What is IVF? The process, risks, success rates and more

What is IVF?

In vitro fertilisation (IVF) treatment involves collecting an egg from the ovaries and fertilising it with sperm in a lab. Once the egg is fertilised successfully it is called an embryo. 1 or 2 embryos are then put into your womb to grow and develop.

IVF is an option when you are having difficulties getting pregnant, or if you want to get pregnant as a single parent or a same sex couple.

Sperm donation

The sperm for IVF may be donated by your male partner if you have one, or a man outside of your relationship.

You may use sperm donation if you are single, in a same sex relationship, or if your male partner has:

• few or poor-quality sperm in his semen and you have decided against intracytoplasmic sperm injection (ICSI), (where sperm is injected into the egg)
• no sperm in his semen
• a genetic disorder that could be passed on to any children
• an infectious disease that could be passed to you or any children
• a blood group that’s incompatible with yours.

Read more about male infertility.

Egg donation

This is when another person’s eggs are used with your partner’s (or a donor’s) sperm for IVF treatment. You may be offered this option if:

• you have gone through the menopause. In some people this happens earlier than expected, which is called premature ovarian insufficiency and can happen after chemotherapy or radiotherapy
• you have a chromosome abnormality, such as Turner syndrome
• you have had unsuccessful IVF treatments
• there is a risk of passing a genetic disorder to your children.

If you decide to have IVF treatment you should be offered independent counselling before, during and after your treatment, regardless of whether it is successful or not.

What is a full cycle of IVF?

A full cycle of IVF is when the ovaries are stimulated to produce eggs, which are then collected and combined with sperm to form 1 or more embryos. 1 or 2 embryos are then placed into the womb. If any embryos are frozen and used later this is still part of the same cycle. 1 cycle of IVF can take between 3 to 6 weeks.

Why might I need IVF?

You might be considered for IVF if you are having problems conceiving. Fertility problems can happen for a number of reasons, such as:

• endometriosis
• polycystic ovarian syndrome (PCOS)
• large fibroids
• fallopian tube problems
• poor sperm quality
• age
• premature ovarian insufficiency
• genetics.

Often, there is no known cause (unexplained fertility). Read more about fertility and causes of infertility.

Who is offered IVF?

If tests show you have a fertility problem which means IVF is the only treatment likely to help you get pregnant, you should be referred for IVF.

For unexplained fertility, the National Institute for Health and Care Excellence (NICE) has guidelines for who may be referred for IVF. 

If you are under 40

If you are a woman or birthing person under 40 living in England, Wales or Scotland you may have 3 full cycles of IVF if:

• you have been trying to get pregnant through regular unprotected sex for 2 years, OR
• you have had 8 cycles of artificial insemination including at least 4 using intrauterine insemination (IUI). Artificial insemination is a fertility treatment that involves inserting sperm into a woman or birthing person's womb.

If you live in Northern Ireland you may be offered 1 cycle of IVF and 1 frozen embryo transfer if:

• you have been trying to get pregnant through regular unprotected sex for 2 years, OR
• you have had 8 cycles of artificial insemination with at least 4 of the cycles using IUI.

If you turn 40 during treatment your current cycle will be completed, but further cycles shouldn't be offered. 

If you are aged 40 to 42

If you are aged 40 to 42 anywhere in the UK you may be offered 1 full cycle of IVF if all of the following apply:

• you have been trying to get pregnant through regular unprotected sex for 2 years, or you have had 12 cycles of artificial insemination including at least 6 cycles of IUI
• you have never had IVF treatment before
• your fertility tests show that your ovaries would respond normally to fertility drugs
• you and your doctor have discussed the risks of fertility treatment and pregnancy.

IVF isn't usually recommended for women and birthing people over the age of 42 because the chances of a successful pregnancy are thought to be too low.

You may have to meet other criteria depending on where you live. Local NHS trusts organise care in your area and may have additional criteria about who should have access to treatment. They may think about things like:

• lifestyle choices, such as whether you smoke, drink alcohol or take drugs
• whether you have any biological children
• whether you are in a relationship
• whether you have a healthy BMI.

Who do I talk to about getting treatment?

Talk to your GP if you are having trouble getting pregnant. They will talk to you about whether there is anything you can do to improve your chances of conceiving. This will include things like getting to a healthy BMI or stopping smoking.

They may also do some tests to find out if you have any underlying conditions that might be affecting your fertility.

They may refer you to a fertility specialist to talk about IVF and other fertility treatments, such as medication and surgery.

You should be offered counselling before any IVF treatment. Many people also find it helpful to talk to other people who have had IVF. Your doctor may be able to give you details of a local support group or you could use an online forum such as Fertility Network UK and Fertility Friends.

Is there a waiting list?

Yes. The length of waiting lists for NHS-funded IVF can vary based on where you live.

Can I have private IVF treatment?

You may decide to pay for private treatment.

Private IVF treatment costs will vary based on the clinic. 1 cycle of IVF including fertility drugs can cost £5,000 or more, although this can vary a great deal.

The Human Fertilisation and Embryology Authority (HFEA) has more information about private fertility treatment and HFEA regulated clinics in the UK.

What are my chances of having a baby with IVF?

Sadly, IVF treatment has a fairly low success rate. These figures show the chances of having a baby after IVF treatment using your own eggs and your partner's sperm. They show the proportion of live births in 2019 after treatment broken down by age group 

• aged under 35: around 1 in 3
• aged 35 to 37:  around 1 in 4
• aged 38 to 39:  around 1 in 5
• aged 40 to 42:  around 1 in 10
• aged 43 to 44:  around 1 in 20
• aged over 44: less than 1 in 20.

There are a several factors that are linked to the success of IVF:

• age: the success rate for IVF decreases with age
• number of cycles: he chances of conceiving falls with the number of unsuccessful cycles you have
• previous pregnancies: IVF is more effective if you have had a baby before, although you are less likely to be offered IVF if you already have children.

You and your partner may be able to improve your chance of success by:

• cutting out alcohol
• stopping smoking
• keeping to a healthy weight
• limiting your caffeine intake.

If you know the cause of your infertility there may be other changes you can make. Your specialist should be able to give you advice on this.

The Human Fertilisation and Embryology Authority has more information on the success rate of fertility treatments in the UK. 

What happens in IVF?

For most people 1 cycle of IVF will take between 3 and 6 weeks.

Preparing for IVF - what to expect

• If you're accepted for IVF treatment at an assisted conception unit, you and your partner will have blood tests, including tests for HIV, hepatitis B and hepatitis C.
• Your cervical screening tests should also be up-to-date. You may also have screening for sickle cell and thalassaemia if you are thought to be at risk.
• The specialist will check how many eggs you have (your ovarian reserve) to work out how effective IVF will be. This can be done with a blood test, or a vaginal ultrasound scan. The scan involves inserting a slim wand into your vagina to scan your ovaries from inside your body (transvaginal ultrasound).
• Before your treatment starts you may be offered the oral contraceptive pill or progestogen tablets. This may feel like a step backwards, but it makes it easier to time when you need to start taking fertility drugs.

The 6 steps of IVF

Step 1: Down-regulation of the ovaries

You may be offered medication to ‘switch off’ egg production in your ovaries. This is given either as a daily injection that you will give yourself, or as a nasal spray. This makes the medication used in the next stage of treatment more effective.

Step 2: Ovarian stimulation

You will be given hormone medication to help your ovaries produce more than 1 egg at a time (more than you usually produce naturally).

You should be monitored throughout this time with regular ultrasound scans to check how your ovaries are responding. Scans will also check for signs of ovarian hyperstimulation syndrome. Sometimes this involves daily scans, or scans every other day.

Step 3: Egg collection

This process will be carried out in the treatment room or clinic. Your eggs will be collected through a needle that’s passed through the vagina, guided by ultrasound. You will be given an injection of sedatives and painkillers, which will make you sleepy during this procedure.

You won’t be able to go back to work, or drive, after this is done. You may want to arrange for someone to take you home.

Step 4: Obtaining sperm

Your partner will be asked to produce a sperm sample at around the same your eggs are being collected. If your partner's sperm count is low or the sperm are poor quality, you may be offered intracytoplasmic sperm injection (ISI). This is where sperm is injected into the egg so they are more effective. Alternatively, you may be asked if you want to use a donor.

Step 5: Fertilisation of the eggs

The eggs and sperm are mixed and placed in an incubator. The sperm may then fertilise some of the eggs. Once an egg is fertilised it is called an embryo. Any embryos are kept in the incubator for up to 6 days. This keeps the temperature and conditions around the eggs and sperm similar to conditions found naturally in the body.

Step 6: Transfer of embryos

The embryos are then transferred to the womb. This is done using a thin tube called a catheter that's passed into the vagina. Your doctor will discuss with you how many embryos will be transferred. You should not have more than 2 embryos transferred at 1 time. This decision will be based on:

• your age (or the donor’s age, if you are using donor eggs)
• the quality of the embryos
• whether you have had unsuccessful IVF cycles before.

Finding out if you're pregnant

Once the embryos have been transferred, you'll need to wait around 2 weeks before taking a pregnancy test.

Some clinics may suggest doing a test at home. Others may want you to come to the clinic for a test.

If you do become pregnant, you’ll have some early ultrasound scans over the first few weeks to check things are progressing well. You'll then be offered the antenatal care given to all pregnant people.

What are the risks of IVF?

There are some health risks involved with having IVF. These include:

• medication side effects such as headaches, restlessness and hot flushes
• ectopic pregnancy
• having twins or more, which can cause complications.

Ovarian hyperstimulation syndrome (OHSS) 

OHSS is a rare complication of IVF. This is when too many eggs develop in the ovaries, which become large and painful. Symptoms include:

• pain and bloating low down in your tummy
• feeling and being sick
• shortness of breath
• feeling faint.

You'll need urgent medical treatment if you have a severe case of OHSS. Your current treatment cycle may be cancelled and started again with a lower dose of fertility medication.

Borderline ovarian tumours

There is a small risk of developing borderline ovarian tumours in the future for people who have had IVF. Borderline ovarian tumours are abnormal cells that form in the tissue covering the ovary. They are not cancer and are usually cured with surgery.

Risks if you're older

Miscarriage is common whether a baby is conceived through IVF or not. The risk of miscarriage as well as birth defects increases with age.

Long-term safety

Before you start IVF, your doctor should give you information about the long term risks. They should also limit the drugs used for ovarian stimulation in IVF treatment to the lowest effective dose and length of use.

Will I need to take time off work for treatment?

You may have to take some time off work for treatment. You can talk to the clinic to find out how much you may need. 

There is no statutory right to take time off work for IVF treatment, but your employer should treat any appointments related to IVF the same as they would with any other medical appointment. 

Your employers may agree to flexible working or a combination of paid, unpaid, or annual leave during the treatment.

In some cases you may be unable to work due to the effects of the treatment and will be signed off sick by your GP. Your employer should treat this sickness absence in the same way as sickness for other reasons.

What if the treatment doesn’t work?

If the treatment does not work you may need to wait a couple of months before trying again, if you decide to. This will give your body time to recover.

Finding out your treatment didn’t work can be very tough indeed. When you are ready, you may find it helpful to talk to the clinic about:

• why they believe the treatment didn’t work
• whether you should try again
• your chances of conceiving if you do try again
• you may also have the option of a different fertility treatment.

Take the time you need, along with your partner if you have one, to think about how you want to move forward.

Remember there is support out there if you need it. Many people find it helpful to talk to others who have been through the same experience. Your fertility specialist may be able to give you details about local support groups. Online forums can also put you in touch with other people who relate to what you are going through.

Your fertility clinic will provide counselling. You can also get more counselling through the NHS or privately.

More support and information

The British Infertility Counselling Association has a directory of accredited therapists.

Fertility Friends and Infertility Network UK have online forums.

The Human Fertilisation and Embryology Authority (HFEA) is the UK’s independent regulator of fertility treatment and research using human embryos. They also provide free, clear and impartial information about fertility treatment, clinics, and egg, sperm and embryo donation.