In Vitro Fertilisation (IVF) – What Is – Disadvantages – Infertility Cure / Treatment
IVF is one of the methods of treatment in infertility that would generally be advised by fertility doctors in an infertility clinics / ivf clinics. It is a process by which egg cells are fertilised by sperm outside the womb.
IVF was not meant to cure infertility (infertility cure), however it might help where there is a known infertility problem with one or both partners, for example if the female partner has blocked or damaged fallopian tubes, or there is a mild problem with the male partner’s sperm.
IVF is also used where no cause has been found for an inability to conceive, especially in couples that have been trying for more than three years.
How it’s done
You’ll usually be given drugs by fertility doctors to stimulate your ovaries to develop several mature eggs for fertilisation. (In a normal menstrual cycle you usually release only one egg a month.) You can choose not to take these drugs, but your odds of getting pregnant will be better with additional eggs (NCCWCH 2004: 102-3).
A variety of fertility drugs are usually used; your doctor (fertility doctors) will decide which combination is most appropriate for you.
Some fertility doctors / experts find it best to take complete control of the woman’s menstrual cycle, and start off the treatment by using drugs called gonadotrophin-releasing hormones (GnRH) analogues which suppress or “switch off” your cycle. These drugs are usually taken as a nasal spray or as an injection.
They are followed by hormone injections that stimulate ovulation, such as human menopausal gonadotrophin (hMG) and human chorionic gonadotrophin (hCG). You will be closely monitored while you are on these drugs as women respond to them in different ways, and some have strong side effects.
By monitoring your blood hormone levels, your doctor can detect when your eggs are mature. An ultrasound scan confirms that the eggs are ready to be retrieved. Shortly afterwards, you’ll be given a sedation anaesthetic, which means that you’ll be drowsy but conscious, and your doctor will remove the eggs from your ovaries using a fine, hollow needle. Another ultrasound helps your doctor to locate the eggs.
At about the same time as the eggs are being collected, your partner needs to provide a fresh sample of sperm. If donated sperm is being used, the sample is taken from the freezer. In either case, the sperm needs to be washed and the best quality sperm extracted ready to fertilise the eggs. The sperm is then combined with the eggs in a dish containing a nutrient medium, which is then cultured in an incubator.
Within the next two days the dish is checked to see if any eggs have been fertilised. Those that have are kept for another day or so before it’s checked again. Any fertilised eggs will each have become a ball of cells called an embryo. The healthiest embryos are chosen to be inserted into your uterus.
By now you will have been helping your uterus to prepare for the embryo by taking progesterone, which helps thicken its lining. This can be given by injection, pessary or gel. If your endometrium (uterus lining) is too thin the IVF cycle is likely to be abandoned, as research has shown that embryos are unlikely to be able to implant (NCCWCH 2004: 113-4).
Usually, one or two embryos are transferred with a thin catheter (tube) through your cervix into your uterus, sometimes using ultrasound to guide the insertion. To avoid the risk of a high multiple pregnancy, no more than three embryos can legally be transferred. The number of embryos that are transferred will depend on your age and your chances of success. This in turn depends on your particular fertility problem.
Women under 40 can only have a maximum of two embryos transferred to the womb. Women aged 40 or over are allowed to receive three embryos per cycle if they wish, as they have a smaller chance of conceiving with their own eggs. However if the eggs are donated, only two can be transferred. Fertility doctors hope this will reduce the growing incidence of multiple births following IVF. If there are any extra embryos, these may be frozen for future use in case the first cycle doesn’t succeed.
Your infertility clinics / ivf clinics may advise you to rest for a short while immediately after treatment, but there is no evidence to suggest that resting for longer than 20 minutes will improve your chances of success. In one study women got up straight away and carried on as normal without any ill-effects (NCCWCH 2004: 113-4).
In a successful cycle, one or more embryos will implant in your uterine wall and continue to grow. You’ll be able to take a pregnancy test in about two weeks.
Once pregnancy has been confirmed following IVF, you should have an early ultrasound scan at about six weeks to check that the embryo has implanted in your uterus.
What are the disadvantages?
Because the procedure often places more than one embryo in a woman’s uterus, you have a higher than usual chance of having twins or triplets. Around one in four couples who have had successful IVF treatment will have twins, compared with approximately one in 80 of the general population (HFEA 2006). Though many couples consider this a blessing, multiple pregnancies do increase your risk of miscarriage and other complications.
In most cases children conceived by IVF are healthy. However, several long-term follow-up studies have found that IVF children are more likely to have accessed health care services, such as hospitals, for surgery or other medical interventions than children conceived naturally (Bonduelle et al 2005; Kallen et al 2005). Some experts have found that this can be explained by circumstances around the child’s birth, such as being born prematurely or as one of a multiple pregnancy (Kallen et al 2005).
The fertility drugs used to stimulate egg production themselves can have severe side effects. You will need to be closely monitored while you are taking them to ensure you do not develop ovarian hyperstimulation syndrome (OHSS). This is a potentially dangerous condition, which can mean a stay in hospital while your over-stimulated ovaries settle down.
There has been concern that any treatments which use drugs to stimulate the ovaries may lead to an increased risk of ovarian cancer in later life (Rossing et al 1994). However, research to date has not confirmed this association. There is a recognised link between childlessness and ovarian cancer, and recent evidence suggests that the risk of ovarian cancer is more strongly linked to the underlying fertility problem rather than the fertility drugs used to treat it (Ness et al 2002; Brinton et al 2004; Rossing et al 2004).
Finally, women who have had IVF are at increased risk of ectopic pregnancy, where an embryo implants in a fallopian tube or a woman’s abdominal cavity. This is particularly likely to happen if the woman has previously had problems affecting her fallopian tubes (HFEA 2007: 24).
This method of treatment is performed in infertility clinics / ivf clinics and could be very expensive in most countries.
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