In vitro fertilization (IVF) is the most effective treatment of childlessness. This technique is used when childlessness is due to problems in the female’s passageway from the ovaries (oviduct) or to poor sperm quality. Also, in situations where the cause for childlessness in not known, IVF is often needed.
Hormone treatment of the female, i.e. the stimulation of the ovaries, is always planned individually. The aim is rather than stimulating the development on one follicle, to stimulate several follicles. This ovarian stimulation may follow a longer program, which involves the use of agonist medication, where the ovaries are put to rest before hormone injections are started. Usually, however, the short program is followed, where antagonist medication is used. Here, hormone injections, following a preplanned schedule, are started during the first days of the menstrual cycle. Often, the menstrual cycle is slightly adjusted before treatment with the use of hormones taken by mouth.
The overall treatment duration is 2–4 weeks, depending on which schedule is chosen. The hormone injections are made in the evening with a fine needle under the skin. Injection of the right amount of hormone is not difficult and does not cause pain. The IVF nurse provides solid and clear instructions on how injections are made. At all stages of the treatment, the IVF nurse is available for answering questions or if something is not absolutely clear. The development of the ovarian follicles if followed with ultrasound 2–3 times during treatment and, if needed, the amount of hormone is adjusted following the development of the follicles. When the follicles have reached a size of 18–20 mm, a hormone injection is administered, and this causes the egg cells to be released. They locate in the liquid environment of the follicles. Egg cells are then collected from the ovaries by suction of the liquid of the follicles into small tubes. A thin cannula is used for suction. The procedure is guided by ultrasound and takes about 10–20 minutes.
During the procedure, a painkiller is given intravenously, and the vagina is locally anesthetized. If needed, anesthesia may be used. After the procedure, the patient’s condition is followed at the clinic for at least one hour. The patient may then leave for home, if she feels well. After the procedure the patient should rest and avoid physical strain, but drink enough. If needed, a physician’s statement on work incapacity is provided. On the day following the procedure hormonal support medication is started according to instructions available at the clinic.
After the procedure the egg cells are collected from the follicle fluid under laboratory conditions.
The male partner provides a sperm sample on the day of the procedure. The sperm is “washed” to facilitate identification of the best sperm cells. If donor sperm is used, the sperm cells are thawed after which they undergo the same procedure for identification of the best sperm cells. The egg and sperm cells are put in a container where the egg cells become fertilized within 20 hours.
In the laboratory the cells are placed in a cell culture cabinet with optimal conditions that simulate the conditions prevailing in the female genital tract. Fertilization and the development of the embryos is followed for 2–5 days in the laboratory, after which the best embryo is selected for transfer to the uterus. In the laboratory, the remaining embryos of high quality are frozen for later use for embryo transfer. The doctor together with the couple or the single woman decide on the number of embryos to be transferred to the uterus. Usually only one embryo is transferred to minimize the risk of a twin pregnancy; the maximum number of embryos transferred to the uterus is two. Hormonal support continues still after the embryo transfer, and a pregnancy test may be carried out two weeks after the transfer.
On average, 30–40% of transfers will end in a pregnancy. The most important determinant of the prognosis (success of the procedure) is the age of the woman.
Before in vitro fertilization is started, a treatment agreement is signed, as required by the Act on Assisted Fertility Treatments (1237/2006). In addition, a blood test is needed to exclude some infections (HIV, hepatitis B and hepatitis C).