Many of us just take our fertility for granted – spending several years ensuring we do not get pregnant at the wrong time – only to find that when we do wish to become pregnant, it`s not as easy as we thought!

It is estimated that one in seven UK couples have difficulty conceiving - approximately 3.5 million people. Though the majority of these will become pregnant naturally given time, a significant minority will not. NICE define infertility as failing to get pregnant after two years of regular unprotected sex. Infertility is the commonest reason for women aged 20-45 to see their GP, after pregnancy itself.

Treatment and Success - Some Facts

The average success rate for IVF treatment using fresh eggs in the UK is:

·        28.2% for women under 34

·        23.6% for women aged 35-37

·        18.3% for women aged 38-39

·        10.6% for women aged 40-42

ICSI represents 44% of all IVF treatment in the UK – the remainder is conventional IVF.

Around 1% of all births are the result of IVF and Donor Insemination.

In the UK around 25% of IVF treatments are funded by the NHS.

Typical cost of IVF is approximately £3,000 – not including consultations, drugs, embryo freezing.

There are currently 85 HFEA licensed clinics in the UK, 52 offering NHS treatment.

A total of 36,861 women were treated at IVF clinics in Britain in 2007, compared with 34,855 the previous year. An increase of 5.8%

·        For women aged 35 or under, 32.3% of treatments resulted in a live birth.

·        For women older than 44, treatment resulted in only a 3.1% chance of a live birth – reflecting the impact of age on IVF success.

·        Multiple birth rates show a continuing decline, falling from 24% in 2005 to 21.4% in 2007.

What Is IVF?

IVF literally means `fertilisation in glass’, giving us the familiar term `test tube baby’. During the IVF process, eggs are removed from the ovaries and fertilised with sperm in the laboratory. The fertilised egg (embryo) is later placed in the women`s womb. This can be used to try and overcome most fertility problems, provided the woman has a functioning ovary (it is possible to work with only one!) and a womb. It is, however, seen as an option to recommend only after all other options have been tried, such as ovulation induction or artificial insemination, or if the fallopian tubes are blocked or missing. If a couple has mild male infertility (a low sperm count) IVF may be offered as an option, but more severe cases would be offered ICSI.

How Does It Work?

Following all the initial consultations and hormonal work ups (to identify any underlying problems) the first step for IVF is to suppress the natural cycle. This involves either a daily injection or a nasal spray, which is taken from around day 21 of the cycle for two weeks.
After two weeks your natural hormones should be suppressed and a bleed should occur – at this point your hormones are controlled artificially in the form of FSH (Follicle Stimulating Hormone) which is again a daily injection, whilst continuing with the previous drug to ensure your own hormones remain suppressed.
The ovaries are stimulated with FSH to produce many more than the one egg normally produced, to offer more chances of fertilisation.
The FSH is taken daily for around 12 days –until the eggs are big enough to collect. The ovaries are scanned alternate days from about day 8 of the FSH, and blood will also be monitored for hormone levels, and when they are big enough the egg collection will be arranged.
At this point, the suppression drugs are stopped along with the FSH, and another drug will be given, to ensure the eggs mature enough to be collected and hopefully fertilise.

This drug is called HCG and is a one off injection, which is strictly timed with the egg collection, being given 34-38 hours before collection.

The eggs are usually collected under sedation, vaginally under ultra sound guidance. They are collected individually from each ovary in turn and taken to the lab to be examined and later fertilised.
The procedure usually takes no more than 20 minutes and women make a speedy recovery and are usually discharged home after just a couple of hours.
At this time the male partner will be required to supply a semen sample, which will be washed and prepared, ready for the eggs.
The eggs are mixed with the sperm and cultured in the laboratory for 16-20 hours. At this point they are checked for fertilisation. Once they have fertilised, they are considered to be embryos, and are kept in the laboratory and transferred back into the women`s womb as 2 or 3 day old embryos – the time thought to be optimum for replacement.

Whilst the embryos are growing progesterone supplements are given in the form of pessaries to prepare the womb to receive the embryos and to help encourage implantation.
Only one or two embryos are replaced – any extra embryos have the option of being frozen for future cycles of treatment.
There is then a 14 day wait, whilst still taking the progesterone pessaries, to determine whether or not a pregnancy has occurred.
A blood test will normally be taken on the correct day, and results are usually available within just a couple of hours. If a pregnancy has occurred the pessaries are continued up until the 3^rd month of pregnancy, and a gestational scan is performed on day 35 to ensure all is well.
If however, no pregnancy has occurred, the drugs are stopped and a bleed will occur.

It is usually advisable to wait for a couple of natural cycles in between treatments – as the body needs to recover from the drugs. The treatment cycles are also stressful for all concerned and couples find they really do need a break to build themselves back up from the great disappointment a failed treatment cycle brings. Counselling is offered and actively encouraged by all clinics, and is usually free.

ICSI

Intra-Cytoplasmic Sperm Injection involves injecting a single sperm into an egg in order to fertilise it. The advantage of this treatment is that it can be performed when the concentration of sperm is very low, therefore offering a chance of fertilisation when it would not be possible with conventional IVF. It is offered for very low sperm counts, sperm with low motility and often for couples who have failed to achieve fertilisation with conventional IVF in previous cycles. Success rates tend to be higher with ICSI:

·        33.2% under 35yrs

·        27.1% aged between 35-37 yrs

·        20% aged between 38-39 yrs

·        11.5% aged between 40-42 yrs

·        4.5% aged between 43-44 yrs

The above figures are for live birth rates.

Where Can I get Treatment?

Treatment is widely available privately but is costly. All clinics in the UK are licensed by the HFEA, but are at liberty to set their own costs. Although they have to be competitive with the market, you will find a variation in what is offered. Alongside the standard cost of treatment, most clinics will offer treatment packages which usually work out cheaper. The best way to resource this is from the web site www.hfea.gov.uk where there is a host of information on all the UK clinics and their success rates. A requirement for the clinics gaining their license from the HFEA is   regular, annual checks which are unannounced by the HFEA, where they check all procedures in place, staff training and witnessing procedures. This is the reason there are very few mix ups within the clinics. The HFEA requirement is that two independent people check everything before any procedure; this includes identifying patient’s eggs/sperms/embryos at each stage of treatment. Failure to comply with this, results in the clinic being closed down and their license revoked.  Other countries are not regulated in the same way and therefore any treatment from abroad should be thoroughly researched.

NHS Treatment

The government have said that IVF should available on the NHS –the major problem with this is funding, and so strict criteria are in place – and this will vary across the country. To access the funding a GP referral to the local hospital is necessary, where the patients will be assessed for eligibility. Some local hospitals offer IVF but often they have contracts with private clinics. There is often a waiting list. Many NHS clinics now run an eighteen week policy, meaning you should be ready to begin treatment within this time span. The NICE guidelines state that up to three cycles of IVF or ICSI should be available to:

·        Women aged 23- 39 yrs

·        Those with identifiable causes of infertility

·        Those with more than 3 yrs of fertility problems

These are still being implemented across England and the number of cycles offered varies from region to region. They tend to be offering between one and three cycles, few offer none. The Department of Health is striving for all areas to offer the three cycles as defined by the NICE guidelines. To find out what is available in your area and whether you are eligible you should discuss it with your GP.