-funded IVF – so if you’re over 40 or need more cycles than those provided by your CCG – then you can opt to have treatment at one of the many private clinics in the UK and abroad (click here to search and book a clinic).

Costs vary but for a single cycle in the UK, once fertility drugs, blood tests and consultation fees have been included, you’ll need to budget £3,000-£5,000 and up.  

There are package discounts available from some clinics – often involving ‘money back guarantees’ for those willing to pre-book a series of IVF cycles – which could work out more cost-effective, particularly given a recent study put the average number of cycles required before success at 2.7, though of course some people do get lucky on the first round.  And it’s also worth remembering that if your initial IVF cycle (often referred to as a ‘fresh’ cycle) is unsuccessful but you have some embryos left over for freezing, it costs a lot less – usually around £1,500 – to do a subsequent cycle to transfer one of your frozen embryos (see our guide to Freezing your eggs).

Will it work?

The good news is that according to a recent report from the HFEA (Human Fertilisation & Embryology Authority), success rates are on the rise:

  • 22% average birth rate for women of all ages using their own eggs
  • 30% in women under 35 using their own eggs in a fresh embryo cycle

However there’s no avoiding the stark reality that success rates in women over 35 decrease quite significantly year-by-year.

To give you an idea, between 2014 and 2015, the percentage of IVF treatments resulting in a live birth was:

  • 23% for women aged 35 to 37 
  • 15% for women aged 38 to 39 
  • 9% for women aged 40 to 42 
  • 3% for women aged 43 to 44 
  • 2% for women aged over 44 

So if you’ve been struggling to get pregnant for some time or are over 35 you might want to get started on treatment sooner rather than later. You might also want to think about alternative ways to start a family, too, such as using donor eggs or sperm; surrogacy and adoption.  See our handy guides for more on these topics, too.

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