While there are other forms of treatment, in-vitro fertilisation (IVF) is the primary means of helping a childless couple conceive a child. IVF involves stimulating and harvesting multiple mature eggs from the wife and fertilising them with her husband’s sperm in a dish in the laboratory. A successfully fertilised egg would then be implanted in the wife.
Dr Wong Pak Seng explains that the success rate of IVF is about 50%, and becomes lower after the age of 35. Therefore, a couple may have to repeat IVF for several times, although for most couples, they may succeed after the 3rd cycle.
“It is very important for parents seeking fertility treatments to have realistic expectations,” he says. “Otherwise, they become easily demoralised and take the failure personally. A failed IVF treatment is not anyone’s fault – a lot of times, we are also banking on luck to help us succeed!”
Having said that, let us now take a look at what happens should you choose to undergo IVF.
The first 2 weeks
During this period, you will receive 1 to 3 daily injections of fertility medications to stimulate the follicles in your ovaries to produce as many eggs as possible during your cycle. These medications are usually hormones that can be injected directly into your thighs or stomach by yourself in the comfort of your own home or in a private space in your workplace.
These hormones all work to ensure that the fertility specialist is able to control the progress of your menstrual cycle and observe, through ultrasound, the development and growth of your eggs so that they can be harvested at the right time. Here are some of the hormones you would be given:
Folicular stimulating hormone (FSH)
Helps to stimulate the ovary to produce eggs
Gonadotropin-releasing hormone (GnRH)
Injected before or in the middle of your cycle to stop premature ovulation
Human chorionic gonadotropin (hCG)
Injected around day 12 to stimulate ovulation
Throughout these two weeks, you would make a few trips to the fertility centres for blood tests as well as ultrasound.
From tests and observations during the first two weeks, your fertility specialist would be able to calculate the time of ovulation. On this day, you would be heavily sedated. Then, with the help of the ultrasound, your fertility specialist would insert a hollow needle through the wall of your vagina to extract your eggs.
Meanwhile, your husband would be in a nearby room to collect and hand over his sperm to a lab technologist, who would then process the sample to extract the most healthy-looking and promising sperm cells.
These sperm cells and your eggs would be mixed together in an incubator to facilitate fertilisation. If the sperm cells have problems penetrating the egg wall, the lab technologist would inject sperm directly into the egg in a process called intracytoplasmic sperm injection (ICSI).
A successfully fertilised egg would then be transferred to your womb for implantation. For eggs from women over 40 or if there is a history of failed IVF attempts, the technologist may first perforate the outer shell to allow for easier implantation. This process is called assisted hatching.
If there are concerns about genetic diseases being passed on to the child, the fertilised eggs would be first screened at the laboratory. The laboratory would then select the healthiest ones for the transfer.
Your fertility specialist will use a thin catheter to insert a few (usually 2-3) fertilised eggs into your uterus through the vagina. There may be some degree of discomfort, but it should not be painful.
The big moment
The days after the transfer could be frustrating, even nerve-wrecking, as you and your partner would wait for nature to take its course. During this time, you would receive daily injections of progesterone, a hormone that supports implantation and pregnancy, and in about 2 weeks, you would visit your fertility centre for a pregnancy test.
Many fertility centres offer counselling services as part of the treatment package. So, if the stress becomes too hard to bear, confide in the counsellor. He or she is usually experienced in helping couples such as you and your husband, and the counselor’s support and advice would be invaluable throughout your treatment.
If you wish to consume herbal remedies or traditional medications to improve your fertility throughout this period, please discuss with your fertility specialist before you begin IVF. There is a possibility that such remedies may interfere with the actions of the hormones and end up affecting your chances of success.
Like nearly all medical treatments, IVF carries a small risk of complications. Complications may include:
- Multiple pregnancy. This is a common complication of infertility treatment. Kate Gosselin, a media personality in the USA with polycystic ovary syndrome, had sextuplets after a successful fertility treatment. They were born prematurely – a common occurrence for multiple births resulted from fertility treatments – but eventually recovered to become the healthy children they are today. However, the risk of developmental and health problems as a result of premature birth is very real, and should be taken into consideration. It is best to discuss your concerns with your fertility specialist when it comes to the possibility of multiple births.
- Ovarian hyperstimulation syndrome (OHSS). The use of injectible hormones may over-stimulate your ovaries, causing them to become swollen and painful. You may experience nausea, abdominal pain and bloating as a result.
- Bleeding or infection.
3-Parent IVF is a new approach in which an embryo is created using the genetic materials of three people – the parents and an egg donor. This method can be used when a structure in the mother’s cells, called the mitochrondrion (plural mitochondria), contains genes which can cause mitochrondrial disease in the baby. Mitochondral disease can cause damage to the brain, heart, liver, muscles, and kidneys as well as the endocrine and respiratory systems.
In 3-Parent IVF, mitochrondria are extracted from a healthy woman free from these problematic genes and are used to replace the mitochondria in the mother’s eggs. Debate on the ethics behind this treatment still continues, but the UK became the first country to license this technique in February 2015.
Can you increase the chances of IVF success?
There are many ideas floating around at the moment about habits that you can adopt to increase your chances of becoming pregnant. Dr Wong addresses some of these ideas.
- Special diets. According to Dr Wong, there is no special diet that has been scientifically proven to increase your chances of success. However, a healthy balanced diet rich in whole grains, fruits and vegetables – the same one that everyone should eat – is important to ensure that you stay in good health and are able to nourish the baby you are hoping to conceive.
- Bed rest. Opinions are divided when it comes to staying in bed all day after IVF treatment. Dr Wong does not believe that it increases the likelihood of a successful pregnancy. You can resume your normal routine, but Dr Wong advises to stick with light and moderate exercises when it comes to physical activity.
- Complementary therapy. There is not much scientific evidence to demonstrate the effectiveness of complementary therapies to boost your chances of success, but Dr Wong believes that certain therapies, such as acupuncture, can be effective in relieving stress – see the next point.
- Stress relief. It is possible that stress can indirectly affect your success rate by affecting the hormone levels in your body. Therefore, stress-relief activities such as acupuncture, yoga, listening to therapeutic music and massage may be good for you. Lowering your stress level can also improve your relationship with your partner and defuse any possible tension that can arise from the frustrations of trying to conceive a child.
Send in the... clowns?
In 2011, a research team in Israel studied a group of women who have gone through the embryonic transfer stage in IVF. Some of these women were entertained by a clown during their recuperation in the recovery room, while the rest were in the control group that was deprived of the clown’s company. The team found that the pregnancy rate for the women who were entertained by the clown was 36.4% compared to 20.2% in the control group. This result was attributed to the lower level of stress in those mothers who were entertained by the clowns.
Other treatment options
IVF is the most common treatment option for many childless couples, but a fertility centre offers other options as well, depending on the nature of the problem.
- Counselling and medications for problems related to erectile dysfunction and premature ejaculation.
- Hormone treatments for cases in which low levels of hormone result in low sperm count or other causes of infertility.
- Assisted reproductive technology (ART) treatments for men who could not ejaculate normally, in which sperm is extracted and then inserted directly into the female genital tract or to be used in IVF.
- Intrauterine insemination (IUI), in which the extracted sperm is inserted directly in the uterus around the time when the woman ovulates.
- Certain problems in the womb such as fibroids and polyps can interfere with the woman’s ability to conceive. These problems can be improved or overcome by surgery, which can also be performed by a fertility specialist.
Friedler S, et al. (2011). The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer. Fertil Steril. May;95(6): 2127-30. doi: 10.1016/j.fertnstert.2010.12.016. Epub 2011 Jan 6.
Medline Plus. In Vitro Fertilization. Retrieved on April 5, 2015, from http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm
National Health Service (UK). MPs vote to give the go-ahead to three-parent IVF. Retrieved on April 5, 2015, from http://www.nhs.uk/news/2015/02february/pages/mps-vote-to-give-the-go-ahead-to-three-parent-ivf.aspx
 Medline Plus. In Vitro Fertilization. Retrieved on April , 2015, from http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm
 National Health Service (UK). MPs vote to give the go-ahead to three-parent IVF. Retrieved from http://www.nhs.uk/news/2015/02february/pages/mps-vote-to-give-the-go-ahead-to-three-parent-ivf.aspx
 Friedler S, et al. (2011). The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer. Fertil Steril. May;95(6):2127-30. doi: 10.1016/j.fertnstert.2010.12.016. Epub 2011 Jan 6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21211796