Generally, infertility treatments are not covered by health insurance. When they are, patients must meet a laundry list of criteria ranging from age, medical history, previous treatments and whether or not you have children already.
In the UK, the National Health Service (NHS) will cover up to 3 cycles of IVF, but only if the woman is under the age of 43, has been regularly trying to get pregnant through unprotected sex for 2 years, and has had 12 cycles of artificial insemination.
On average, a cycle of IVF in the UK costs between £6,000 – 10,000 at a private clinic. Some top clinics in London may change upwards of £15,000 per cycle. A cycle of IVF in the United States costs about £9,000. Very often this does NOT include the price of the initial consultation, STD testing, semen analysis, and hormone stimulation medication.
|IVF cycle including medicaments||from 2700 EUR||The package includes all medications needed for IVF cycle, initial consultation at the clinic (including ultrasound examination), examination on sexually transmittable diseases (STD), general anesthesia, oocytes retrieval, fertilization of oocytes, embryos cultivation up to 72 hours and embryo transfer.|
|IVF cycle including donor oocytes and medicaments||from 4000 EUR||The package includes all medication needed for IVF cycle for recipient and donor, initial consultation at the clinic (including ultrasound examination), examination on sexually transmittable diseases (STD), general anesthesia, oocytes retrieval, fertilization of oocytes, embryos cultivation up to 72 hours and embryo transfer.|
|IVF cycle including donor oocytes, medicaments and a guarantee of cryo embryo transfer||from 5800 EUR||The package includes all medication needed for IVF cycle for both recipient and donor, medicaments needed for transfer preparation, initial consultation at the clinic (including ultrasound examination), cryopreservation of sperm including the spermiogram, examination on sexually transmittable diseases (STD), general anesthesia, oocytes retrieval, fertilization of oocytes using ICSI, prolonged embryos cultivation up to blastocyst stage (up to 120 hours), one embryo transfer of 2 „fresh“ embryos and one embryo transfer of 2 frozen embryos.|
|Embryo donation including medicaments||from 2000 EUR||The package includes 2 transfers of 2 frozen embryos per each transfer and medicaments needed for transfer preparation. Embryos are cultivated up to 72 hours.|
In Vitro Fertilisation (IVF) is an infertility procedure for women and men who are unable to get pregnant naturally. The first successful IVF procedure was performed in 1977, and as of 2016 it is responsible for the birth of over 5 million babies worldwide. In the last several decades, new IVF techniques have been discovered, and success rates have increased dramatically. Unlike other infertility treatments, such as artificial insemination in which sperm is directly introduced to the uterus and conception occurs normally IVF takes place outside of the body and is generally reserved for cases in which other fertility drugs, surgeries or artificial insemination have not worked. Female eggs and male sperm are collected from the patients, and are combined in a laboratory. Eggs can either be harvested from the patient or provided by a donor. Embryos (fertilised eggs) are then grown and inserted into the uterus, allowing the embryos to attach to the womb and develop as they would during natural conception.
IVF is for couples who are struggling to conceive naturally. Thirty years ago the average age of a new mother was 22. Today that number is closer to 26, as women are waiting until later in life to begin families. As a woman’s body ages, it begins to produce fewer viable eggs. Similarly, as a male ages, his sperm do not swim as well. Today 15 % of couples face infertility problems and many seek out medical specialist to increase their chances of pregnancy. The average age of a woman getting IVF is between 28 and 42 years old.
Infertility can stem from a number of reasons. As mentioned above, age is the number one factor for decreased egg and sperm vitality. It is also important to note that infertility is not just a “woman’s problem”, but that in about 20 % of infertility cases, the man is the main reason why the couple can not conceive. Another 30 % – 40 % of the time, he is a contributing factor. Discovering a male fertility problems early can mean quicker treatment and a successful pregnancy to happen sooner. Other causes may include (but are not limited to) either partner being diagnosed with:
The decision to travel abroad for IVF will be different for every couple, but benefits often include significant cost savings, higher success rates, increased availability of donor eggs, sperm and embryos and access to special techniques. IVF also remains widely insured by most healthcare providers, and even controversial with strict donor laws. Some patients travel outside of their home country for a different legal status of IVF.
To ensure the best results, patients are advised to work closely with a local specialist while their treatment plan is being developed by the physician abroad. Patients must also decide how much time they want to spend abroad, as the full IVF treatment process lasts between 15 – 21 days. After selecting a clinic, you will be put in touch with them either by email or by phone. Often the initial consultation, which involves collecting medications and an optional sperm collection, can be done at home with a cooperating clinic. Other times, patients are asked to make a first visit, which allows the physician to discuss all necessary information and perform all pre-examinations. The first visit only requires 1 – 2 days, followed by approximately 10 days at home, to begin taking the necessary medication, and a second visit which lasts another 5 – 6 days.
Length: Approximately 1 – 2 hours
During this step you and your physician will discuss your medical history, treatment plan, and perform any preliminary examinations. This regularly includes an STD (Sexually Transmitted Disease) test, as well as blood tests for HIV, hepatitis B and C, and syphilis.
Hormone tests (including FSH, LH, oestradiol and prolactine) will also be performed, as well as a male semen samples to analyse the quality of the sperm. So the results can be used during the initial evaluation, your physician abroad may ask that you bring a blood hormone profile from your general practioner at home. Semen samples, can be collected at the clinic or at home, with 2-4 days of sexual abstinence before.
Medication for hormone stimulation is administered in the form of a daily injection or nasal spray are administered, so that ovulation (the release of an egg) does not occur.
Length: 7 – 10 Days
Using a daily dosage of follicle stimulating hormone (FSH), the ovaries are stimulated to produce multiple eggs. During a woman’s natural cycle, several eggs develop in the ovaries but only one will reach maturity. Stimulation hormones are used so that several eggs in the ovary develop and mature.
During this phase, an ultrasound examination is performed to monitor the stimulation and assess the outcome. This can be performed at your clinic abroad or by your gynecologist at home.
Length: Approx. 30 minutes
About one day (35 hours) before the egg retrieval, you will be given a final dose of HCG to help promote egg maturity. For men, a fresh semen collection may also be performed at this time.
Once the eggs are sufficiently matured, ovulation is induced and the egg retrieval process can begin (called OPU - ovum pick up). Using an ultrasound-guided hollow-needle, your physician will remove the eggs from each ovary. Patients often report that this procedure can be uncomfortable and may result in some pain afterwards, similar to menstrual cramps.
Length: 1 – 5 Days
Within hours of the retrieval, the eggs are taken to the lab where they are introduced to the sperm. The next day your physician will inform you if any of the eggs were fertilized and how many. The remaining fertilized eggs (embryos) are then left to develop for 1 – 5 days.
Sometimes an alternative method of artificial insemination called ICSI (intracytoplasmic sperm injection) is used, in which the male sperm is injected directly into the egg. This option is determined based on the appearance and motility of the sperm from the sample collected, and can optimise the number of successfully fertilised eggs.
During this time special medication (progesterone) is administered to help thicken the lining of the uterus. This increases the chances that once the embryos are transferred, they will adhere to the uterine wall and begin developing naturally.
After fertilization, the embryos are cultivated approximately 3 days, but in some cases, a 5-day prolonged cultivation is necessary.
Length: Approx. 5 – 10 minutes
At this step, the embryo or embryos are transferred into the uterus. It is common that two embryos be transferred to increase the success rate, but this should be discussed with your physician beforehand.
Any fertilized embryos that are not used during the transfer can be cryopreserved and used for further transfers (cryo-embryo transfers).
An hour after the embryo transfer is complete, you may go home.
Two weeks after the embryo transfer, you’re required to take a pregnancy test. This will reveal if the IVF was successful. During this final phase it is important to wait the full 2 weeks before testing in order to prevent inaccurate results.
With any medical treatment, the risks and complications must always be taken into consideration. Although IVF is a fairly safe procedure, patients should always prepare for the potential risks and side effects.
Side effects from the hormone stimulation drugs can range from mild to severe. Mild symptoms may include dizziness, headaches, mood swings and hot flashes. Other side effects may resemble normal hormonal symptoms during the menstruation process, including abdominal cramps and irritability.
Less common, but a more severe side effect is Ovarian hyperstimulation syndrome (OHSS). Too much of the hormone medication can result in the ovaries becoming painful and enlarged. Symptoms may include rapid weight gain, severe abdominal pain, nausea, diarrhea and shortness of breath. If this occurs, even mild symptoms, it is important that you see a physician immediately.
If more than one embryo is transferred into the uterus, this increases the risk of multiple births. Any pregnancy with multiple fetuses carries a higher risk of premature labor and low birth weight.
*Even if only one fetus develops, IVF slightly increases the risk of a premature delivery and low birth rate.
This occurs when the embryo begins to grow inside the fallopian tube instead of the uterus. Is is not possible for the egg to survive outside of the uterus, so there is no way to continue with the pregnancy. This can occur during a natural pregnancy as well, but the risk is slightly higher after IVF. Symptoms to look for include abdominal and vaginal bleeding after a positive pregnancy test.
Women who conceive using IVF (and fresh embryos) are at about the same risk of miscarriage as those who conceive naturally 15 – 20 % but the rate of a miscarriage increases with age. Women who use frozen embryos are at a slightly higher risk.
Some couples may get pregnant through IVF, only to learn that they have lost the child. This can be physically and psychologically devastating. It is important to understand the risks and have exceptional support during the entire IVF treatment process.
IVF can be very physically and emotionally demanding for the couple, and can put a strain on relationships. For the woman, the process can feel rather invasive and she may feel as though her privacy is gone. It is important to remember you are in the hands of medical professionals and that millions of other couples around the world can relate to your experience. After IVF is complete, many couples report that their relationship is even stronger than before.
An IVF treatment is successful when a couple has a healthy baby in their arms. Factors that influence this include age, cause of infertility and lifestyle before and during the pregnancy.
Success rates begin to decrease after a woman turns 35 years old. For instance, a woman under 35 has a 39.6 % chance of getting pregnant and having a baby, while a woman over 40 has an 11.5 % chance.
Success rates also depend on the clinic and their laboratory methods and ability to prevent undesired IVF complications. For instance, a clinic that is successful in reducing the number of multiple pregnancies, will see more successful births.
It is also important to remember that not all pregnancies occur after the first cycle of IVF. While this can be extremely discouraging, even an unsuccessful IVF cycle can provide the physicians with valuable knowledge such as embryo quality, amount of hormonal drugs used, endometrial thickness and infertility diagnosis. All of this can increase your chances of having a baby in the next IVF cycle.
As mentioned in, IVF is usually the last option after natural conception and other means of artificial insemination have been unsuccessful.
Artificial insemination is a process often combined with hormone treatment, and is considered when the man experiences erectile dysfunction or problems with ejaculation. The procedure involves injecting semen directly into the vagina or uterus.
If the problem is the sperm’s quality or motility, couples may also opt for artificial insemination with donor sperm. Before this option, it is common that IVF be tried first so the baby will have both parents DNA.
Other alternatives include cryoconservation- a process aimed at preserving sperm or embryos in a frozen state for later. This method is used to preserve sperm and the remaining fertilised embryos during the IVF process. It is also used for female eggs (oocytes), and ensures that healthy eggs are preserved. Also known as “egg banking” or social freezing, egg freezing has been made popular amongst celebrities in the media, and is for women planning a pregnancy at a later time in life using their own germinal cells.
For women who are unable to carry their own pregnancy to term due to problems with the uterus, a surrogate mother may be an option. This can be very costly and result in some legal issues. A tradition surrogate woman is artificially inseminated with the father's sperm, making her the biological mother. Gestational surrogacy uses IVF to harvest eggs from the mother, fertilise them with sperm from the father, and then places the embryo inside the uterus of the “birth mother”. This makes having a baby possible using both partner’s DNA. About 750 babies are born each year using gestational surrogacy.
Another choice is adoption. For some couples this can be an alternative to IVF, or an option if all infertility treatments have proven unsuccessful. This process can be lengthy and averages between 1-2 years before all of the necessary paperwork is complete. Children of all ages can be adopted, but most are between the ages of 1-4 years old.
Though IVF is a medical process on which you have no influence, your lifestyle can have an influence on the success of the treatment. It it advised that women who smoke stop smoking at least 3 months before an IVF cycle begins. For those who can not quit “cold turkey”, it is advised that they seek help from a professional before continuing the IVF process. By-products of tobacco can be extremely toxic to the eggs (oocytes) and numerous studies have shown that smoking during pregnancy results in lower birth weights and puts the baby at greater risk. It has also been proven to lower pregnancy rates.
Similarly, alcohol should be avoided during infertility treatment and throughout the entire duration of the pregnancy. From the time the hormone stimulation medications are administered, to the time the pregnancy test is taken, alcohol should not be consumed.
If you are taking any prescriptions or over-the-counter medications, it is important that you inform your physician. Some medications may interfere with the fertility medications, and others might interfere with ovulation or pregnancy. Additional medications may also be unsafe to use before an operation or medical procedure. Your clinic may prescribe a prenatal or multivitamin during the IVF cycle. It is important not to use any herbal supplements during this time.
From a mental standpoint, an IVF cycle can be very stressional and emotionally draining for both partners. The couple should have a strong support system at home or may want to seek out the professional support of a clergy member, psychologist or therapist.
During ovarian stimulation, heavy exercise, i.e. aerobics, jogging, lifting heavy weight, are prohibited until after the pregnancy test. Acupuncture is prohibited as well.
Once again, the most important thing you can do before starting IVF is to stop smoking - for both partners. Studies have shown that women who smoke need about twice as many IVF attempts in order to achieve a pregnancy. Woman who smoke also tend to enter menopause 1 – 4 years earlier than women who do not.
Smoking can have an equally negative influence on the fertility of the man. A male smokers’ sperm tend to be of poorer quality than that of a non smoker. To drastically increase your chances at getting pregnant, the first step you should take is to stop smoking.
As stated in, the hormones administered during an IVF cycle may have some side-effects. Fortunately, in most cases they are not serious and only temporary. Claims have been made that the stimulation medication used during IVF treatment can be carcinogenic or have ‘harmful’ effects on the fetus, but there is no medical data to support this. Up until now, no children born from IVF/ICSI have suffered any short-term or long-term side effects due to the treatment. This being said, side effect research is continually being conducted worldwide in the interests of safety.
This is a decision you and your physician will discuss during your consultation, but usually during the first cycle of IVF only one embryo is transferred.There are also many regulatory laws that control how many embryos may be transferred. These measures are to reduce the risk of multiple pregnancies. For instance, in the UK only 2 embryos can be transferred. For women over 40, this number increases to 3. These numbers may vary depending on your individual diagnosis and regulations in the country and clinic you choose.
If there are any embryos leftover after the initial transfer, they can either be frozen or vitrified and saved for further IVF cycles. Embryos can be kept for many years, with most clinics requiring a yearly fee. They may used at any time if a pregnancy is not successful during the first cycle, or if you plan on having more children in the future. If you have a successful pregnancy or abandon further treatment, you have the choice to donate the material, to have it disposed of or to release it for scientific research.
After the embryo is transferred into the uterus there is nothing that can be done to aid its implantation medically or practically. Some physicians will encourage bed rest after the procedure, but in most cases the patients are free to leave within an hour and resume normal activity. There is also no medical data to indicate that best rest will actually lead to an increased chance of pregnancy.
As for other activities i.e. travel, sports, and bathing, no research has revealed that these activities cause any adverse effects. There is no reason to feel personally responsible if the implantation does not occur your behavior is not the cause.
Two weeks after the IVF cycle is complete, you will be asked to take a pregnancy test. If the results are positive, you will be asked to return to the clinic or visit your gynecologist at home for bloodwork and eventually an ultrasound to ensure a successful pregnancy. Once a fetal heartbeat is confirmed, you will likely be referred to an obstetrician for the remainder of the pregnancy.
It is not uncommon that couples go through several cycles of IVF before successfully getting pregnant. Patients are usually asked to wait one or two complete menstrual cycles before beginning another IVF cycle. Research has shown that after the third cycle of IVF pregnancy rates begin to slightly decrease, but no significant decrease has been observed between cycles 4 and 20. Between cycles 7 and 20 a successful IVF cycle/pregnancy is achieved about 15 % of the time.
Absolutely not. Naturally around 1 – 4 % of women experience an ‘early menopause’ before the age of 40, sometimes as early as in their 20’s, but for 70 % there is no medical reason. During a normal menstrual cycle, 10 or more eggs are stimulated and develop. The only difference is that most die during the normal cycle, leaving only 1 or 2 survivors. During IVF, they all ripen. In reality, ovarian stimulation draws from a large reserve of eggs and ensures the survival of many eggs that would have otherwise been lost or unused. In no way would this deplete the ovarian reserve and lead to early menopause.