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.
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.
The reasons for pursuing treatment using IVF have been extended to include prolonged unexplained infertility, endometriosis, social infertility, 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.
The WA Government enacted legislation in 1991 (amended in 2004) that stipulates eligibility criteria for IVF. These are:
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.
IVF treatment involves four main stages:
The main risks of IVF are most easily categorised by the stage in the IVF procedure:
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 fertilisation.
This laboratory based process has it’s own associated risks whilst the patient risks are for the male partner.
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.
While any system is susceptible to human error, the implementation of a robust quality management system, RI Witness system and a standardised double checking system are in place at Fertility North. These are implemented at every sample at every step, to produce the safest process possible for your eggs, sperm and/or embryos.
Similarly, high standards in equipment quality, maintenance and planned replacement are designed to minimise the risk of equipment failure and subsequent damage to stored eggs/sperm/embryos.
Although we have our own laboratory backup power supply in place and a 24/7 alarmed monitoring system in our laboratory, being onsite at Joondalup Health Campus gives us the added security of the hospital generators. This ensures continuity of power supply in the event of a power outage.
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. In the rare event that the doctor is unable to pass the catheter through the cervix, the procedure can be performed under anaesthetic in the operating theatre.
If more than one embryo is transferred there is an increased risk of a multiple pregnancy. Mutliple pregnancies are associated with increased risk and therefore must be regarded as a potential complication. In accordance with the Reproductive Technology Accrediation Committee (RTAC) Code of Practice, Fertility North takes every possible step to avoid this.
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.