There are many possible reasons why a woman fails to get pregnant. There may be irregularities in her ovulation cycle, a problem with her reproductive organs, some underlying medical condition, or it may be that her sexual partner has low sperm count (azoospermia). Irregular periods or menstrual cramps may indicate an ongoing problem of infertility, but the causes of infertility can be invisible and male infertility can have no symptoms at all. A simple semen analysis, which measures the health of semen and sperm is the best way of establishing if the problem lies with the male sexual partner. If his semen is healthy and sperm count sufficiently high it may be a matter of age: a man over 40 can take longer to impregnate a woman, while a woman’s fertility naturally declines after the age of 35, though it is of course still possible for her to get pregnant.
The failure to conceive may simply be due to the fact that the couple haven’t been trying long enough. Around 80% of fertile couples conceive after six months of unprotected sex, and around 90% will achieve conception after twelve months of trying. So, if some form of infertility is not the problem, persistence should pay off.
If it doesn’t, IVF treatment may be the answer.
What is IVF?
IVF or In Vitro Fertilisation is sometimes confused with artificial insemination. In the latter procedure, sperm is introduced directly into the uterus to fertilise the egg, whereas in IVF sperm is introduced to the egg outside the woman’s body in a clinical laboratory. After an embryo has formed through successful fertilisation it’s placed in the uterus where it develops normally. The first child to be born through IVF was Louise Brown, in England in 1978 and since then nearly half a million babies are born through the process each year.
How Does In Vitro Fertilisation Work?
IVF can be carried out using a woman’s own eggs or those of a donor, combined with her partner’s sperm or that of a sperm donor. The donors can either be known to the woman and her partner or remain anonymous. There are four stages to the process:
- Stage 1: Ovarian Stimulation: if a woman is using her own eggs in the procedure she’ll begin taking synthetic egg-growing hormones to encourage the ovaries to produce multiple eggs, rather than the single egg that develops naturally each month. Multiple eggs are required as some eggs won’t be fertilised or develop normally. Other medications may be needed at this stage to help the oocyte (egg cell) mature, prior to egg retrieval, to prevent premature ovulation and to prepare the lining of the uterus.
- Stage 2: Egg Retrieval: the mature eggs are retrieved from the uterus 34 to 36 hours after the last injection of hormonal medication before ovulation. This involves sedation, during which an ultrasound probe is inserted in the vagina to detect the follicles bearing mature eggs. These eggs are retrieved through a thin needle attached to a suction device, placed in a nutritive liquid and incubated.
- Stage 3: Fertilisation: eggs are fertilised either using conventional insemination, with healthy eggs and sperm mixed and incubated overnight or through ICSI, Intracytoplasmic Sperm Injection. Here, a single healthy sperm is directly injected into each egg. This is often resorted to when there’s a problem with semen quality or sperm count or previous fertilisation attempts haven’t succeeded.
- Stage 4: Embryo transfer: two to five days after Stage 3 the woman is given a mild sedative, a catheter (a long thin flexible tube) is inserted into her vagina, through the cervix, and into the uterus. At the other end of the catheter is a syringe containing a small number of embryos in a solution which are then injected into the uterus. Six to ten days after transfer, if the process has been successful, an embryo will start to grow in the lining of the uterus. A doctor will test for pregnancy twelve days to two weeks after the transfer.
Some women will fail to conceive after IVF, but if some of their embryos were frozen they can go through the process again without the need for more hormonal medications. Others will receive a diagnosis which may indicate reasons why conception failed and adjustments can be made so that a subsequent cycle is successful. Happily, many women do conceive after IVF. For women under the age of 35 the percentage of live births per egg retrieval is 54.5%, for those between 35 and 37 the percentage is 42% and decreases steadily at older ages. Which is why many women over 40 opt for using donor eggs, as successful conception with these is not dependent on the woman’s age. But there are other factors, apart from age, which influence a successful outcome with IVF.
- Condition of the Embryo: the transfer of more developed embryos is associated with higher pregnancy rates than less developed embryos. And not all embryos survive the development process.
- Reproductive History: women who’ve given birth previously have an increased chance of doing so again with IVF. The chance of success is lessened for women who’ve attempted IVF previously, perhaps repeatedly.
- Egg Supply/Infertility: a normal, healthy supply of eggs increases the chances of getting pregnant. Infertility problems such as endometriosis (a disorder involving the tissue lining the uterus) also affect the likelihood of achieving pregnancy.
- Lifestyle: a woman who smokes lessens her chance of getting pregnant through IVF by as much as 50%. Fewer eggs are retrieved and the possibility of miscarriage is higher. Obesity, alcohol usage, recreational drugs, caffeine and other medications can also have an impact.
But there is no aspect of IVF which cannot be discussed with a qualified practitioner, and the more women — and their partners — know about the process, their own reproductive system and the factors which affect it, the better their chances of successfully conceiving a baby.