Alternative Names assisted reproductive technology, IVF, ART
Definition In vitro fertilisation, also called IVF, is a method used to enable couples who are unable to conceive naturally, to have a child. IVF refers to the combining of egg and sperm outside the woman's body. Once the egg is fertilised, the embryo is put back into the woman's body for full development.
Who is a candidate for the procedure? IVF is used for women who have:
blocked or absent fallopian tubes
endometriosis, a condition in which tissue that normally lines the uterus is found elsewhere in the body
other medical reasons that prevent the egg and sperm from joining naturally within the woman's body
How is the procedure performed? Fertility medications or hormonal preparations are used to help stimulate ovulation and/or support the development of the uterine lining. These medications are taken daily, at home, usually by injection.
Normally, the ovaries take turns releasing one egg each menstrual cycle. With IVF, fertility medications suppress normal hormone function and reduce the risk of eggs being released from the ovary before they can be retrieved. Later in the cycle, more medications are given to cause the ovaries to produce many mature eggs at the same time. Vaginal ultrasound and blood testing every 2 to 3 days can monitor the body's response to these medications, and the maturity of the eggs. When enough eggs have matured, another type of medication is given to stimulate their release from the ovary. These mature eggs are removed 32 to 36 hours later.
The egg retrieval process is done in the doctor's office or special procedure room. The woman is sedated to keep her comfortable. An ultrasound device is inserted through the vagina to see the follicles in the ovaries that house the mature eggs. The doctor then inserts a needle through the vaginal wall and withdraws the eggs. This procedure takes 15 to 60 minutes, and usually only causes mild pelvic discomfort.
Once the eggs have been withdrawn, they are incubated for several hours before sperm cells are added. When the sperm cells are added to the eggs, they are again incubated for about 12 to 18 more hours to allow for fertilisation. After fertilisation occurs, the embryos are checked for quality and viability. Not all embryos will develop well enough to be transferred to the womb.
Embryos are usually transferred 3 to 5 days after egg retrieval. This transfer occurs in the doctor's office or procedure room. No anaesthesia is used. It is much like a regular pelvic examination. The embryos are inserted into the uterus using a soft, flexible catheter attached to a syringe. Usually a maximum of three embryos are inserted. This will depend on the quality of the embryos and the age of the woman. Extra embryos, if any, can be frozen for future use.
What happens right after the procedure? 20 to 30 percent of IVF pregnancies result in multiple births. The hormone progesterone is given after egg retrieval until a pregnancy test is negative or sometimes throughout the first trimester. After the embryos have been transplanted, the woman may need to take it easy for a few days, or she may need to stay in bed for several hours to a few days. A blood pregnancy test will be taken 10 to 12 days after the embryos have been transplanted. If blood tests come back positive for pregnancy, a pregnancy ultrasound is scheduled to visualise the foetus and confirm a healthy heartbeat.
What happens later at home? Once pregnancy is confirmed, regular antenatal checkups and good nutrition are essential for proper health and development of mother and baby. No special testing is needed for pregnancies resulting from IVF.
What are the potential complications after the procedure? 20 percent of all pregnancies are lost regardless of how they are conceived. Less than 1 percent of IVF pregnancies result in an ectopic pregnancy, or one in which the egg implants outside the uterus. Other problems associated with this procedure may include bleeding, infection, damage to other organs near the ovaries and uterus, and allergic reaction to any medications used during the procedure.
Author: Linda Agnello, RN, BSN Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 12/06/2005 Contributors Potential conflict of interest information for reviewers available on request
