The term refers to a procedure for artificial insemination. The doctor removes fertilizable egg cells via the vagina. These are then brought together in a glass dish with the man's prepared (good motile) sperm. Hence the term in vitro fertilization: fertilization in glass.
After successful fertilization, the doctor inserts a maximum of three embryos,but normally 1 to 2 embryos, into the uterus. This usually takes place 24 to 48 hours after fertilization of the egg cells.
In order to increase the probability of pregnancy, hormone treatment is carried out beforehand. The stimulation causes several eggs to develop at the same time. The aim of IVF treatment is for one of the embryos to implant and grow in the uterus.
When the first baby was born through artificial insemination in Germany in 1982, hundreds of thousands of children were conceived through artificial insemination.
Between 1997 and 2016 alone, there were 275,452 children. To date, only 1 percent of children born in Germany are the result of artificial insemination. But the trend is rising.
This can also be seen from the fact that there are more than 130 centers across Germany that offer in vitro fertilization. The reason for the increasing number of in vitro fertilizations is that many couples decide to have a child very late in life.
From the age of 30, a woman's fertility begins to decline continuously. So does the probability of becoming pregnant.
There are many reasons why a pregnancy may not work out. Before undergoing IVF treatment, it makes sense to clarify the individual causes of infertility.
Complete infertility in women or men is rather rare. A woman could, for example, have a missing, blocked or scarred fallopian tube that blocks the passage of eggs.
In vitro fertilization also offers women with endometriosis the opportunity to become pregnant. In this disease, the lining of the uterus grows outside the uterus, leading to inflammation.
Hormonal disorders or reduced fertility in men can also be the cause of infertility. Last but not least, the psyche can also have an influence.
In vitro fertilization only has a chance of success if certain physical requirements 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 immobile or not very functional, ICSI is the preferred method.
It is not only the physical requirements that are needed to carry out IVF treatment. It is also important to be in good mental health, as the treatment is very demanding on the psyche.
Treatment is associated with high hopes, which are not always fulfilled. Success is often only achieved after several attempts and sometimes not at all. This is very stressful for body and soul. It is therefore important to be mentally well prepared for the treatment. IVF treatment often requires a lot of patience and perseverance.
In the run-up to IVF, the couple undergoes a whole series of examinations and treatments.
These include
- Ultrasound
- blood sampling
- Testing for diseases such as HIV or hepatitis or a transmissible inflammatory liver disease or certain pathogens such as chlamydia.
The future mother should also be vaccinated against rubella and chickenpox, as these diseases damage the embryo in the womb.
Last but not least, the doctor informs the prospective parents about the main aspects of IVF treatment in 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 fertilizable eggs.
Phase I: Oocyte and sperm retrieval
In order to stimulate the development of egg cells, the woman first receives hormone injections. The aim is to obtain sufficient egg cells.
If several eggs are available for treatment, fertilization is more likely to take place. The doctor checks the development of the follicles repeatedly using ultrasound (sonography).
As soon as the egg cells have reached a certain size, the reproductive physician provokes ovulation by administering the hormone hCG. Around 36 hours later, he removes the follicles from the ovary. The follicles are removed via the vagina. From the vagina, he inserts a thin needle into the ovaries and aspirates the fertilizable eggs.
The doctor monitors the procedure using ultrasound and it only takes a few minutes. If desired, the woman can be given a short anesthetic or analgosedation and can go home after a rest period. At the same time as the egg retrieval, the man provides the necessary sperm cells. If the couple live nearby, the partner can also donate at home.
Phase II: Fertilization of the retrieved eggs
The reproductive biologist brings the follicles together with the sperm in a dish and places them in an incubator. A temperature of 37°C simulates a normal fertilization situation.
During fertilization, the most agile and strongest sperm cell prevails and naturally fertilizes the egg cell. The only difference is that it takes place outside the womb in a Petri dish. This is why doctors also refer to it as extracorporeal fertilization.
Phase III: Implantation of the fertilized eggs into the uterus
After fertilization, the cells begin to divide. Small embryos develop, which are ready for transfer to the uterus after 2 to 3 days. The doctor inserts up to three embryos, usually 1-2, into the uterus.
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 via the cervix. There he places the embryos. He monitors the entire process using ultrasound.
In the days that follow, the woman should take it easy and not perform any physically strenuous activities. This makes it easier for the embryo to implant in the lining of the uterus and protects the enlarged ovaries.
If more than one embryo implants, this results in a multiple pregnancy. The probability of this is higher compared to natural fertilization. Around 5 to 15 percent of all women give birth to twins, 1 to 3 percent even to triplets.
Phase IV: the corpus luteum phase (luteal phase)
In the luteal phase (second half of the cycle), the doctor supports the development of the embryo by administering progesterone. Progesterone is a luteal hormone that is available in various forms: as tablets, as capsules for insertion into the vagina, as a gel or as an intramuscular injection.
At the end of this 14-day phase, the pregnancy test provides information on whether the artificial insemination was successful.
The chances of success depend on many individual factors. The type and duration of the fertility disorder, but above all the woman's age, play a role here.
From the age of 30, fertility in women decreases continuously. In women over 40, the success rate even drops significantly. Only up to 15 percent of those treated become pregnant. IVF treatment usually requires several cycles.
In vitro fertilization carries risks:
- Multiple pregnancies are the main one. They may even be welcome to some parents, but they increase the risk for mother and child.
- The risk of miscarriage is also increased in the first few weeks of pregnancy, especially in women over 35 and in multiple pregnancies.
- There is also a risk of an ectopic pregnancy.
- Hormone treatment can also lead to overstimulation of the ovaries (ovarian hyperstimulation syndrome - OHSS). Symptoms include enlarged ovaries, possible cyst formation and associated pain in the lower abdomen.
- Last but not least, the future parents are exposed to a high level of psychological stress. Constant emotional fluctuations between hope and fear cost a lot of energy.
The costs of in vitro fertilization are not insignificant: future parents should expect to pay around 2,000 euros per cycle. Under certain conditions, statutory health insurance companies will cover the costs. However, only half of the costs are covered and only for married couples.
The prerequisites: At the start of treatment, couples must be at least 25 years old. After the age of 40 for women and 50 for men, the health insurance fund normally no longer pays. As a rule, three treatment cycles are covered, although this depends on the federal state and the respective health insurance fund.
If the quality or motility of the sperm is insufficient, there is the option of so-called intracytoplasmic sperm injection (ICSI).
Behind the complicated name lies a simple procedure. The reproductive biologist injects a sperm directly into the cytoplasm of the egg cell using a fine needle.
If the man only has a few sperm capable of fertilization, the urologist can obtain sperm cells from the testicular tissue or epididymis.
Many childless parents undergo IVF treatment despite the psychological strain and the time and expense involved. After all, artificial insemination promises the fulfillment of a great wish. To start a family.
