IN-VITRO FERTILISATION (IVF) |
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What is it? |
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In-Vitro Fertilisation (IVF) is the process by which eggs are taken from a woman’s body, fertilised with sperm in a laboratory and after a few days of incubation, replaced back into her body. |
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| Why is it used? |
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The fundamental biological requirements of a couple trying to conceive are eggs, sperm, a womb and no blockages in the female reproductive organs. The classic reason for IVF is to treat tubal blockages. This was the reason why the first ever IVF child’s mother was treated, resulting in Louise Brown, the first IVF child in 1978.
From that start the indications for IVF have been extended to include prolonged unexplained infertility, endometriosis, the treatment of male factor problems with intra-cytoplasmic sperm injection (see ICSI) and more recently to reduce the chance of transmitting infection or genetic disease. |
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| Who is it suitable for? |
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| The WA Government enacted legislation in 1991 (amended in 2004) that stipulates eligibility criteria for IVF. These are: |
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An inability to conceive for medical reasons |
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Not infertile because of age alone |
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Couples for whom pregnancy and birth are, in the best interests of both prospective parents and child, in the opinion of the treating doctor. |
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| How is it done? |
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| IVF treatment involves four main stages: |
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Controlled Ovarian Hyperstimulation (COH) - the growth and maturation of several eggs and the triggering of their release through self administered injections |
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Trans Vaginal Oocyte Aspiration (TVOA) - The collection, under anaesthetic, of the eggs prior to their release |
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In-Vitro Fertilisation (IVF) of the eggs in the laboratory with a fresh semen sample |
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Embryo Transfer (ET) back into the uterus |
| Each of these stages will impact on the overall chance of the procedure resulting in an on-going pregnancy and ultimately a healthy baby. |
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| How will I feel? |
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The drugs used in the controlled ovarian hyperstimulation stage of the procedure are designed to “hijack” your normal menstrual cycle and force the ovary to produce several instead of 1 egg. Any symptoms that you associate with your normal cycle will be exaggerated by this process.
Other symptoms such as hot flushes and dizziness are common in the early stages whilst some lower abdominal pain, bloating and tiredness are common after the TVOA. |
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| What are the risks involved? |
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| The main risks of IVF are most easily categorized by the stage in the IVF procedure. |
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Controlled Ovarian Hyperstimulation (COH)
The main risks associated with stimulation arise from either too much or too little stimulation.
Too much gives rise to a complication called Ovarian Hyperstimulation Syndrome (OHSS). In this, over sensitivity to the drugs used causes so many eggs to develop that they produce such high levels of circulating hormones that they become toxic.
To protect against this potentially dangerous situation any resulting embryos are cryogenically frozen, as pregnancy would make the condition worse and more prolonged. Particularly bad cases can result in the complete cancellation of a treatment cycle.
Too little response to the drugs results in too few eggs. This sometimes also necessitates the cancellation of a cycle or the production of just a small number of eggs for fertilization.
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Trans Vaginal Oocyte Aspiration (TVOA)
Whilst the egg pick-up procedure requires an anaesthetic, it is usually very light and has few associated risks, though some post operative nausea and dizziness are relatively common and transient. There may be some light vaginal bleeding and rarely, a pelvic infection occurs.
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In-Vitro Fertilisation (IVF)
This laboratory based process has it’s own associated risks whilst the patient risks are for the male partner.
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Laboratory Risk
While any system is susceptible to human error, accreditation to an internationally accepted standard (ISO 9000), the implementation a quality management system and the double checking, with 5 points of personal details, on every sample at every step is done to produce a fail-safe process, regarding mismatch of eggs/sperm/embryos.
Similarly, high standards in equipment quality, maintenance and planned replacement are designed to minimize the risk of equipment failure and subsequent damage to stored eggs/sperm/embryos. Being onsite at Joondalup Health Campus gives us the security of the hospital generators to ensure continuity of power supply in the event of power cuts.
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Male partner risks
Provision of an unsuitable semen sample on the part of the male partner may necessitate either a repeat sample, or if that is not possible, an emergency surgical collection. This is obviously a rare event and is only an issue where there is a recognized semen problem.
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Embryo Transfer (ET)
This is usually the easiest part of the whole IVF process and for most women is very much like having a pap smear. Some women can have narrowed or unusually shaped cervices which can make the process more difficult and uncomfortable. Rarely failure to be able to get through the cervix can mean the procedure must be done under anaesthetic in the operating theatre.
In practical terms, twins as the result of the transfer of more than one embryo is the most common complication of this procedure. It is because of the increased risk associated with multiple pregnancies that they must be regarded as a potential complication and every possible step is taken to avoid this.
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