A beginner’s guide to IVF

Around 55,000 patients had IVF or donor insemination in the UK in 2021, up from 53,000 in 2019
Around 55,000 patients had IVF or donor insemination in the UK in 2021, up from 53,000 in 2019

The first baby born through in vitro fertilisation (IVF) was Louise Brown in 1978, when the term “test tube baby” was coined. Today one in seven couples may have difficulty conceiving and the numbers seeking treatment are rising. Around 55,000 patients had IVF or donor insemination in the UK in 2021, up from 53,000 in 2019. The average age of IVF patients is also rising, up to 36 in 2021.

“One of the most common reasons people are coming for IVF, and with increasing occurrence, is women start trying to conceive naturally later in life,” says Dr Yau Thum, a fertility specialist at the private HCA Lister Fertility Clinic in London. “Understandably this happens mostly not by choice but due to social, financial or career issues.”

The cost of living crisis, putting off procreating until later in a woman’s career and not meeting the right partner in time also clearly doesn’t help.

There are also more single women and same sex partners having IVF and, says Thum. “Declining male fertility may be a factor in the increase too, with more men living hectic, unhealthy lifestyles and having poor sperm quality, especially those living in cities.”

So what exactly is IVF?

IVF treatment begins with stimulation of the ovaries. Eggs and sperm are collected, with fertilisation happening outside the body in a laboratory, then one or two embryos are placed in the womb. The term assisted reproductive technology (ART) is the umbrella term used to cover IVF, but it also includes other fertility treatments, including intrauterine insemination (or IUI, where sperm is prepared and deposited into a woman’s womb to increase chances of fertilisation) and intracytoplasmic sperm injection (or ICSI, where a single sperm is injected directly into a woman’s egg outside the body), as well as egg and sperm donation.

Who needs to use IVF as a fertility treatment?

If you’ve been having unprotected sex for a year and you’ve not become pregnant, you should see your GP for investigations (sooner if you are 36 or above, or have medical problems that you know about that may make it difficult for you to conceive). Around one in five couples don’t have an obvious cause for their infertility and this is known as unexplained fertility.

The most common causes of infertility are irregular ovulation, poor quality semen, blocked or damaged fallopian tubes, or endometriosis where tissue similar to the lining of the womb grows in other places.

IVF is also used by same sex partners and single women who want to conceive using donor sperm via IUI.

The term used to describe a regimen of medical treatment is a “protocol”. Although there are a number of different IVF treatment protocols available, there are two that are the most commonly used. One is longer because hormone injections are given first to suppress ovulation a few weeks before the follicle stimulation phase, when more hormone injections are given to produce eggs.

In the shorter protocol, the two sets of hormone injections are given at the same time. The principle of each phase for the various IVF protocols is the same, but the duration can vary from a couple of weeks to four to six weeks, and which one is used is determined by an individual’s unique situation.

Dr Ippokratis Sarris, a consultant in reproductive medicine, a member of the British Fertility Society’s executive committee and the director at King’s Fertility, London, explains: “In both, women need to inject themselves every day to stimulate follicles containing eggs to mature for anything between eight to 14 days. In this phase, women are scanned every few days to measure the size of their follicles and also to check how the uterine lining is thickening, and occasionally blood tests may be done to check hormone levels.”

For up to two weeks, women need to inject themselves every day to stimulate follicles containing eggs to mature
For up to two weeks, women need to inject themselves every day to stimulate follicles containing eggs to mature - Aleksandr Zubkov

When the follicles reach the right size, the eggs are collected by inserting a needle that’s passed through the vagina and into the ovaries, guided by ultrasound (this is done under sedation).

The eggs are then combined with the partner’s or donor sperm in a laboratory to allow them to be fertilised. The resultant embryos are left to develop for up to six days in an incubator. The best one or two embryos are then selected to implant back into the woman’s womb – it’s a simpler procedure so sedation is not usually needed – and a pregnancy test is done two weeks later.

What are the side effects of IVF hormone treatment?

Side effects from the medications used in IVF can include hot flushes, headaches and mood swings. Women can also develop ovarian hyperstimulation syndrome (OHSS), an excessive response to ovary-stimulating drugs, where ovaries can swell and release chemicals into the bloodstream causing a range of symptoms.

Around a third of women having IVF treatment may get mild symptoms of OHSS, including abdominal swelling, according to the Royal College of Obstetricians and Gynaecologists. Around 1 per cent may get more severe symptoms, which include dark, concentrated urine, breathing difficulties and, rarely, blood clots. In these cases, urgent medical attention is needed.

Are there any medications that interfere with treatment?

Sarris says that occasionally medication does need to be stopped or substituted with an alternative drug. “However,” he explains, “patients should never just stop taking their medication without the advice and guidance from the specialists who originally prescribed it, or the medical team performing the IVF treatment.”

How can women prepare for IVF treatment?

Before starting a cycle of IVF, Sarris advises that women should eat a healthy and balanced diet and optimise their weight if they are either over or underweight. “They should also stop smoking and drinking alcohol and take prenatal vitamins, including folic acid and vitamin D,” he says.

It’s also important to control or rectify any other pre-existing medical conditions, including thyroid conditions, diabetes and fibroids, as well as checking your immunity to rubella.

How can men prepare for IVF treatment?

All the healthy lifestyle advice for women applies to men too, and men should also check they are not taking any supplements that can affect their sperm quality (such as anabolic steroids, for instance, which are often used to increase muscle mass and improve athletic performance). Illegal drugs such as cannabis or cocaine can affect sperm quality too (as well as female fertility).

Keeping the testicles cool can help maintain sperm quality, so taking breaks outside if you work in a hot environment or sit at a desk all day may help. Try to avoid tight-fitting underwear, heated car seats or having a laptop on your lap for prolonged periods of time.

How do I know if IVF will work?

UK figures from the Human Fertilisation and Embryology Authority (HFEA) show the average birth rate from IVF using fresh embryo transfers increased from 8 per cent per embryo transferred in 1991 to 22 per cent in 2021.

The average birth rate from IVF using fresh embryo transfers increased from 8 per cent per embryo transferred in 1991 to 22 per cent in 2021
The average birth rate from IVF using fresh embryo transfers increased from 8 per cent per embryo transferred in 1991 to 22 per cent in 2021 - getty

However success rates vary greatly according to a woman’s age. In the 18 to 34 age group, there is a birth rate of 33 per cent per embryo transferred; this is 25 per cent for those aged 35 to 37; 17 per cent in ages 38 to 39; 10 per cent in 40-42-year-olds; and 4 per cent in ages 43 to 50 (where women are using their own eggs).

You can check out the success rate of every licensed clinic in the UK on the HFEA website.

What IVF treatment is available on the NHS?

Women under 40 should be able to access three full cycles of IVF if they have been trying unsuccessfully to conceive for two years, according to guidelines from the National Institute for Health and Care Excellence (Nice).

This also applies to women using artificial insemination who have not become pregnant after 12 cycles (at least six of these cycles should have been using intrauterine insemination, an ART technique, where better-quality sperm are separated from sperm that are sluggish or abnormally shaped).

Women aged 40 to 42 who have not previously had IVF, have satisfied the criteria of trying above and who have a good ovarian reserve should have one full cycle of IVF made available to them, says Nice.

However, these are just recommendations, and in England Integrated Care Boards can decide who is funded and who isn’t. In Scotland and Wales decisions are made centrally, and in Northern Ireland IVF funding decisions are made by the Health and Social Care Board.

According to the charity Fertility Network UK, the reality is that access to NHS IVF varies according to where you live. Figures from the HFEA reveal the number of IVF cycles funded by the NHS fell by 16 per cent between 2019 and 2021.

How much does private treatment cost?

HFEA stats show that 63 per cent of IVF cycles in the UK were funded privately in 2021, compared to 52 per cent in 2019. According to a report by Queen Mary University of London, costs range from between £3,000 and £5,000 for a standard IVF cycle to £20,000 with certain extras such as blood tests, embryo freezing and storage, scans and tests. 

Sarah Law, 37, a solicitor who lives in Liverpool with her partner Martin, 35, a payments accounts manager at a large accountancy firm, paid £14,500 for one round of IVF, which resulted in the birth of her daughter Hope, now three.

“The costs are considerable. Although the initial cycle of IVF cost £10,000, there was another £4,000 for scans and tests and two lots of £2,800 for later failed embryo transfers we had after Hope was born,” says Law, who also had three rounds of NHS-funded IVF treatment prior to the private treatment, none of which was successful. “We also had to pay £25 a month for embryo storage.

“I’m completely exhausted by the whole IVF journey we’ve been on, but I would like to try again at some point, so Hope can have a brother or sister,” she says. “We can’t afford it currently because it would be at least £10,000 for another cycle and we’re still paying off £8,000 on our credit card from the last lot of treatment.”

What’s it like to go through IVF and what’s the best advice to anyone currently having it?

Dr Thum says there are three types of stress with IVF: time and financial pressures and emotional stress.

“As doctors we’re pretty good at telling women about the physical aspects of IVF and the timetable of treatment, but quite often we forget about the emotional and mental toll,” he says. “This is why it’s important to choose a clinic where counselling is available.”

Lisa Ashworth, a career coach and author of Fertility Mindset and Meltdowns, became pregnant with triplets at 41 after spending £25,000 on five cycles of IVF over 10 years.

“The emotional impact of IVF was the biggest part for me,” she says. “It can be incredibly isolating and it’s easy to become depressed. Every month you get fresh hope that you might get pregnant, but it’s devastating when you don’t, or you have a miscarriage.

“You have to deal with so many negative emotions and disappointments, but I learnt how to handle the negative chatter in my head by using mind-body techniques such as visualisation and positive affirmations.”

After spending £41,000 on IVF treatment at the private Lister Fertility Clinic in London between 2019 and 2022, Rebecca Allen, 34, a former analyst with an oil company, gave birth to her daughter Isabella in April 2022.

Rebecca Allen, 34, gave birth to her daughter Isabella in April 2022
Rebecca Allen, 34, gave birth to her daughter Isabella in April 2022 - Rii Schroer

“I had six IVF cycles back to back,” says Allen. “I was very lucky that I didn’t have severe physical side effects, but I struggled mentally with all the uncertainty and not being able to control everything.

“I also lost two babies through miscarriage, which was devastating. I’m the sort of person who likes to have a plan, and even with the very best doctors you can still have failed rounds. IVF totally consumed me for three years and I put my whole life on hold. It definitely put a big strain on my mental health.

“My advice to others would be to stay off the internet and ask your doctor instead – trust that they have the experience and expert knowledge. You need a lot of patience to go through IVF, but having Isabella has meant it’s all been worthwhile.”