When is in-vitro fertilisation carried out?
There are many reasons why IVF treatment might be necessary:
- If the fallopian tubes are blocked or damaged or are not functioning properly (e.g. after operations, infections, or due to endometriosis).
- If there is a mild impairment in the sperm. If the sperm quality is severely impaired, it is better that ICSI is carried out (intracytoplasmic sperm injection)
- If you have not become pregnant despite one year of regular unprotected sex
- If other treatments were not successful
- If the change of becoming pregnant in the normal way is reduced due to age
Success of IVF treatment
The pregnancy rate is approximately 30%. This depends to a large extent on the age of the woman at the time the ovum cell is taken, but also on other factors. The chance of a success increases with the number of treatment attempts (Article). IVF treatment is a very effective and established method of fertility treatment.
Costs of IVF treatment
The statutory medical insurance companies assume half of the costs for three treatment cycles. You will need to meet the other costs yourself. The requirements for costs being assumed by the statutory health insurance companies are:
- The couple must be married
- Only ovum and sperm cells of the spouses may be used
- The wife and husband must have reached the age of 25 years before the start of treatment
- The wife must be under 40 (40th birthday); the man, under 50 (50th birthday) at the start of treatment (IVF age limit)
- Before the start of treatment, an IVF treatment plan must have been submitted to the health insurance company for approval (this is something that we will take care of together)
- Additional counselling for the spouses concerning treatment by a doctor who is not carrying out the treatment themselves (certificate of advice from your gynaecologist)
- There must be a sufficiently high chance of success
The aim of hormonal stimulation in the woman is to cause several follicles to form in the ovaries at the same time. The ova mature in the follicles. To this end, the woman injects herself with follicle-stimulating hormone (FSH) for about 10-12 days, depending on the growth of the follicle. The hormone dosage is determined individually. The hormone is administered subcutaneously, which is to say under the skin in the abdominal region (link to injection videos).
The growth of the follicle and thereby the maturation of the ova is monitored through the use of ultrasound scans and checking the hormone values in the blood. In this way, we can plan the most favourable time to collect your ova. At the best time, the follicles are now prepared for ovulation through a further hormone preparation.
Ovum collection (follicular puncture)
The next step is the collection of the ova (follicular puncture). In order to collect the ova, the follicles are punctured in a way that is guided by ultrasound. This takes place transvaginally (through the vagina) with the aid of an ultrasound wand, to which a thin puncture needle is attached. The follicular punction takes place under brief anaesthesia, so that the patient does not experience pain. The fluid from the follicle is sucked out and then, in the laboratory, under a microscope, the ova are sought out from within the fluid.
Obtaining the sperm
At the same time as the ovum collection, the man provides a semen sample so that sperm are available for the fertilisation.
In IVF treatment, the ova are now brought together with the sperm in a small glass dish. On the next day, the number of ova that can be fertilised can be determined. Ova that are said to be in pro-nuclear stages have formed as precursors to embryos. Even though this process takes place outside of the body, the fusion of ovum and sperm cells is still an individual and natural process. Not every ovum becomes fertilised. The fertilisation rate is about 50-60%. Therefore, it is important that several ova are available.
An embryo arises from a fertilised ovum through cell division. The embryo is the first stage on the path to birth. After a few days, the embryo is transferred. Optimally, two embryos are transferred into the uterine cavity. To do this, a thin, flexible tube is inserted through the cervix into the uterine cavity. This takes place on either the 2nd-3rd day after ovum collection or the 4th-5th day (Blastocyst). The embryo transfer is not painful and takes place without anaesthetic.
In Germany, a maximum of three embryos may be implanted. One should take into account the risk of multiple births and a high-risk pregnancy that is linked with this.
If excess ova that can be fertilised, which is to say precursors to embryos, emerge during the treatment, they can be frozen (cryopreservation). These ova, which are said to be in the pro-nuclear stage, can later be thawed and develop further into embryos. They therefore preserve a valuable chance of a repeated embryo transfer and therefore pregnancy.
In the time after the embryo transfer it makes sense to administer progesterone (corpus luteum hormone) to support the implantation of the embryo. This normally takes place through hormone capsules that are inserted into the vagina.
17 days after the ovum collection, through a determination of the pregnancy hormone (HCG) in the blood, an unambiguous statement about the result of the treatment can be made (pregnancy test). The waiting time is often very stressful for the couple.