Assisted reproductive technology – IVF and ICSI

This page gives a general overview of two types of assisted reproductive treatment (ART): in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).

What are IVF and ICSI?#

IVF and ICSI are forms of assisted reproductive treatment in which eggs are fertilised with sperm outside the body. IVF is generally used for female infertility and for unexplained infertility, while ICSI is used when there is a male cause of infertility. ICSI is sometimes offered when there is no male cause of infertility, although research suggests this does not increase the chance of having a baby.

The steps in IVF and ICSI#

• Hormone stimulation – the woman’s ovaries are stimulated with a course of injectable fertility drugs.
• Egg retrieval – when the eggs are mature, they are collected while the woman is under a light anaesthetic.
• Fertilisation and embryo development – with IVF, sperm from the male partner or a donor is added to the eggs so they can be fertilised. With ICSI, a scientist picks up a single sperm and injects it into each egg using a microscopic needle. The eggs and sperm are then kept in the laboratory for 2 to 5 days (depending on the clinic) for embryos to develop.
• Embryo transfer – if embryos develop, one embryo (sometimes two) is placed in the woman’s uterus. If several embryos develop, the extra ones can be frozen for later transfer.
• Pregnancy test – about 2 weeks after the embryo transfer, the woman has a blood test to see whether the treatment has worked. If it is positive, an ultrasound is usually scheduled about 2 weeks later to check the pregnancy is developing normally. (A clinical pregnancy does not guarantee a birth, as miscarriage can still occur.) If it is negative, the woman will have a period and can decide whether to try again.
• Live birth – the birth of a living baby or babies (a multiple birth is counted as a single live birth).

If a woman has frozen embryos, these can be transferred one at a time without needing to stimulate the ovaries again.

Understanding success rates#

Clinics report their success rates in different ways. When comparing clinics, make sure you compare like with like. Most importantly, consider your own circumstances and medical history when estimating your own chance of having a baby. The woman’s age is the single most important factor affecting the chance of success with IVF, and it can help to look at the chance of a baby after one, two and three cycles for women of different ages.

Possible health effects and risks#

In experienced hands, IVF and ICSI are safe and serious medical complications are rare. As with any medical procedure, however, there are some risks to consider for the woman, her partner, and children born as a result of treatment. These include:

• an excessive response to fertility drugs (ovarian hyperstimulation syndrome)
• multiple birth (twins or triplets)
• premature labour and low birth weight
• a small increased risk of birth defects compared with babies conceived spontaneously
• caesarean delivery

IVF and ICSI can also be psychologically and emotionally demanding. Counselling services are commonly available through fertility clinics, and women having treatment, along with their partners, are encouraged to use them if they experience emotional difficulties.

Cost#

The cost of IVF and ICSI varies depending on the treatment, the clinic, and where you live. In some places, public health schemes or private health insurance may cover part of the cost, but there are often substantial out-of-pocket expenses. Ask your clinic for a clear breakdown of the costs before starting treatment.

Add-ons#

Some clinics offer “add-ons”, or adjuvant therapies. These are extra procedures or medications added to IVF treatment to try to improve the chance of success. Examples include endometrial scratching, time-lapse imaging of embryos, and the prescription of steroids, testosterone and growth hormones. Many add-ons are experimental or have not been properly tested, so it is not known whether they make any difference to the chance of having a baby. They may also cause side effects and add to the cost. It is worth asking your fertility specialist whether a particular add-on is right for you.

Deciding what to do with unused embryos#

Some people have embryos in storage that they do not intend to use, most often because they have completed their family, though sometimes health reasons prevent them from using stored embryos. Storage time limits apply and vary by location, and at the end of the limit people need to decide what to do with any unused embryos.

There are generally four options:

• apply for an extension of the storage time
• dispose of the embryos
• allow the embryos to be used for research
• donate the embryos to another person or couple who are unable to conceive

Many people find this a difficult decision, and counselling can help you work through the options.

Key points#

• IVF and ICSI fertilise eggs with sperm outside the body, then transfer a resulting embryo to the uterus.
• The woman’s age is the most important factor in the chance of success.
• Risks include ovarian hyperstimulation syndrome, multiple birth, premature labour and a small increased risk of birth defects.
• Treatment can be emotionally demanding, and counselling support is usually available.
• Be cautious about unproven “add-ons”, and plan ahead for what to do with any unused frozen embryos.

Where to get help#