Treatment for infertility: in vitro fertilization (IVF)

In vitro fertilization or in vitro fertilization (IVF) is the process by which oocytes taken from the ovaries and mixed in a laboratory in the Petri dish with semen. Fertilization takes place in a shell, ""in vitro"", which means ""in glass"".

Louise Joy Brown was born in 1978, the first baby born in a test tube (""retort baby""), and thousands of IVF babies have been born since 2009. In 2009, nearly two percent of all babies born in Germany were conceived through IVF treatment (HFEA 2011a).

Does IVF qualify for us?

IVF is recommended for the following fertility disorders:
  • If you have blocked or damaged fallopian tubes (eg after surgery or surgery) by endometriosis).
  • If your partner has a ""small"" problem with his sperm. Larger problems are better treated with intracytoplasmic sperm injection (ICSI).
  • If you have already tried unsuccessful fertility drugs, such as Clomiphene, or other infertility treatments, such as IUI.
  • If you've been trying to get pregnant for at least two years, or less if you're 35 years or older. This is true if no reason has been found that explains why you did not become pregnant (HFEA 2011b).

Do the statutory health insurance pay an IVF?

The assumption of the costs for an artificial insemination are regulated for patients of the legal health insurance in the social code V § 27a. The health insurances contribute to the costs for up to three measures. The prerequisite is that a doctor considers the IVF necessary, that you and your partner are married, and that egg and sperm cells are used by you and your partner. In addition, your partner and you must have undergone a reconnaissance and counseling session with another doctor.

If you are younger than 25 or older than 40, or your partner is older than 50, you are not entitled to benefits in kind.

Most importantly, you submit a treatment plan to your healthcare provider for approval before your treatment starts. The health insurance company contributes half of the approved costs, the rest you have to pay.

How is an IVF performed?

The IVF consists of a series of steps. It starts with an injection for cycle regulation.

You may need to inject medication to stimulate your ovaries, produce and mature one or more eggs. During your normal menstrual cycle, you release an egg cell every month.You may also choose not to take these ovarian stimulating drugs, but your chances of getting pregnant are greater with multiple eggs (NCCWCH 2004: 102-3).

Your specialist will offer you a treatment to control your menstrual cycle. Medications called gonadotropin releasing hormone (GnRH) analogs (pituitary agonists) suppress or stop your cycle. You take the drug daily for two weeks as a nasal spray or get a syringe in the middle of the cycle. If you have endometriosis, you may be taking Cetrotide (a GnRH antagonist) to control your cycle and improve your chances of success (Sallam et al 2006).

Hormonal Injections

Starting at the beginning of the cycle, you will be given hormonal injections every day for 12 days (hormone FSH = follicle stimulating hormone). These stimulate your ovaries to release a larger number of mature oocytes than usual.

Women respond differently to these fertility drugs. They could have strong side effects. Your doctor will monitor you closely to intervene if necessary.

Your doctor can tell when your eggs are ripe by monitoring hormone levels in your blood and making regular ultrasound checks. An injection of human chorionic gonadotropin (hCG) triggers the release of your oocytes 34 to 38 hours before collection.

Obtaining and Collecting Sperm

An ultrasound scan shows when your eggs are ready to be picked. You get a narcotic that makes you sleepy, but you are still conscious.

Your doctor will remove the eggs from the ovaries. He / she uses a fine hollow needle, which is connected to an ultrasound probe. The probe helps to find the follicles containing the eggs. You may have mild discomfort during the procedure. But if you have pain later, your doctor will prescribe painkillers.

While your eggs are being collected, your partner needs to provide fresh sperm. If sperm from the donor or frozen sperm is used, it will be taken out of the freezer. The sperm is washed and the best sperm chosen for fertilization of the eggs. It is mixed with the egg cells in a dish and a cell culture is created with both in an incubator.

Fertilization and Transfer of the Embryo

Within one day after mixing the eggs and sperm, the shell is checked to see if eggs have been fertilized (IVF). In intracytoplasmic sperm injection (ICSI), the sperm are injected directly into the egg. When this happens, they will be picked up for another two to five days before being returned to your uterus.

Traditionally, embryo transfer occurs two to three days after egg retrieval.If you wait until the fifth day, the embryo is in the blastocyst stage. This is hoped for a better selection of vital implantable embryos. However, depending on the quality of the eggs, only a few embryos may reach this stage. Therefore, this must first be individually weighed in consultation with the doctor, which method should be chosen.

By that time, you've helped your uterus prepare for the embryo by taking progesterone, which thickens the mucous membrane. It is given as an injection, tablet (oral or vaginal) or gel. If the lining of your uterus (endometrium) is too thin, the embryos are unlikely to set (NCCWCH 2004: 113-4). If this is the case, the IVF cycle unfortunately has to be stopped (but it is very rare!).

Usually one or two embryos are transferred through the cervix into your uterus with a thin tube (tube). Your doctor probably uses ultrasound for guidance.

In order to avoid the risk of multiple pregnancies in large numbers, in Germany no more than three embryos can be legally implanted. The number of embryos transferred depends on your age and the chances of success. This in turn depends on your specific fertility disorder.

If you are younger than 35, you can transfer a maximum of two embryos into your uterus. To increase the chances of success, three embryos can be used in women over the age of 35, which in turn increases the multiple risk. (HFEA 2011c)

If you are under 37 and a suitable candidate, you may be recommended for an elective single embryo transfer (eSET). This is the insertion of a single ""selected"" embryo into the uterus, which is intended to reduce the risk of multiple pregnancy and give the ""best"" embryo a chance to become well implanted. This method is widely promoted in Scandinavia, but has not really gained acceptance in Germany because of the strict embryo protection law and the lack of suitable selection methods.

If you're 40 years or older, you can get three embryos per cycle because you have less chance of getting pregnant with your own eggs.

Repeated Cycles

If there are excess embryos, they can be frozen for a future opportunity. This happens in case the first cycle is unsuccessful or if you want a baby after your successful treatment.

In an IVF, the embryos are usually transferred approximately two or three days after fertilization. Another possibility is to wait until about five days after fertilization for the cell ball to develop into a blaté cyst.Only the healthiest embryos reach the stage of blastocysts in vitro. If you have a blastocyte transfer, you may have a better chance of a healthy pregnancy (Blake et al 2007).

Most clinics offer the transfer of a blastocyst to all patients. This depends on the quality and number of embryos that are available. Some clinics only require a blastocyst transfer if:

  • you had a normal IVF before with healthy embryos that did not set
  • you are under 40
  • you have opted for eSET
Your clinic probably recommends that you rest for approximately 30 minutes immediately after treatment, although there is no evidence to confirm that this increases your chances of becoming pregnant (Abou-Setta et al 2009). In a successful cycle, one or more embryos attach to your uterine wall and continue to grow. In about two weeks, you can do a pregnancy test.

If your pregnancy has been confirmed after IVF, you should have an early scan done one to two weeks after the positive pregnancy test. This will determine if the embryo has become lodged in your uterus.

How long does IVF treatment take?

A complete IVF cycle lasts four to six weeks. You and your partner can count on spending half a day in your clinic for egg collection and fertilization. Two or three days later you go back to transfer the embryos to your uterus, or five or six days later for a blastocyte transfer.

What is the success rate of an IVF?

Success rates depend on your specific fertility disorder and your age. The younger you are and the healthier your eggs are, the higher your chances of success.

The following figures are based on 2009 data. The percentage of cycles in women using their own fresh ova and giving birth to a live baby is:

  • 32 percent if you are under 35
  • 27 percent if you are between 35 and 37
  • 19 percent if you are between 38 and 39
  • 13 percent if you are between 40 and 42
  • five percent if you are between 43 and 44
  • two percent if you are 45 or older (HFEA 2011a)
If you have been pregnant or have given birth before, your chances of success increase (NCCWCH 2004: 95).

If your weight is normal and you have a body mass index (BMI) between 18, 5 and 25, you're more likely to succeed. If you are overweight or underweight, you can increase your chances of success by getting closer to your ideal weight for your size before starting treatment (NCCWCH 2004: 96).

If you have not got pregnant after your third attempt with IVF, you may have to accept that it does not work for you (NCCWCH 2004: 94-5).It can be very hard to cope with, but there are organizations that can help you master this. Ask your family doctor or your clinic for more information.

What are the benefits of IVF?

Most children conceived with the help of IVF have no long-term problems.

IVF can give you a chance to have a baby if you are unable to get pregnant naturally, for example, if your fallopian tubes are blocked or damaged or missing.

What are the disadvantages of IVF?

IVF increases your risk of certain complications, such as:
  • A multiple births if more than one embryo has been implanted in your uterus. Many couples consider twins a blessing. But multiple pregnancy increases the risk of premature birth or a low birthweight baby (Basatemur and Sutcliffe 2008).
  • The side effects of infertility drugs are usually low. This can be hot flashes, headaches and nausea (HFEA 2009). However, you must be alert for signs of ovarian hyperstimulation syndrome (OHSS). If this happens, it may mean you have to stay in the hospital until your enlarged ovaries have calmed down.
  • An increased risk of peritoneal pregnancy where an embryo attaches to the fallopian tube or abdominal cavity. This is more likely to happen if you have previously had problems affecting your fallopian tubes (HFEA 2009).
  • You may more likely have a baby with a birth defect, such as spina bifida, if you become pregnant with IVF. (Fortunato and Tosti 2011) One study has shown an increase in birth defects of approximately three percent in naturally-bred babies to approximately six percent after IVF (Sala et al 2011). But this increased risk could also be related to the age of the parents or other fertility disorders (HFEA 2009).
Despite these (minor) risks, many couples have the opportunity to father the much-anticipated babies with the help of IVF.

Would you like to discuss IVF treatment with other women? Then visit our BabyCenter Community.

Sources

This article was written using the following sources:

Revermann, Christoph, Hüsing, Bärbel Hüsing: Reproductive Medicine. Framework conditions, scientific and technical progress and consequences. Berlin: edition sigma 2011 [as of April 2014]

Abou-Setta AM, D'Angelo A, Sallam HN, et al 2009. Post-embryo transfer interventions for in vitro fertilization and intracytoplasmic sperm injection patients. Cochrane Database of Systematic Reviews (4): CD006567. www. online library. wiley. com [pdf file, as of April 2014]

Basatemur E, Sutcliffe A. 2008. Follow-up of children born after ART. Placenta Oct 29 (Suppl B): 135-40 [As of April 2014]

Blake D, Farquhar C, Johnson N, et al.2007. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database of Systematic Reviews (4): CD002118. www. online library. wiley. com [pdf file, as of April 2014]

Expert Group Commissioning NHS FP. 2010. Final Report of the Expert Group on Commissioning NHS Fertility Commission. Expert Group on Commissioning NHS Fertility Commission www. ie. gov. uk [pdf-file, April 2014]

Fortunato A, Tosti E. 2011. The impact of in vitro fertilization on children's health: an update. Eur J Obstet Gynecol Reprod Biol 154 (2): 125-9 [as of April 2014]

HFEA. 2009. Risks of fertility treatment. Human Fertilization and Embyrology Authority. www. HFEA. gov. uk [as of April 2014]

HFEA. 2011a. Fertility treatment in 2010: trends and figures. www. HFEA. gov. uk [pdf-file, as of April 2014]

HFEA. 2011b. IVF: what is in vitro fertilization (IVF) and how does it work? Human Fertilization and Embyrology Authority. www. HFEA. gov. uk [as of April 2014]

HFEA. 2011c. Improving outcomes for fertility patients: multiple births. A statistical report. Human Fertilization and Embyrology Authority. www. HFEA. gov. uk [pdf file, as of April 2014]

NCCWCH. 2004. Fertility: assessment and treatment for people with fertility problems - full guideline. National Collaborating Center for Women's and Children's Health. London: RCOG Press. www. rcog. org. uk [pdf file, as of April 2014]

NHS Choices. 2011. IVF. NHS Choices Health A-Z. www. nhs. [April 2014]

Sala P, Ferrero S, Buffi D, et al. 2011. Congenital defects in assisted reproductive technology pregnancies. Minerva Ginecol 63 (3): 227-35 [as of April 2014]

Sallam HN, Garcia-Velasco JA, Dias S, et al. 2006. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database of Systematic Reviews (1): CD004635. www. online library. wiley. com [pdf-file, as of April 2014]

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