In vitro fertilisation (IVF)

Having children with the help of in vitro fertilisation has become quite common, and more than ten million babies have been born worldwide using IVF since the end of the 1970s.

Who can receive an IVF treatment?

IVF is the most advanced way to get pregnant and is only used if other methods have not worked or if, following a fertility investigation, there is reason to believe that other methods will not produce a child. IVF may be a viable option if, for example:

• the woman who wants to get pregnant has endometriosis;
• the quality of the sperm is not good enough;
• the woman who wants to get pregnant does not have any eggs;
• there is damage to the fallopian tubes.

A couple who are experiencing involuntary infertility and have undergone a fertility investigation may be able to receive an IVF treatment as the next step, and it is sometimes also possible for single women to receive an IVF treatment, for example in situations where several previous attempts at insemination have proven unsuccessful.

As always when it comes to treatments for infertility, it is important to find out what rules and requirements apply in the country where you live. In some instances, previous requirements on genetic links have been lifted and it has now also become possible to use donated eggs and/or sperm for IVF if a fertility investigation has shown that the woman who wants to get pregnant does not have any eggs that can be used, or that the man’s sperm simply won’t work. IVF may also be possible for people who already have a child, although in such cases the treatment may only be available via a private clinic.

Age limit for IVF

Depending on where you live, a certain age limit may apply to women who want to get pregnant via IVF, and men may also be subject to an upper age limit, as sperm quality deteriorates with age. For women wishing to receive an IVF treatment beyond the age limit prescribed for the public healthcare service in their country, it may be possible to arrange the treatment via a private IVF clinic, as such clinics often apply a somewhat higher age limit. It may also be an option to investigate treatment possibilities in other countries, as the rules on IVF, including the age limit, can vary from country to country.

The cost of an IVF treatment

Once again, it is important to find out what rules apply in the country where you live with regard to IVF treatment via the public healthcare service, including, for example, the number of attempts included in the standard treatment cost. Treatment via a private clinic will, of course, be more expensive, but the waiting times are often shorter. The cost may vary somewhat from clinic to clinic and is typically not insubstantial, with the final cost often dependent on the number of attempts or treatments required.

A step-by-step guide to IVF

In basic terms, IVF involves taking eggs from the woman and sperm from the man, bringing them together outside the body and then reinserting the fertilised egg in the woman. The following is a general description of the different steps involved, although certain parts of the process may vary somewhat from clinic to clinic.

1. Hormone stimulation
2. The eggs mature (check performed via ultrasound)
3. Egg retrieval/withdrawal and sperm collection
4. Fertilisation
5. Embryo transfer – the egg attaches to the lining of the uterus
6. Luteal support with administration of progesterone
7. Pregnancy test

1. Hormone stimulation (H3)
   Initially, the woman who is trying to get pregnant usually receives a nasal spray with a hormone that causes the ovaries to fall into a dormant state, so that ovulation will not start on its own. It is then time to stimulate the ovaries with the help of the hormone FSH, to help the eggs mature. This is done by way of daily injections for about two weeks. You can easily take the injections yourself at home with the help of an injector pen.
2. The eggs mature (H3)
   The hormone level required to stimulate the ovaries during these two weeks is very individual from person to person, and to ensure that the dose is correct, blood samples are taken on several occasions during this part of the treatment. As always when it comes to hormones, both your mood and your body will be affected, although the effects vary greatly from person to person. At the end of this part of the treatment, an ultrasound is used to see when it is time to remove the eggs. If you are to receive a donated egg, no preparation is needed prior to insertion of the embryo. Instead, the hormone treatment is given to the donor, unless the eggs have been frozen previously.
3. Egg retrieval (withdrawal) and sperm collection (H3)
   Using a thin ultrasound-guided needle, the fluid containing the eggs is retrieved from the follicles. This takes around 20 minutes and may hurt a little, but you will be anaesthetised during the process. After a brief rest you will then be able to return home on the same day.
   Following the egg retrieval process, the doctor now hopefully has several eggs that can be used – although even a single egg may suffice. If a male partner is involved in the pregnancy, his sperm are collected on the same day the eggs are retrieved, after which the sperm are screened so that only the most lively and viable sperm remain. If, on the other hand, donated sperm are going to be used, the sperm are already frozen at the clinic ready for use.
4. Fertilisation (H3)
   The eggs are cleaned of blood and other fluids with the help of a nutrient solution, after which the sperm and eggs are brought together in a culture dish – in other words, not an actual test tube, despite the commonly used term “test tube baby”. The small dish is then placed in a warming cabinet where the conditions are designed to simulate the female body as much as possible in terms of temperature, pH value and humidity, after which the medical staff wait for the sperm to fertilise the egg.
   There is also a fertilisation method called microinsemination (ICSI), whereby a single healthy sperm is selected and injected directly into the egg, rather than simply allowing the sperm to fertilise the egg on their own.
5. Embryo transfer – the egg attaches to the lining of the uterus (H3)
   After about three days, a fertilised egg (embryo) is selected, and if there is more than one, the remaining eggs are frozen so that they can be used later if needed. The egg is then placed in the uterus in the hope that it will attach to the lining of the uterus. Many people wonder if there is anything they can do to help the egg attach, but apart from living healthily there is unfortunately not much else that you can do to aid the process.
   As a rule, only one egg is placed in the uterus, as this reduces the risk of various complications that are more common when carrying more than one child, and these days the methods of freezing eggs are so good that it is generally thought better to only insert one egg and then try again with a frozen egg if necessary, rather than taking the chance of inserting two eggs at the same time. It is therefore only in a few exceptional cases that the doctor may choose to place two embryos directly in the uterus at the same time.
6. Luteal support to increase the chance of successful implantation (H3)
   After the egg has been placed in the uterus, you may also be administered vaginal tablets or gel with the hormone progesterone for approximately 2–3 weeks. This is done to stimulate the lining of the uterus and increase the chance of successful implantation.
7. Pregnancy test after two weeks (H3)
   Now comes the difficult wait between the implantation of the egg and the first pregnancy test, which can be done two weeks after the embryo has been placed in the uterus. If the pregnancy test is positive, the doctor performs a vaginal ultrasound to make sure that everything looks good. If the pregnancy test is negative, the entire procedure must be repeated.
8. 
   For a pregnancy achieved through IVF, the estimated due date is calculated slightly differently: the pregnancy is deemed to have started two weeks prior to placement of the embryo in the uterus, as the actual fertilisation process occurs before the embryo is placed in the body.

What is the difference between ICSI and a standard IVF treatment?

ICSI (microinsemination) involves largely the same approach as a standard IVF treatment, apart from the fact that the actual fertilisation process is achieved by selecting a single healthy sperm to be injected directly into the egg. Microinsemination is mainly used in cases of male infertility, i.e. if there are only very few viable sperm left and it is important not to waste them. Sometimes it may also be necessary to collect the sperm directly from the testicles, if there is a blockage in the tubes that normally transport the sperm. This procedure is performed via a needle through the skin, during which the man is placed under local anaesthesia. The same type of procedure can, in fact, also be used on men who have previously undergone sterilisation.

Does IVF provide a good chance of getting pregnant?

Around one in three women get pregnant after a first attempt at IVF, but the likelihood of getting pregnant increases with each attempt and is also affected by age – the younger you are, the greater the chance that you will get pregnant. Around two thirds of all women who attempt IVF three times experience the joy of getting pregnant.

Hyperstimulation in connection with IVF

The most serious (but uncommon) complication in connection with IVF – hyperstimulation – occurs before pregnancy and involves the ovaries responding too strongly to the hormonal stimulation provided as part of the treatment. This is something that is usually noticed towards the end of the treatment or when the egg is placed in the uterus. Hyperstimulation results in very enlarged ovaries, which can result in severe pain, abdominal bloating, vomiting and difficulty taking deep breaths. To reduce the risk of hyperstimulation, blood samples are taken several times during the treatment, but if you still get symptoms of hyperstimulation, you should always contact the clinic for an assessment, and if you start feeling very unwell, you may need to seek emergency medical care. After recovering from hyperstimulation, it is usually fine to attempt IVF again, but it often takes a while to recover properly, and all embryos are therefore usually frozen until the next attempt can be made.

Preparing mentally for an IVF treatment

Waiting is a large part of the IVF treatment, and constantly waiting without any guarantee of success (i.e. pregnancy) is often very stressful mentally. If you are a couple undergoing the treatment, you should try to have as open a dialogue as possible with each other during the process. This sort of situation can place a strain on your relationship, but it can also bring you even closer together! Apart from leaning on each other for support, it can also be nice to have someone else with whom you can talk and vent your feelings. Most clinics usually have affiliations with therapists and/or psychologists who can provide advice and support. One sound piece of advice is to try to allow life to continue as normal to the greatest extent possible, and to stick to your usual routines and spend your time doing the things you enjoy.

Before commencing an IVF treatment, it could be a good idea to discuss how many attempts the treatment will involve (sometimes this discussion occurs naturally, as you may, for example, be required to pay for several attempts at once). It may then become necessary to re-evaluate this decision, for example if new information comes to light during the process – but it can still be good to have considered this aspect before commencing the treatment. So discuss this with your partner if you are a couple, or make a decision that you feel happy with if you are on your own – and remember that your doctor is always on hand to provide guidance and answer any questions you may have.