In Vitro Fertilization
In the process of in vitro fertilization (IVF), the part of conception where the egg is fertilized by the sperm takes place outside the body, in a glass dish - although many people imagine it is done in a test tube, which is the origin of the expression 'test-tube baby'. This process was first pioneered in the 1960s, and the first test-tube baby - named Louise Brown - was born in 1978.
What it involves
Once you have been accepted onto a course of IVF treatment after tests and assessment, you will be offered counselling. IVF, like any fertility treatment, can be stressful and exhausting, and a counsellor can help with any emotional difficulties.
Next, you will be given drugs to suppress the activity of your ovaries. This involves'sniffing'a hormone spray for about 21 days. After this, you will receive a course of injections to stimulate your ovaries to produce eggs. This is done so that the doctors can ensure that you produce a number of eggs at the same time. Your blood will be tested regularly and you will be given ultrasound scans so the doctors can check the progress of the eggs'development. It is important to get the timing right because the eggs will be collected within 2-3 hours of ovulation. When the follicles are almost ready to release eggs, you will be given an injection of human chorionic gonadotrophin (HCG), a hormone that will trigger the final maturing and release of your eggs.
What happens next
When your eggs are ready to be'harvested'you will be given a local anaesthetic and, using an ultrasound scan as a guide, and a tiny needle, the doctor will remove several eggs. The needle is usually inserted through the top of your vagina but it can pass through your abdomen. You will be able to go home straight afterwards to rest.
Your eggs and your partner's sperm will be put together in a laboratory and left for a few days, by which time those eggs that have been fertilized will have divided many times and become embryos. Up to three embryos will then be placed into your uterus, using a catheter.
In some countries, such as the United Kingdom, if you are under 40, only two embryos will be used, to reduce the risk of your conceiving triplets. If you are over 40, you can have three embryos implanted if you wish, as it is less likely that all of them will implant. If more than three embryos have been produced, the extras can be frozen and used for another IVF cycle.
The pros and cons
IVF has good success rates and means that a couple can conceive a baby using their own eggs and sperm. On the downside, it involves a lot of medical intervention, which at times can be painful and distressing, so if you need to have several cycles it can take its toll emotionally. Also, the drugs that boost ovulation can have unpleasant side-effects, and you will have to be monitored while you are taking them. It can also be expensive if you have to pay for it yourself.
The various stages of the in vitro fertilization process have different side-effects.
Taking drugs to suppress your ovaries may produce symptoms that are similar to those of the menopause. These can include hot flushes, sweating, night sweats, insomnia, dizziness, headaches and vaginal dryness.
Taking HCG (human chorionic gonadotrophin) to stimulate ovulation may produce symptoms similar to pre-menstrual tension (PMT), for example, anxiety, stress or tearfulness, bloating, sore ovaries or general aching and tiredness. Collecting eggs may leave you feeling tired from the effects of the anaesthetic, and your ovaries and abdomen will ache. Transferring embryos will leave you drowsy and you may feel emotional, and have sore breasts and a painful abdomen.
Tips for couples undergoing IVF
Decide early on who you are going to tell: You may not want to tell the world what you are doing, but it can be stressful to keep it to yourselves, and it might help to have a friend or family member to whom you can talk. Also, you may need time off work for treatment, so confiding in a colleague can be useful in order to stop speculation about your frequent disappearances.
Consider donating eggs or sperm: Some clinics give priority to couples who are prepared to do this for other couples with fertility problems, and it may mean a shorter wait for treatment.
Learn to give yourself injections In this way you will save yourself time and effort going to your doctor's surgery for the long course of hormones to suppress your ovaries. Remember that many people do not succeed at the first attempt; in many respects, it is a way for you and your doctors to find out how you respond to treatment.
Know when to stop: It can be harder to give up than it is to begin -you may feel you are letting people down or being a quitter. But IVF is a hard slog, and it can be empowering to decide that it is no longer for you.
Keep communicating with each other: If either of you feels in need of a break or is unable to cope with any more, do not be afraid to say: one partner may be soldiering on for the sake of the other. Keep talking about how long you want to continue, how you feel after each attempt and whether your desire for a baby makes it all worthwhile.