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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

In Vitro Fertilization

ivfIn vitro fertilization (IVF) is one of several techniques available to help couples with fertility problems or single women, fall pregnant and carry their baby to term. IVF literally means "fertilization in glass", hence the term "test tube baby". IVF typically involves the removal of the eggs from the female ovaries and the fertilization of the embryo, with the male sperm in the laboratory. The fertilized egg is later placed back into the uterus.

How do I know if I am a candidate for IVF?

IVF may be recommended if:
  • You have been diagnosed with unexplained fertility
  • You have been unsuccessful with other techniques, such as using fertility drugs or intrauterine insemination (IUI)
  • Your fallopian tubes are blocked
  • Your inability to have a baby is due to a pelvic factor
  • There is a minor degree of male factor infertility involved- more severe problems are treated with intra-cytoplasmic sperm injection (ICIS)

What does an IVF procedure typically involve?

IVF treatments may vary depending on the clinics protocol, the individual needs of the couple involved, and the reproductive technologies being used. Traditional IVF, generally involves the following steps for women:

Step 1: You may be given drugs to suppress your natural monthly cycle. This is given in the form of a self-administered daily injection or as a nasal spray, for approximately 2 weeks. The aim of this medication is to prevent ovulation the cycle before treatment, so that your doctor can control ovulation and not lose the eggs before retrieval.

Step2: Once a woman's natural cycle has been suppressed, she is given a fertility hormone called Follicle Stimulating Hormone (FSH). FSH increases the number of eggs that are produced, which potentially increases the number of eggs that can be fertilized.

Step 3: Your progress will be monitored during this time, by means of blood tests and vaginal ultrasound scans. 34-38 hours before your eggs are collected, you will be injected with a hormone to help your eggs mature. The hormone that induces the final maturation of the egg (oocyte) is called hCG or human chorionic gonadotropin hormone.

Step 4: Approximately 34-36 hours after the hCG injection, an egg retrieval is performed. This is an in-patient procedure (day visit) that occurs with the assistance of ultrasound guidance. A needle is inserted into the scanning probe and into each ovary. The eggs are then collected through the needle. The process is done under sedation. There may be some cramping and a small amount of vaginal bleeding after the procedure.

Step 5: Your eggs are then mixed with your partner's or a donor's sperm and are cultured in a laboratory for 16-20 hours. An embryologist monitors egg development. The fertilized eggs, known as embryos, are grown in the lab incubator for another day or two. The best embryos are then chosen for transfer. Medication is given in the form of an injection, gel or progesterone pessaries, to prepare the lining of your womb for the embryo transfer. This is known as luteal support.

Step 6: 3-5 days after egg retrieval, the embryo is transferred, in a procedure that is similar to artificial insemination. A thin catheter is placed into the uterus and the embryo is injected into the uterus by means of ultrasound guidance. In women under the age of 40, 1-2 embryos are usually transferred. In women over the age of 40, a maximum of 3 can be used.

Step 7: 12 days after embryo transfer, you will undergo a blood test to establish whether you are pregnant or not.

For men:

Step 1: Collecting sperm

Around the time that your partner's eggs are collected, you will be required to produce a fresh sample of sperm. The sperm are stored briefly, then washed and spun at a high speed. This allows the healthiest and most active sperm to be collected for fertilization.

If donor sperm are being used, it is removed from frozen storage, thawed and prepared in the same way.

What is the success rate of IVF?

The success rate of IVF is 30% per cycle. However, the success rate depends on several factors; including the age of the woman undergoing treatment, her body mass index, whether she smokes or not, her past history, the initial cause of the infertility and previous treatment outcomes. There is a higher implantation rate with fresh embryos and therefore a higher success rate, than there is with a frozen embryo transfer.

What are the potential problems or risk factors of IVF?

Drug reactions

Most women will have some side effects associated with fertility drugs. The most common reactions include; hot flushes, feeling down or irritable, restlessness, nausea and vomiting, shortage of breath, and abdominal bloating due to an accumulation of fluid.

A less frequent but potentially dangerous complication of IVF is known as ovarian hyper-stimulation syndrome (OHSS). This occurs when too many eggs develop in the ovaries, which become swollen and painful. OHSS generally develops the week after egg collection. It is more common in women under the age of 30 and in women who have polycystic ovarian syndrome.

Multiple births

If more than one embryo is replaced in the womb during an IVF procedure, there is an increased chance of producing twins or triplets. Having a multiple pregnancy significantly increases the risk of certain complications to you and your babies. If you are carrying more then one baby, you are more likely to develop diabetes during pregnancy. A multiple pregnancy can significantly raise your blood pressure, putting you at higher risk for preeclampsia. Half of all twins and 90% of triplets are born prematurely or have a low birth weight. The risk of your baby dying in the first week of life is 5 times higher for twins and 9 times higher for triplets, than it is for a single baby.

Emotional stress

Couples considering undergoing IVF, have to consider whether it is the right treatment for them. They have to accept that it is a complicated procedure that is going to take over their lives for some time. Besides the financial expense of IVF and the physical discomfort, the treatment can have huge emotional consequences too. Some IVF couples express feeling conflicting emotions, such as excitement (is it going to happen?) and fear. The waiting to find out if the treatment has been successful can also be highly distressing, especially if you have a long history of infertility or have had previous unsuccessful treatments. Some couples feel that getting pregnant is just the beginning. It is carrying the baby to term that is the hard part and once again, medications to support the pregnancy do have potential side effects.

How much does IVF cost?

The cost of fertility treatment may vary from one patient to another, depending on the root cause of their inability to get pregnant and/or remain pregnant, their age and whether or not a male factor is present.

Conventional IVF costs approximately R 12 000 per cycle, for medication alone. This excludes doctor and laboratory fees, a possible stay in hospital and an anesthetic. In general, medical aids do not perceive infertility as being a medical condition and therefore do not cover fertility treatments. Hospitalizations for surgical procedures are often covered. If you are considering pursuing IVF treatment, it is important to query your medical insurance company beforehand.

The New York Times Company. Updated December 3, 2011. Accessed May 20, 2012.
Infertility Network UK. IVF- What is in vitro fertilization (IVF) and how does it work? Human Fertilization & Embryology Authority. Published November 2, 2011. Accessed May 24, 2012.
Dr. S. Edelstein. In-Vitro fertilization. Dr. Sascha Edelstein Fertility Specialist.
NHS Choices. IVF Introduction. NHS Choices. Published August 23, 2011. Accessed May 26, 2012.