IVF is the process by which egg and sperm are mixed in a plastic dish outside the body. Within two to five days of fertilization occurring, the embryo is taken from the dish and placed in the mother’s uterus using a fine tube. It involves the removal of eggs from the ovaries and the collection of sperm from her partner. At five days of development, no organs have formed, and the embryo is invisible to the naked eye. At this stage, the embryo comprises about eight to 160-minute cells.
IVF has huge publicity, gaining a false reputation as the only answer to infertility. It is the most demanding of all procedures in reproductive medicine and actually less successful than many alternatives. Strictly speaking, IVF is not even a ‘treatment’ for infertility as it does not alter the underlying cause. It is simply a one-off attempt to help someone to have a baby. The attempt can be repeated, but the cause of infertility remains.
Because IVF does not change the underlying causes of infertility, it is often best where possible to seek other treatments likely to improve the chances of becoming pregnant naturally. However, IVF has revolutionised the treatment of very many infertile people who have no serious alternative. It also has dramatically improved our knowledge about many causes of infertility and is often very useful diagnostically when the cause of infertility is obscure.
IVF is still frequently confused with artificial insemination (AI) which is completely different. Artificial insemination usually involves a doctor or nurse placing sperm directly into a woman’s vagina or uterus with a syringe. Admittedly, some women avoid the doctor and self-inseminate. Of course, a key problem then is how they obtain sperm from an untested donor that is free of infection. Once artificial insemination is done fertilisation occurs in the fallopian tube in the normal way.
IVF is not really the first option to be considered. My contention is that more than half of all women referred to IVF clinics may be better treated by alternatives. Too frequently no systematic assessment of the medical condition of the patient is made at the outset. There is a real need for referring General Practitioners (GPs) to educate themselves about fertility treatments (usually ignored in most medical student teaching programmes). A good GP should have the information and sensitivity to make sound judgments about whether his or her patient would most benefit from IVF treatment, rather than from one of the alternatives. Sometimes, of course, patients themselves push for IVF when there may be a more suitable, possibly cheaper, treatment.
Even specialists in reproductive medicine are tending to refer patients for IVF before it is proved to be necessary. Too many couples enter an in vitro fertilisation programme before complete medical investigation. This is doubly unfortunate. Firstly, IVF may fail because there may be an underlying condition – for example, a uterine abnormality – that needs treatment and may prevent pregnancy even if an embryo is successfully generated and transferred to the womb. And secondly, it also means that treatment of the actual cause is avoided, when this may well give a better chance of conception. Diagnosing the true cause of infertility is vital if at all possible.