In Vitro Fertilisation has been part of the medical and social landscape for 40 years, and even though it is a familiar concept, we don’t always know what it means. In this article we get back to basics and set out the definition of IVF in straightforward terms and explain exactly what is involved in IVF fertility treatment. We also take a look at how treatments and techniques have been refined during that comparatively short time and how these developments can contribute to making assisted fertility treatments more successful for a larger number and wider spectrum of people.

The meaning of IVF can be set out very simply, but its wider implications are more significant. They hold great promise for freedom of choice and the ability for those who wish to become parents to do so in spite of obstacles that only a generation ago may have dashed their hopes.

What does IVF mean?

In Vitro Fertilisation is assisted fertility treatment in which female eggs are removed from the ovaries and combined with semen from the male partner in a laboratory setting. ‘In vitro’ simply describes a process that takes place in a test tube or culture dish, outside of a living organism. In more precise medical terms, the process is one in which the ovum is united with the spermatozoon in the laboratory in order to obtain fertilised embryos for transfer to the patient’s uterus.

These are the stages involved in the process:

1. Ovarian stimulation: the first step in IVF

Ovarian stimulation during IVF consists of the administration of daily injections which cause the ovaries, instead of producing a single ovum which is what they do naturally each month, to produce more oocytes so that a larger number of embryos can be obtained.

2. Next IVF step: Retrieval of oocytes

When there is evidence through ultrasound scans that the follicles have reached an adequate size, and that there is a suitable number of oocytes, an injection of the hormone hCG is administered. Thirty-six hours later, retrieval of the oocytes takes place in a procedure known as follicular puncture. This part of the process takes place in an operating theatre with the patient under sedation, so no discomfort is involved.

4. Fertilisation of the oocytes

This is at the heart of the meaning of IVF. Insemination of the ova occurs as a result of placing an oocyte and spermatozoa in a culture plate and allowing the two to mingle so that fertilisation takes place. The resulting embryos are observed in the laboratory for a number of days, allowing the most promising to be selected.

5. Transfer of the embryos: the culmination of the IVF process

Implanting the embryos into the patient’s uterus involves inserting them with the help of a specially designed cannula. The procedure is carried out in an operating theatre, although sedation is not necessary since it is a quick and painless procedure.

Developments of the basic IVF technique

The above answers in a nutshell the question, ‘What is IVF?’ But as medical research delves deeper and new techniques are developed, the meaning of IVF has come to represent much more. It is no longer a single concept, used for a single purpose, but is now a series of possibilities for addressing issues of infertility. Some of the refinements of the basic technique are:

Intracytoplasmic Sperm Injection (ICSI)

This is an assisted reproduction technique which can be included as part of IVF treatment. It has enabled pregnancy to be achieved for couples diagnosed with severe male factor infertility. The male partner provides a semen sample (or undergoes a testicular biopsy if necessary) in order to extract and select the best spermatozoa which will be used to fertilise the oocytes. ICSI allows the egg and the sperm to be brought together directly, facilitating fertilisation. A sperm that has low motility or poor morphology would have greater difficulty achieving this naturally or through the technique of standard IVF. During the process of ICSI, the selected sperm is placed in a tiny pipette and is injected directly into the ovum. In this way, fertilisation is facilitated to the greatest possible extent.

You can watch a video on our IVI YouTube channel which explains what IVF is and how it works and well as the refinement of ICSI.

IVF Genetic (IVF + PGT-A)

This is the combination of IVF and PGT-A (Preimplantation Genetic Testing-Aneuploidy). Thanks to chromosomal screening, the IVF GENETIC treatment offers a higher success rate per embryo transfer, and in the longer term increases the chances of having a baby free of any genetic anomalies. The selection of the soundest embryos through PGT-A raises the chances of pregnancy after implantation to 70%, and reduces the chance of miscarriage. This higher first-time success rate leads to reduced waiting time and often eliminates the need to undergo more than one cycle.

Who benefits from IVF and its developments?

Naturally, couples experiencing infertility or low fertility for a range of reasons, including severe male infertility, have benefitted from IVF and will continue to do so. But there are other groups of people for whom the benefits of IVF and its associated developments can transform their lives by allowing them to see their dreams of becoming parents come true. These include:

1. Female same-sex couples who wish to share motherhood

The ROPA method, which stands for Reception of Oocytes from the Partner, allows same-sex couples to ‘share motherhood’. This technique consists of an IVF procedure where one woman contributes with her oocytes, fertilised by anonymous sperm donation, and her female partner contributes with her uterus. Thus, both women actively participate in the process of creating a new life. One of them is the genetic mother of their baby and the other is the gestational mother.

2. Women who wish to preserve their fertility

The preservation of fertility is an option for women who are about to undergo treatment for cancer or other medical interventions which could compromise their subsequent fertility. It is also increasingly used where there is no medical indication, but social reasons instead. This applies to women who decide to postpone motherhood for various reasons, or because their financial or work circumstances currently prevent them from having a child.

The preservation of fertility depends on the vitrification of oocytes which allows the mature eggs obtained following ovarian stimulation to be cryopreserved so that they can be used at a later date, when the patient decides she is ready, with the same prognosis as at the point when they were vitrified. Due to the fact that ice crystals do not form, oocyte survival rates are high, allowing motherhood to be postponed with reasonable guarantees of success. When the woman decides the time is right, the IVF process, which has been in a sense put on hold by the vitrification of oocytes, continues in the normal way. For more about how the process works, have a look at the video on our IVI YouTube channel.

3. Women who are unable to produce ova

In cases where there are medical or physical reasons why a woman’s own oocytes cannot be used, egg donation is a solution. This is the process whereby the female patient uses oocytes from a donor which are combined with spermatozoa from her partner to produce embryos. These are implanted into the patient using the standard IVF technique in order to achieve conception. As such, oocyte donation makes the miracle of life possible for women who would not be able to have children any other way.

4. Couples who need to test for inheritable genetic conditions

For couples who need reassurance that their offspring will not inherit certain genes, Pre-implantation Genetic Diagnosis (= PGT-SR et PGT-M) is used. This is the diagnosis of genetic and chromosomal alterations in embryos before they are implanted, in order to ensure that any children subsequently born are free of hereditary diseases. This screening process is carried out following fertilisation using ICSI (sperm microinjection).

What does IVF stand for: the wider definition

Having addressed the definition of IVF, how it works and some of the various techniques that enhance the basic IVF process or include it as part of the treatment, let’s consider the wider definition of IVF.

Clearly IVF has opened up possibilities for many people. What IVF stands for in this wider picture is a new chance for individuals to see their dream of becoming parents come true. We are proud that through our work at IVI we have helped to develop some of the new techniques which are now used as a matter of routine. Not only that, but with our help more than 160,000 babies have been born to date. In fact, 9 out of 10 couples that consult IVI due to problems with infertility and put their trust in us achieve their goal of becoming parents. In this sense, what IVF stands for can be measured in dreams fulfilled.

If you would like to see how we may be of assistance in your particular circumstances, do get in touch. You can fill in our online form and one of our medical advisers will get back to you. Or you can give us a call on 08 000 850 035 from the UK or on +34 960 451 185 from outside the UK. We’re here to help.