What is IVF?

The first person in the world to be born through In Vitro Fertilisation (IVF) was Louise Brown, who was born in 1978 at Oldham General Hospital. In 1978, IVF was highly experimental. The treatment was pioneered by gynaecologist Patrick Steptoe and Nobel Prize-winning physiologist Robert Edwards, and Louise’s birth was hailed as a miracle of modern science at the time.

Forty plus years on, UK Government figures show that between 1991 and 2019, around 390,000 babies have been born from fertility treatment; IVF accounts for 2%–3% of all live births in the UK.

Worldwide, over 8 million IVF children have been born, and over 2.5 million treatment cycles are being performed every year, resulting in over 500,000 deliveries annually (source RBMO Journal).

What is IVF?

In vitro from Latin, means outside the body. In Vitro Fertilisation, most commonly referred to as IVF, is one of the more widely known types of assisted reproductive technology (ART) used to help people conceive. Treatment begins with stimulation of the ovaries and includes collecting eggs and sperm, fertilising the eggs outside the woman’s body, and placing one or two of the embryos into the womb.

What are the steps involved in IVF?

Once a patient has been accepted for IVF treatment, there are a number of stages in the process to achieve pregnancy.

These include:

• Ovarian stimulation – once IVF treatment starts the first step is to stimulate the ovaries. The patient is given medicine that temporarily switches off (suppresses) the hormone that releases their eggs, meaning the clinic can control when the eggs are released. This is followed by another medicine to encourage or ‘stimulate’ the ovaries to produce more eggs. The aim is to collect as many eggs as possible.
• Egg retrieval – once the follicles are big enough, the eggs can be collected. The patient receives a ‘trigger’ injection which allows for the final maturation of the eggs. During the collection procedure, the patient is under sedation; however, they can normally go home on the same day. Some patients might get some lower tummy or pelvic pain after the procedure, and it is safe to take paracetamol for this.
• Sperm preparation and collection – a sample of semen, the fluid that contains sperm, is collected from the patient’s partner. Before sperm can be used for fertilisation it must first be prepared to ensure that only the best quality sperm are used in the IVF process. If using frozen or donor sperm, the sample is prepared.
• In vitro fertilisation – once the eggs have been collected and the sperm has been prepared, it is time to incubate them together in a laboratory. During incubation, the sperm cells swim towards the eggs and fertilise them. Sometimes, each egg needs to be injected individually with a single sperm; this is called intra-cytoplasmic sperm injection (ICSI).
• Embryo transfer – after incubation, the best quality embryos are chosen for transfer. During embryo transfer, the best one or two embryos are put into the womb. This is a much simpler procedure than egg collection and there is no need for sedation. If the embryos cannot be transferred straight away or if there are extra ones, these embryos might be frozen for later transfer.
• Pregnancy test – after treatment, the patient is asked to wait for 14–16 days before performing a pregnancy test, often called the two-week wait. If the test is positive, the doctor will oversee the rest of the patient’s journey. The chances of a clinical pregnancy, this is when an ultrasound scan confirms a foetal heartbeat, are:
  – 1 in 3, when a patient starts a cycle.
  – 1 in 2 if the patient is under 35 years old and has a blastocyst embryo transfer – this is when embryos that are better developed by day 5 after egg collection are placed in the womb.

If the pregnancy test is negative, all the information gained through the IVF cycle will be used to create a plan for the next steps.

HealthUnlocked’s IVF community is a network of people who have gone or are going through cycles of IVF who provide advice and support to others in the same situation.

How long does IVF take?

IVF processes will be different for every clinic, but you can expect one IVF cycle to take between six and nine weeks, including the time it takes to know whether you are pregnant or not. The IVF cycle itself takes around four weeks, the length of a normal ovulation cycle.

How to prepare for a cycle of IVF

How you go about preparing for IVF depends on your timeline. It is obvious that the longer you have to prepare your body the better, and that includes both partners. The egg and the sperm are exposed to everything that is circulating in your bloodstream. This includes vitamins, minerals and any chemicals that you come into contact with. This may be through your skin, via the food that you eat or the air you breathe.

Taking three to six months to prepare your body for IVF is ideal; however, many people may not have that amount of time and often only have 1–2 months. Irrespective of how long you have there are always things you can do to prepare:

Quit smoking and drinking – nicotine is ten times more concentrated in the uterine fluid than in the rest of your body. Nicotine also ages the ovaries and makes eggs resistant to fertilisation. In addition, studies have shown correlations between alcohol consumption and a decreased likelihood of recreational drugs and live birth following IVF treatment. Recreational drug use by either or both partners also has an impact on IVF success.

Lose weight if you are overweight – national guidelines on obesity and infertility are very clear; your weight can affect your fertility. Guidelines indicate that your chances of getting pregnant with IVF are better if your BMI is between 19 and 30. A BMI over 30 has a significant negative effect on IVF pregnancy success rates.

Eat fertility enhancing foods – fertility boosting foods include:

• Eggs.
• Citrus fruits.
• Pomegranate.
• Pineapple.
• Green leafy vegetables.
• Asparagus.
• Walnuts.
• Mature cheeses.
• Full-fat dairy.
• Beans and lentils.
• Oats.
• Sunflower seeds.
• Liver.
• Oysters.
• Salmon.
• Cooked tomatoes.
• Fish roe / caviar.
• Seaweed / algae.

Four foods that may increase male fertility and improve sperm health are fish, green and leafy vegetables, fruit, and walnuts.

Vitamins and nutrients are important for fertility and pregnancy particularly:

• Folic acid.
• Omega-3.
• Vitamin D.
• Zinc.
• Magnesium.
• Iron.

The quality and quantity of sleep influences sex hormones, sperm production and ovulation. It is critical to make sure you and your partner are getting enough good quality sleep, especially leading up to an IVF cycle.

Research indicates that lower levels of measurable physiological stress indicate higher IVF success. The process of IVF can be stressful, so taking measures to reduce stress and increase relaxation before and during IVF can be very helpful, such as:

• Deep breathing.
• Massage.
• Meditation.
• Yoga.
• Aromatherapy.
• Hydrotherapy.

As you learn relaxation techniques, you can become more aware of muscle tension and other physical sensations of stress. Once you know what the stress response feels like, you can make a conscious effort to practise a relaxation technique the moment you start to feel stress symptoms.

How successful is IVF?

IVF definitely increases the chances of pregnancy for people having fertility problems; however, there is no guarantee, as everyone’s body is different and IVF doesn’t work for everyone.

In the UK, around 20%-25% of IVF treatment cycles result in a birth. In 2019, the percentage of IVF treatments that resulted in a live birth was:

• 32% for women under 35.
• 25% for women aged 35 to 37, with success rates decreasing dramatically in women over 40.

How safe is IVF?

No medical procedure is 100% safe. As a fertility treatment, IVF treatment itself has proved to be extremely safe for the majority of patients; however, for some patients there are a number of risks and possible side effects which are outlined below.

Additionally, if IVF is successful, pregnancy and childbirth will bring their own medical hazards and risks.

What are the risks of IVF?

As with all medications and medical procedures, IVF has some risks and possible side effects. These can include:

• Bloating.
• Cramping.
• Breast tenderness.
• Mood swings.
• Headaches.
• Bruising from injections.
• Allergic reaction to medicines.
• Bleeding.
• Infection.

As everybody is unique, an individual patient’s reaction to any of the medications or medical procedures involved in IVF treatment will often differ. For some there is a chance that they might under or over respond to the dosage of medication, causing the need to cancel the cycle and start again from the beginning to get a better response.

If an individual’s ovaries are particularly sensitive, they can over respond to the stimulation from the drugs and develop Ovarian Hyperstimulation Syndrome (OHSS). OHSS occurs in 0.5% of patients and is a potentially serious complication of fertility treatment, particularly of in vitro fertilisation (IVF).

Although it is normal to have some mild discomfort after egg collection, you should seek medical help and advice from your fertility unit in the first instance if you develop any of the symptoms below:

• Mild OHSS – mild abdominal swelling, discomfort and nausea.
• Moderate OHSS – symptoms of mild OHSS, but the swelling is worse because of fluid build-up in the abdomen. This can cause abdominal pain and vomiting.
• Severe OHSS – symptoms of moderate OHSS with extreme thirst and dehydration. You may only pass small amounts of urine which is dark in colour and/or you may experience difficulty breathing because of a build-up of fluid in your chest. A serious, but rare, complication is the formation of a blood clot (thrombosis) in the legs or lungs. The symptoms of this are a swollen, tender leg or pain in your chest and breathlessness.

If you are unable to contact your fertility clinic, then you should contact either your GP, the NHS on 111 or the A&E department at your local hospital.

The risk of having an ectopic pregnancy, that is when a fertilised egg implants itself outside of the womb usually in one of the fallopian tubes, is slightly increased for patients having IVF.

If more than one embryo is placed in the womb as part of IVF treatment there is an increased chance of having a multiple birth such as twins.

IVF can also be difficult emotionally, both for the person having the procedures and for their partner and/or family. For patients undergoing treatment, it can be physically and emotionally demanding. For partners it can be difficult to watch a loved one go through a stressful experience. Many people going through IVF treatments struggle with depression and anxiety throughout the process.

New mental health issues may arise, or pre-existing mental health issues may become more severe or even worsen during IVF treatment. For some, the disappointment of an IVF cycle not being successful can be a form of grief. Patients should make their mental health a priority if they are undertaking IVF treatment.

Why may IVF be an option?

IVF helps many patients who would be otherwise unable to conceive, making having a baby a reality for people who would be unable to have a baby otherwise, for example:

• For women with blocked or damaged fallopian tubes, IVF provides the best opportunity of having a child using their own eggs.
• IVF can be used to maximise the chance of patients conceiving, such as older women, and those with low ovarian reserves, as it can focus on the quality of eggs, rather than the quantity.
• Couples with a male infertility problem will have a much higher chance of conceiving with IVF than conceiving naturally.
• Sometimes couples will suffer undiagnosed fertility problems that persist even after investigation. These patients may benefit from IVF intervention; however, in some cases of unexplained infertility, there could be a problem with fertilisation. Cases such as these may not be diagnosed until fertilisation is attempted in IVF.
• Polycystic ovary syndrome is a common condition in which there is a hormone imbalance leading to irregular menstrual cycles. IVF has proved very successful in patients with PCOS, who will not conceive with ovulation induction.
• Patients with endometriosis, where parts of the womb lining grow outside the womb, may like to try IVF, as it has proved successful in this group.
• Women with premature ovarian failure or menopause can have IVF treatment using donor eggs, which typically has high success rates.
• For single women or for same-sex couples who wish to have a child, IVF can provide a great opportunity for helping them to become parents if Intrauterine Insemination (IUI) has not been successful; IVF with donor sperm can help potential patients achieve this.
• For individuals who are known carriers of genetic disorders such as cystic fibrosis, Huntington’s disease and muscular dystrophy, IVF with pre-implantation genetic diagnosis (PGD) is one of the most reliable ways to ensure that a child conceived will not suffer from the disorder.

Can IVF be done on the NHS?

NHS funding for IVF treatment varies greatly across the UK. In Scotland, 62% of IVF cycles were funded by the NHS, whilst in the East of England this was as low as 20%.

Recommendations about the criteria for who should have access to IVF treatment on the NHS in England and Wales are made by the National Institute for Health and Care Excellence (NICE). Although their recommendations are that IVF should be offered to women under the age of 43 who have been trying to get pregnant through regular unprotected sex for two years, or who have had 12 cycles of artificial insemination, with at least six of these cycles using Intrauterine Insemination (IUI), the final funding decisions about who can have NHS-funded IVF in England is made by local Integrated Care Boards (ICBs). Integrated Care Boards (ICBs) were established as statutory bodies in July 2022 and succeed Sustainability and Transformation Partnerships (STPs).

Although NICE recommend that up to three cycles of IVF should be offered on the NHS in England, some ICBs only offer one cycle, or only offer NHS-funded IVF in exceptional circumstances. Below is an example of NHS England IVF funding differences. These differences occur even between hospitals under the same Clinical Commissioning Group, in this example case, University College London Hospitals (UCLH):

• Camden – 3 fresh IVF cycles and 3 frozen cycles.
• Islington – 2 fresh cycles.
• North West London – 1 fresh cycle and 1 frozen cycle.

In the other three UK nations, Northern Ireland, Scotland and Wales, funding decisions for IVF are taken by that individual nation’s NHS services.

Anyone who is not eligible for NHS-funded IVF, and this may include patients who have already had some self-funded (private) cycles, or anyone who requires more cycles of IVF than NHS funding is available for, may be able to access treatment through a private fertility clinic. Costs for private IVF vary greatly and can be expensive depending upon such things as the number of cycles required, the clinic selected etc.

What could prevent someone from getting IVF?

One of the biggest barriers to being able to get IVF on the NHS, apart from funding issues, is age. NICE guidelines are that IVF is not usually recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be too low. Women over the age of 42 may be considered for IVF treatments in the private health sector.

Conditions that may interfere with IVF success include:

• Fibroid tumours.
• Ovarian dysfunction.
• Abnormal hormone levels.
• Uterine abnormalities.

Women with these issues may face lower rates of pregnancy with IVF and may not be accepted for the treatment.

A major issue that could prevent someone getting IVF that has little to do with health, is finance. As we have seen, not all potential IVF patients are eligible for treatment on the NHS, or even if they are, they may require more cycles of treatment than there is funding for. In these cases, patients would need to fund the expensive treatment themselves, which for many people may be prohibitive.

A final reason related to finance may be the ability to take time off work for IVF treatment. Currently, there is no legal right for time off work for IVF treatment or related sickness. However, your employer should treat your medical appointments for IVF treatment like any other medical appointment, which may mean taking unpaid leave. You do, however, have all the same pregnancy and maternity rights as non-IVF pregnancies if you become pregnant through IVF. If the IVF was unsuccessful, you are still protected by law against pregnancy discrimination for two weeks after finding out an embryo transfer was unsuccessful.

Final thoughts

It has been 44 years since the birth of the world’s first IVF baby Louise Brown. Louise married in 2004 and has had two naturally conceived sons. In 2018 she gave an interview to Time magazine on “What It Was Like to Grow Up as the World’s First Test-Tube Baby”.