A brief historical overview

In vitro fertilization, commonly referred to as IVF, is not new, and yet it remains cutting-edge. For instance, IVF treatment in South Africa has recently taken great strides. Dr. Thabo Matsaseng of the FMHS has recently developed procedures that make IVF more affordable, so more people can access this life-changing technology.

Though there was earlier work done in Australia, America, and India, the first doctors to successfully employ this assisted reproductive technology, or ART, were Patrick Steptoe and Robert Edwards. Their groundbreaking work resulted in the world’s first baby to be successfully conceived by IVF, Louise Brown, who was born in 1978 in Manchester. A second IVF baby was born some six months later, Alastair MacDonald, in January 1979, in Glasgow.

So how does it work?

As said, IVF employs assisted reproductive technology to conceive a viable embryo that will result in a live, healthy baby being born. This is achieved by combining the use of medicines and surgical procedures to fertilize an ovum, or egg, with sperm, and then implanting the fertilized egg into the uterus, after which the embryo will develop through normal gestation to be born nine months later as a healthy baby.

Okay, but how does it really work?

Well, the first thing to realize, is IVF treatment is normally only pursued after other fertility treatments have been unsuccessful and you have more than likely been trying to get pregnant for years with no success. It must further be realized that it is a very expensive process (health care providers are often somewhat reluctant participants, to put it politely!) and it can also be an extremely stressful experience, both physically and emotionally. So it is emphatically not to be lightly undertaken.

Okay, IVF is the way to go, now what happens?

So once the decision has been taken that IVF is the way to go, you will normally start off the procedure by taking medication that will increase your egg production, and also prepare them for retrieval (also referred to as harvesting) and fertilization.

This part of the process is called ovulation induction and may take several months. During this time you will have regular ultrasounds and/or blood tests to establish how your egg production is progressing and to check your hormone levels, particularly your E2 or estradiol levels.

Once your eggs have reached the requisite maturity levels, the next step comprises the doctor retrieving the eggs from your body. This can happen either at the consulting rooms or at a fertility clinic. The egg retrieval procedure takes about 30 minutes and is performed under light sedation. The eggs, or oocytes, are removed from the ovarian follicles by gentle suction with an aspiration needle and the help of ultrasound images.

After removal, the eggs are passed directly to lab technicians who mix them with sperm (either from your partner or a donor, depending on the circumstances) for insemination and hopefully fertilization. The fertilization and cell division process is closely monitored in the lab, and typically, if fertilization has occurred, embryo transfer is done five to ten days after egg retrieval, when one or more embryos are transferred into your uterus.

This is usually done at your doctor’s office or a fertility clinic. It is done with the aid of a thin tube with which the doctor puts the embryo/s directly into your uterus. It is generally a painless process, and it is recommended that you take it very easy for the rest of the day – you can go back to normal the next day. And if any of the embryos attach successfully to the lining of your uterus, pregnancy has occurred!

Progesterone injections may make it easier for the embryo to initially survive and thrive in the uterus, and can usually be discontinued after about the eleventh week of pregnancy.

But surely there are side effects and risks to IVF?

Indeed, yes, like all medical procedures and/or medications, IVF does carry risks and could have possible side effects. These could be as many and varied as vaginal bleeding, bloating, sore breasts, pelvic pain, blood in urine, cramping, constipation, nausea, vomiting, headaches, allergic reactions, infection, and mood swings.

And because multiple embryos are implanted to increase the chance of a successful pregnancy, a definite further risk is the possibility of multiple births. These could carry immediate health risks for the mother and babies during pregnancy and have a very definite future impact on the parent/s. Thankfully, as the field of fertility treatment continues to advance rapidly, these risks continue to come down.