In vitro fertilisation (IVF)

If you are having trouble getting pregnant, you may be offered fertility treatment. One of these options is In vitro fertilisation (IVF)

What is IVF?

In vitro fertilisation (IVF) treatment involves collecting an egg from the woman’s ovaries and fertilising it with sperm in a lab. Once the egg is fertilised successfully it is called an embryo. This is returned to the womb to grow and develop.

IVF is an option when a couple is having difficulties getting pregnant naturally.

Sperm donation

The sperm for IVF may be donated by another man.

You may be offered this if your 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)
  • has no sperm in his semen.
  • has a genetic disorder that could be passed on to any children
  • has an infectious disease that could be passed to you or any children
  • has a blood group incompatible with yours

You may also use sperm donation if you don’t have a partner or you are in a same sex relationship.

Read more about male infertility here.

Egg donation

This when another woman’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 women this happens earlier than expected (link to premature ovarian insufficiency), 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, these are collected and combined with sperm to form one or more embryos and one or two are placed into the womb as fresh embryos. If any embryos are frozen and used later this is still part of the same cycle. For most women, one cycle of IVF can take between 4 to 6 weeks.

Who is offered IVF?

The National Institute for Health and Care excellence (NICE) recommends that if you are a woman under 40 living in England and Wales you should be offered three full cycles of IVF if:

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

If tests show IVF is the only treatment likely to help you get pregnant, you should be referred straight away.

If you are a woman aged 40-42 you should be offered one 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.
  • 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 in women ages 40 years or older

However, the final decision about who can have NHS-funded IVF is made locally, not nationally. This means that what you are offered will depend on where you live.

Each area’s decision-makers will have their own criteria about who should have access to treatment. They may take into consideration things like:

In Scotland, women under 40 are currently offered two full cycles of NHS-funded treatment. Women are offered one cycle in Northern Ireland.

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

Who do I talk to about getting treatment?

Talk to your GP if you are having difficulty getting pregnant. They will talk to you about your experiences and whether there is anything you can do to improve your chances of conceiving. This will include things like taking folic acid (link) or stopping smoking (link).

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

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

Is there a waiting list?

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

Can I have private IVF treatment?

If you’re not eligible for NHS treatment you may decide to pay for private treatment.

Private IVF treatment is expensive and costs will vary depending on the clinic. One cycle of IVF including fertility drugs normally costs between £3,000 and £5,000.

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?

Unfortunately, IVF treatment is often unsuccessful. These percentages show the average chance of a birth from IVF treatment per cycle, depending on a woman’s age:

  • under 35: 29%
  • 35-37: 23%
  • 38-39: 15%
  • 40-42: 9%
  • 43-44: 3%
  • over 44: 2%.

There are a several factors that can contribute to the treatment’s success:

Age

The success rate for IVF decreases with age.

Number of cycles

The 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:

Women should also try to maintain a healthy weight and reduce their caffeine intake if it over 200mg a day.

The cause of infertility (if known) can also be a factor. Your specialist should be able to provide more details.

What happens in IVF?

For most women one cycle of IVF will take between four and six weeks.

Before your treatment starts you may be offered the oral contraceptive pill or progestogen tablets. This may feel like a step backwards, but it is important because it makes it easier to time when you need to start taking fertility drugs.

There are then six steps:

Step 1 - down-regulation of the ovaries

You may be offered medication to ‘switch off’ egg production in your ovaries. 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 one egg at a time(unlike your natural cycle).

You should be monitored throughout your ovarian stimulation by regular ultrasound scans to check how your ovaries are responding and to check for signs of ovarian hyperstimulation syndrome. (jumplink to below) Sometimes this involves daily or alternate day scans.

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. 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 - getting sperm

Men will be asked to produce a sperm sample. If their sperm count is low or the sperm are poor‑quality, you may be offered further procedures as well as IVF. They are intracytoplasmic sperm injection and sperm donation

Step 5 - fertilisation of the eggs

The eggs and sperm are mixed together 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 resulting embryos are kept in the incubator for up to six 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 two embryos transferred at one 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 previously.

Finding out if you're pregnant

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

Some clinics may suggest doing a test at home and letting them know the result. Others may want you to come into the clinic for a test.

If you do become pregnant, you’ll have some ultrasound scans over the following weeks to check things are progressing as expected. You'll then be offered the normal antenatal care given to all pregnant women.

Are there any risks?

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

Ovarian hyperstimulation syndrome

This 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.

Severe cases can be dangerous and you will need medical attention straight away. 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 woman 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 for older women

Miscarriage is very 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

The health risks to children born using IVF treatment are low. Before you start IVF, your doctor should give you up‑to‑date 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 legal right for employees to take time off work for IVF treatment, but your employer should treat any medical appointments related to IVF the same as any other medical appointment under the terms and conditions of your contract of employment.

Your employers may agree to flexible working arrangements 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 be signed off sick by your GP. Your employer should treat this sickness absence in the same way as sickness for other reasons in accordance with the normal organisation rules.

What if the treatment doesn’t work?

If the treatment is unsuccessful you may have to wait a couple of months before thinking about trying again. This will give your body time to recover.

Finding out your treatment didn’t work can be incredibly difficult. When you are ready, you and your partner may find it helpful to talk to the clinic about:

  • why they believe the treatment didn’t work
  • whether you should try again
  • what are the chances of conceiving if you do.

You may also have the option of another fertility treatment.

You and your partner should take the time you need to think about how you want to move forward.

Remember there is support available if you need it. Many people find it helpful to talk to other people who have been through the same experience and can relate to what they are going through. You could also talk to a counsellor who specialises in fertility problems.

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

More support and information

The British infertility counselling association has a directory of accredited therapists.

The Fertility Network UK has support and forums for those affected by infertility.

The Human Fertilisation and Embryology Authority 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.

Sources

1. NICE Guideline (2017) Fertility problems: assessment and treatment National Institute for Health and Care Excellence

2. NICE Choices (accessed 01/05/2018)) IVF, Page last reviewed: 11/06/2018 Next review due: 11/06/2021. https://www.nhs.uk/conditions/ivf/ 

3. Human Fertilization and Embryology Authority (accessed 01/05/2018) In vitro fertilisation (IVF) https://www.hfea.gov.uk/treatments/explore-all-treatments/in-vitro-ferti...

4. NHS Choices (accessed 01/05/2018) Can I get IVF on thie NHS? Page last reviewed: 23/07/2015 Next review due: 23/07/2018.   https://www.nhs.uk/chq/Pages/889.aspx?CategoryID=68&SubCategoryID=154

5. Human Fertilization and Embryology Authority (accessed 01/05/2018) In vitro fertilisation (IVF) https://www.hfea.gov.uk/treatments/explore-all-treatments/in-vitro-ferti...

6. Cancer Research UK (accessed 01/05/2018) Borderline Ovarian TumoursPage last reviewed: 28/03/2018 www.cancerresearchuk.org/about-cancer/ovarian-cancer/types/borderline

7. ACAS (accessed 01/05/2018) Employees rights during IVF treatment www.acas.org.uk/index.aspx?articleid=5457

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Last reviewed on June 5th, 2018. Next review date June 5th, 2021.

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