IVF – what you need to know
6th July 2018
IVF is incredible. But it can be a little overwhelming: a sea of acronyms, and pros and cons. To begin with, we break down the myths and medical jargon around IVF. We go through statistics to give you a comprehensive guide to IVF. The first IVF took place in 1977, so the treatment is still in its infancy. We’re still learning a lot about it, but let’s take a look at the facts, success rates and risks of IVF, to prepare for your IVF journey.
What is IVF?
During IVF, a healthy egg is removed from a women’s ovary and fertilised with sperm in a lab, hence the phrase Test Tube Baby. IVF stands for “in vitro” (Latin for ‘in glass’) fertilisation! Once an egg has been successfully fertilised (which sometimes involves something called ‘ICSI’ – injecting the sperm directly into the egg), the embryo is then returned to the uterus to develop. While this specific procedure may sound simple, there are quite a few steps taken before arriving here. When you decide to undergo IVF, first you’ll take medication to suppress your natural menstrual cycle, as well as medication to boost your egg supply. After careful monitoring to ensure your eggs have matured, doctors will then ‘harvest’ your eggs. The eggs will be collected from your ovaries via your vagina. Once the eggs are collected, they’re fertilised and any viable embryos are put back into the womb. The NHS then advises waiting two weeks to take a pregnancy test, to see if the procedure has worked.
The length of these different stages depends on whether you’re undertaking the long or short protocol. The long protocol starts on day 21 of your menstrual cycle. You will start injections to down-regulate your cycle and when your period starts, you’ll take injections to stimulate your ovaries. In a short cycle, you start stimulation drugs on the first day of your period. You later start different drugs to help ensure the follicles all grow at the same rate. With the long protocol, it can take 4-6 weeks from starting the process to implantation, whereas short will be more like 3-4 weeks. You tend to see long protocol adopted when the woman is an over-responder or under-responder.
There are a number of stages of IVF and it can be draining emotionally and physically. At each stage, there is the potential for positive and negative outcomes. Your GP should prepare you for possibilities at each stage.
Is IVF right for me?
IVF can be effective for a wide range of fertility problems including low sperm count and issues with ovulation. You may experience ovulations problems for example, due to PCOS and endometriosis or tubal factors – e.g, if your fallopian tubes are blocked. Many women decide to try IVF often after other fertility treatments, such as hormone medications or conceiving naturally have proved unsuccessful. It is important to remember that it’s normal to take up to 12 months to conceive naturally (when having sex 2-3 times a week). It’s a very personal decision, so it’s important to discuss whether it’s the right course of action for you with your doctor, your partner and your support system.
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What are the risks?
As with all medical procedures, there are certain risks and side effects that come with IVF. Many women going through the treatment will have minor side effects to the medication prescribed, such as headaches, hot flushes and fatigue. The main serious complication is called Ovarian Hyper-Stimulation (OHSS) in which your ovaries become too large, and it can cause a dangerous amount of bodily fluid retention. This can occasionally require you to be admitted to hospital. IVF also increases your risk of both ectopic pregnancy and multiple births (twins or triplets). This can give a risk for mom and baby – low birth rate.
There isn’t much long term data from babies born through IVF, so it’s currently hard for us to understand the health risk for babies. There is some research that indicates they could have a higher rate of birth defects, but the research is inconclusive – and the number of birth defects associated with IVF is still relatively low.
How can I access IVF?
The NHS guidelines advise that three cycles of IVF should be offered to women under 40, and one cycle to women aged 40-42 (providing there is no evidence of low ovarian reserve) who have been trying to conceive naturally for 2 years and have no children. However, what is offered varies according to where you live, and is constantly changing, – and sadly only 12% of commissioning groups across the UK are able to offer this – with the majority only offering one cycle.
You should speak to your GP about what is available in your area, and can also consult the website www.fertilityfairness.co.uk. Often, the criteria only require you to have been trying for one year over the age of 35 – so you should consider seeing your GP sooner if you’re approaching 40.
If you’re not eligible for NHS treatment or you decide to pay for IVF, you can have treatment at a private clinic. The cost of private treatment can vary, but one cycle of IVF usually costs at least £5,000.
How successful is it?
The success rate of IVF often depends on the cause of infertility and tends to decrease as you get older, as your egg quality decreases. For women under 35, the rate of successful pregnancies is around 29% and this drops to 15% when you are in your late thirties. The NHS will generally not advise women over 42 to undertake the treatment, as the success rate is low (3%), however, private clinics will conduct the procedure with women who are much older. Almost all pregnancies above the age of 45 involve donor eggs. Lower AMH can mean your response to IVF drugs will be lower – which can be mean fewer eggs and embryos. IVF is a bit of a numbers game, so a smaller amount of eggs could decrease your chances of success.
How can I prepare for IVF?
IVF can be a physically and mentally demanding process, so looking after yourself and your mental wellbeing should be a high priority.
Maintaining a healthy lifestyle is one of the most important ways you can prepare for IVF. Smoking is associated with infertility, so both women and men should stop smoking before undertaking IVF – as smoking is linked to poor sperm quality. Eating a healthy, balanced diet and making sure you’re sleeping well are also crucial. Any woman who is trying to conceive should take prenatal vitamins, and that includes women going through IVF. The most important vitamins you should take at this stage are folic acid and vitamin D.
When it comes to exercise, my general advice for both IVF and pregnancy is that you shouldn’t’ start-up something new when you’re having treatment, so don’t start training for a marathon for the first time! But if you regularly practice pilates or go running, your body is used to that and it won’t affect what happens with IVF. There is no evidence to show that lying down for days after the transfer will increase the chances of pregnancy – just do what feels right for you! Listen to your body and be kind to yourself.
Trying to destress is very important when going through IVF. Acupuncture is something that comes up all the time, as there has been a lot about it in the press, but ultimately there isn’t strong evidence to show that it improves outcomes. However, it’s important to manage stress and be in a good place for yourself emotionally and mentally, so you can cope with the stresses of fertility but be aware of why you are doing it. If acupuncture makes you feel good and positive and helps you sleep, great – but it doesn’t mean your chances will be significantly better. You could also try yoga or meditation to help you relax.
Can I take antidepressants whilst having IVF?
Mental health is so important when you are on a fertility journey. When it comes to medication, this is something that should be managed with your GP or mental health practitioner, it isn’t something your IVF consultant will be advising on. If you have mild to moderate depression, you might want to think about weaning off your antidepressants before embarking on IVF and switching to a physiological intervention such as counselling or CBT. But weaning off antidepressants should be done slowly and carefully. We know that some antidepressants are associated with birth defects, and some are safer than others, so talk to your GP before making any decisions.
What do people mean by ‘Natural IVF’?
Natural IVF is when you are not given drugs to stimulate the growth of your eggs or the time of ovulation. Doctors will simply retrieve the one egg when you have ovulated naturally. This is a highly debated topic amongst IVF professionals, but personally I think that stimulated IVF has better results than natural IVF, simply because you are usually able to retrieve more eggs – as we said earlier, IVF can be a bit of a numbers game.
What’s the difference between using frozen embryos versus fresh?
This debate is really interesting. Essentially the majority of women who have IVF will have a fresh embryo transfer and then will freeze the rest of their good quality embryos. Then if you come back, say for example your first cycle hasn’t worked or if you are trying for a sibling – thats when you will come to use your frozen embryos. There have been some studies indicating that frozen embryos have a better success rate, but when you think about it you realise that only good quality embryos are being frozen, which could be why you’re seeing better results. We don’t have all the answers yet, but there’s a big multi centre trial that was randomising women having fresh vs frozen embryos, so we should have more information soon.
If you have good quality frozen embryos and are happy with your clinic, when and if you go back you should try the frozen embryos first, as it will stop you having to go through the injections and other steps you went through the first time. However, if you are getting older and want to take the opportunity to harvest more eggs, then maybe going for another round is right for you. The choice is very personal, so always consult your partner and your doctor for advice that is centred around your situation.
What are the advantages and disadvantages of “batching?”
Batching is a technique where you do the egg collection phase twice, or sometimes three times, back to back. It’s not something that is undertaken at all clinics – and it’s of course a more expensive procedure. Some couples or women choose to do this if they have lower ovarian reserve – that way you will have more eggs to create embryos from.
Should I have fibroids removed before having IVF?
It all depends on where the fibroid is. if the fibroid is protruding into the uterus – if it is pushing into where the baby would be growing then it should be removed as this could reduce the chances of a successful pregnancy. However, if it is outside your uterus then it doesn’t necessarily need to be removed.
Need more advice? We recently launched a 4-week course specifically designed, where Dr Linda Farahani will be helping you prepare for your IVF Journey! You can find more info and sign up for the course, here.
If you would like more general support, you can also join the Adia community, where you can access fertility experts and more information for your fertility journey, all for free!