In Vitro Fertilization (IVF): Answers to all your IVF questions

Recent developments in reproductive technology, have brought about an increase in success of infertility treatments. More treatment options are now available to women who have difficulty in conceiving, and IVF is one of the options. Over 1 million babies have been conceived by IVF throughout the world.
In recent times, more Nigerians have come to accept IVF as a form of fertility treatment; unlike a few years ago when it was almost considered a taboo subject. It is important to note that IVF is quite an expensive procedure; therefore it is mostly attempted after all other options have failed.

What is IVF?

IVF – In vitro fertilization is basically a process of assisted reproductive technology, by which an egg is fertilized by sperm outside the body. Eggs are removed from the woman’s ovaries and mixed with sperm in a laboratory dish. The laboratory dish is a glass test tube; hence the name “in vitro” which means “in glass”. When the egg is fertilized, it is put back into the woman’s womb to grow and develop.The first success was recorded in 1978 following the birth of the first “test tube baby”- Louise Brown.

Why is IVF done?

1.  It is an assisted reproductive technology for the treatment of infertility caused by advanced maternal age, damaged or blocked Fallopian tubes, and endometriosis.
2.  In cases of male infertility (including decreased sperm count and blockage), which is not severe enough to be treated with intra-cytoplasmic sperm injection (ICSI).
3.  Unexplained infertility.
4.  In gestational surrogacy.
5.  To avoid passing on a genetic condition to a child by doing what is called “embryo testing”.

At what point in my TTC journey should I go for IVF?

It is usually recommended to go the IVF route if you have tried other fertility treatment options such as fertility drugs or Intrauterine Insemination IUI, without success. Also, if you have been trying to conceive for at least two years and no explanation has been found for your infertility.

What is the procedure?

This would depend on individual circumstances and the clinic’s procedure; but usually, treatment follows in 6 stages:

1. Suppressing the woman’s natural menstrual cycle, using medication in form of a daily self-administered injection or nasal spray. This is done for about 2 weeks.
2. Boosting the egg supply, by taking a type of fertility hormone called gonadotrophin. This hormone increases the number of eggs the ovaries produce. It is administered in form of an injection which you have to give yourself daily for about 12 days.
3. Monitoring your progress and maturing your eggs: Vaginal ultrasound scans and sometimes blood tests are used to monitor your progress throughout the treatment About 34-38 hours before your eggs are due to be collected, a final hormone injection is given to help mature your eggs.
4.  Egg Retrieval and sperm collection: An ultrasound-guided procedure is used to retrieve eggs from the sedated patient, using a fine hollow needle attached to the ultrasound probe. About 10-30 eggs are collected. This procedure usually takes between 20 to 40 minutes, depending on the number of mature follicles. Some women experience cramps, soreness or a small amount of vaginal bleeding after this procedure.
   While the eggs are being collected, the man is asked to produce a sample of sperm. The sperm will be washed and prepared, so the active and normal sperm are separated from the poorer-quality sperm. If the sperm sample is donated or frozen, it will be removed from frozen storage, thawed and prepared in the same way.
   After egg collection, progesterone hormone medicine is given in the form of pessary, injection or gel, to help prepare the lining of the womb(endometrium) to receive the embryo.
5.  Fertilizing the eggs: The eggs will be mixed with the sperm in a dish and left to culture in an incubator for about 16-20 hours. They are then checked to see if any has been fertilized. The fertilized eggs (now referred to as embryos) will be grown in the laboratory incubator for up to six days. They are monitored and the best quality embryo will be selected for transfer.
6.  Embryo transfer: This procedure is pain-free and done with ultrasound guidance. It involves transferring the embryo(s) into the womb through a catheter passed into the cervix. There is a restriction on the number of embryos that can be transferred and it usually depends on the maternal age. One or two embryos can be transferred for women under the age of 40. A maximum of three embryos can be transferred for women above the age of 40. This restriction is as a result of the risks associated with multiple births.

What is the chance of success of the procedure?

Each clinic has its own success rate, but the chance of success of IVF depends on a number of factors:

• The age of the woman undergoing treatment (women younger than 40 have a higher chance of getting pregnant).
• The cause of the infertility (if it’s known)
• Embryo quality
• Reproductive history (Success with previous pregnancy and/or live birth increases chances)
• Lifestyle: A healthy lifestyle may improve your chances of having a baby with IVF. It’s best to maintain a healthy weight, avoid alcohol, smoking and caffeine during treatment.

Either a urine or blood pregnancy test is done about 2 weeks after embryo transfer. This period before the pregnancy test is popularly referred to as the “two-week-wait”, and is the most emotionally challenging time of the IVF cycle. As mentioned previously, counselling and joining support groups can ease off the anxiety associated with this time.

What are the risks associated with IVF?

1.  The major complication that can arise from IVF treatment is the risk of multiple births (twins or triplets or more) . Multiple births can be dangerous for both the mother and baby as it increases risk of pregnancy loss, prematurity, neonatal death, and other obstetrical complications.
   This risk is reduced by applying strict control on the number of embryos that can be transferred.
2.  Uncertainty: IVF doesn’t always result in pregnancy,
3.  Anxiety: IVF is both physically and emotionally stressful. Counselling and support groups can make it easier to deal with.
4.  There are possible side effects/allergic reaction to the medications used during treatment, such as hot flushes and headaches.
5.  There is also a possibility of an Ectopic pregnancy where the embryo develops in the Fallopian tubes, rather than in the uterus.
6.  Ovarian hyperstimulation syndrome (OHSS). This is a situation where too many eggs develop in the ovaries. It can lead to swollen and painful ovaries.

What’s the Cost of IVF in Nigeria ?

It depends on the clinic, but the cost usually ranges from N800000 to N1500000 per cycle.

Where in Nigeria can it be done?

There are top class clinics in Nigeria that offer IVF treatment. The procedure, cost and success rates differ with each. Some of the clinic are:

1.  The Brigde Clinic
2.  Medical Art Center
3.  Omni Advanced Fertility Center
4.  Olive Branch Lekki (George’s Memorial)
5.  Fusion Nest
6.  DIFF Hospital Abuja
7.  National Hospital Abuja
8.  Deda Hospital Abuja
9.  Nordica Fertility Clinic