The term refers to a procedure for artificial insemination. During the procedure, the doctor retrieves viable eggs through the vagina. These are then placed in a glass dish with the man’s prepared (motile) sperm. Hence the term in vitro fertilization: fertilization in a test tube.
After successful fertilization, the doctor transfers a maximum of three embryos—but usually 1 to 2—into the uterus. This typically occurs 24 to 48 hours after the eggs are fertilized.
To increase the likelihood of pregnancy, hormone treatment is administered beforehand. This stimulation causes multiple eggs to develop simultaneously. The goal of IVF treatment is for one of the transferred embryos to implant in the uterus and develop.
Since the first baby was born in Germany through artificial insemination in 1982, hundreds of thousands of children have been conceived through this method.
Between 1997 and 2016 alone, there were 275,452 such children. Although only 1 percent of children born in Germany to date have been conceived through artificial insemination, the trend is on the rise.
This is also evident from the fact that there are more than 130 centers throughout Germany that offer in vitro fertilization. The reason for the rising number of in vitro fertilization procedures is that many couples decide to have a child very late in life.
A woman’s fertility begins to decline steadily starting at age 30. So does the likelihood of becoming pregnant.
There are many reasons why a woman may have difficulty getting pregnant. Before undergoing IVF treatment, it is advisable to determine the specific causes of infertility.
Complete infertility in either the woman or the man is relatively rare. For example, a woman might have a missing, blocked, or scarred fallopian tube that blocks the passage of the egg.
In vitro fertilization also offers women with endometriosis the opportunity to become pregnant. In this condition, uterine lining tissue grows outside the uterus, leading to inflammation.
Hormonal imbalances or reduced male fertility can also be causes of infertility. Last but not least, psychological factors can also play a role.
In vitro fertilization has a chance of success only if certain physical conditions are met. The woman must have at least one functioning ovary and an intact uterus.
A regular menstrual cycle with ovulation is beneficial. The man’s testicles should produce motile and healthy sperm. If the man’s sperm are immotile or have low motility, ICSI is the preferred method.
Physical requirements alone are not enough to undergo IVF treatment. A healthy mental state is also important, as the treatment places significant demands on the psyche.
Treatment is associated with high hopes that are not always fulfilled. Success often comes only after several attempts—and sometimes not at all. This is very stressful for both body and mind. That is why it is important to be well prepared emotionally for the treatment. After all, IVF treatment often requires a great deal of patience and perseverance.
In the run-up to IVF, the couple will undergo a whole series of examinations and treatments.
These include:
- Ultrasound
- Blood tests
- Screening for diseases such as HIV or hepatitis, or a transmissible inflammatory liver disease, or certain pathogens such as chlamydia.
In addition, the expectant mother should be vaccinated against rubella and chickenpox, as these diseases can harm the embryo in the womb.
Last but not least, the doctor will discuss the key aspects of IVF treatment with the prospective parents during a consultation.
The treatment consists of many individual steps that take several weeks or months. Once the preparatory phase is complete, the actual treatment begins. The first step is the retrieval of viable eggs.
Phase I: Retrieval of Eggs and Sperm
To stimulate egg development, the woman first receives hormone injections. The goal is to obtain a sufficient number of eggs.
If multiple eggs are available for treatment, the likelihood of fertilization occurring is greater. The doctor repeatedly monitors the development of the follicles using ultrasound (sonography).
Once the eggs have reached a certain size, the reproductive specialist induces ovulation by administering the hormone hCG. About 36 hours later, he retrieves the follicles from the ovary. The retrieval is performed through the vagina. He inserts a thin needle into the ovaries through the vagina and aspirates the viable eggs.
The doctor monitors the procedure using ultrasound, and it takes only a few minutes. If desired, the woman can receive a short-acting anesthetic or analgosedation and can go home after a short rest. At the same time as the egg retrieval, the man provides the necessary sperm. If the couple lives nearby, the partner can also donate at home.
Phase II: Fertilization of the Retrieved Eggs
The reproductive biologist places the follicles containing the eggs together with the sperm in a dish and places them in an incubator. A temperature of 37 °C simulates a normal fertilization environment.
During fertilization, the most agile and strongest sperm cell prevails and naturally fertilizes the egg. The only difference is that this takes place outside the womb, in a Petri dish. This is why medical professionals also refer to this as in vitro fertilization.
Phase III: Transfer of the Fertilized Eggs into the Uterus
After fertilization, the cells begin to divide. Small embryos develop, which are ready for transfer into the uterus after 2 to 3 days. The doctor transfers up to three embryos—usually 1 or 2—into the uterus.
During the procedure, the woman lies on a gynecological examination chair. Anesthesia is not required. The embryos are placed in a special transfer cannula, which the doctor inserts into the uterus through the cervix. There, he deposits the embryos. He monitors the entire process using ultrasound.
In the days following the procedure, the woman should take it easy and avoid physically strenuous activities. This facilitates the embryo’s implantation in the uterine lining and protects the enlarged ovaries.
If more than one embryo implants, a multiple pregnancy results. The likelihood of this is higher compared to natural conception. About 5 to 15 percent of all women give birth to twins, and 1 to 3 percent even give birth to triplets.
Phase IV: The Luteal Phase
During the luteal phase (the second half of the cycle), the doctor supports the embryo’s development by administering progesterone. Progesterone is a hormone produced by the corpus luteum and is available in various forms: as tablets, as vaginal capsules, as a gel, or as an intramuscular injection.
At the end of this 14-day phase, a pregnancy test will indicate whether the artificial insemination was successful.
The chances of success depend on many individual factors. The type and duration of the fertility issue, but above all the woman’s age, play a role here.
Starting at age 30, fertility in women declines steadily. For women over 40, the success rate drops significantly. Only up to 15 percent of those undergoing treatment become pregnant. IVF treatment typically requires several cycles.
In vitro fertilization carries risks:
- Multiple pregnancies are a primary concern. While some parents may even welcome them, they increase the risk for both mother and child.
- The risk of miscarriage is also higher in the first weeks of pregnancy, especially for women over 35 and in cases of multiple pregnancies.
- There is also a risk of an ectopic pregnancy.
- Hormone treatment can also lead to ovarian hyperstimulation (ovarian hyperstimulation syndrome—OHSS). Symptoms include enlarged ovaries, possible cyst formation, and associated pain in the lower abdomen.
- Last but not least, the prospective parents are subjected to high levels of psychological stress. Constant emotional swings between hope and anxiety take a heavy toll.
The costs of in vitro fertilization are not insignificant: Prospective parents should expect to pay approximately 2,000 euros per cycle. Under certain conditions, statutory health insurance plans cover the costs—but only half of them, and only for married couples.
The requirements: At the start of treatment, couples must be at least 25 years old. Once women turn 40 and men turn 50, the insurance provider typically no longer covers the costs. As a rule, three treatment cycles are covered, though this depends on the federal state and the specific insurance provider.
If sperm quality or motility is insufficient, there is the option of a procedure known as intracytoplasmic sperm injection (ICSI).
Behind this complicated term lies a simple procedure. The reproductive biologist uses a fine needle to inject a single sperm directly into the cytoplasm of the egg.
If the man has only a few viable sperm, the urologist can retrieve sperm cells from the testicular tissue or the epididymis.
Many childless parents undergo IVF treatment despite the emotional strain and the significant time and financial costs involved. After all, artificial insemination holds the promise of fulfilling a deep-seated desire: to start a family.
