IVF: where are we now?

What is IVF? 

In vitro fertilisation (IVF) is a form of assisted reproductive technology used to help a woman who has been unable to conceive naturally. 'In vitro' means 'in glass' IVF is the process used to conceive a child outside the body.

The main reason for its use is infertility. Infertility is defined as not being able to get pregnant after trying for one year or the inability to carry a pregnancy to achieve a live birth. With IVF, a woman's eggs and a man's sperm are placed together in a culture dish for fertilisation. Once fertilised, the resulting embryos are placed in the woman's uterus in the hope that a successful pregnancy will follow.² If a woman is unable to produce her own eggs, or her partner is unable to produce viable sperm, donor eggs or sperm may be used.

The couple will undergo a series of tests to determine whether they can overcome any obstacles to fertility. If not, they may try a range of treatments that may involve hormones to stimulate egg production followed by IVF.

Why is it important? 

Fertility rates vary from year to year but the average age of women trying to conceive has been showing an upward trend in many developed countries, including Australia. The latest available statistics (2008) show:

• approximately 15 percent of Australian couples have difficulty conceiving³ with about one in six couples taking longer than a year to conceive.⁶
• around 40 percent of infertility cases originate in the woman; around 40 percent in the man and for the remaining 20 percent it's a joint problem or the cause is unknown.³

What are common causes of infertility? 

Men: Male infertility can be caused by abnormalities in sperm numbers, motility (ability of the sperm to get to the egg) or morphology (structure of the sperm cell). These may be brought about by factors such as: ^3,4,5

• failed vasectomy reversal
• retrograde ejaculation, where semen enters the bladder instead of the penis
• structural problems or blockage in the reproductive organs
• erectile dysfunction or other problems with intercourse
• undescended testes in childhood
• exposure to toxic chemicals including alcohol, tobacco and drugs
• exposure to excessive heat
• hormonal disorders
• autoimmune (antibody) disorders
• some medical conditions or infections, including mumps, sexually transmitted diseases, and inflammation of the prostate, epididymis (tubes from the testes) or urethra
• other unknown causes.

Women: Causes of female infertility commonly include: ^3,4,5

• fallopian tube damage or blockage - chlamydia is a common cause of this
• endometriosis, with resulting pelvic inflammatory disease
• ovulation disorders
• premature menopause
• polycystic ovary syndrome (PCOS)
• hormonal problems including thyroid hormone dysfunction
• uterine fibroids and polyps
• medical conditions that have caused delayed or absent periods
• a previous pelvic infection.

What's happening with IVF in Australia? 

IVF may be a solution for some people who want to start a family but have trouble doing so. The use of assisted reproductive technology has increased by 10 percent every year since 2002.⁶

In 2008:⁶

• the average age of women who had assisted reproductive technology treatment using their own eggs was 35.7 years, slightly older than the average age of women in 2007 (35.5 years).
• the proportion of women aged over 40 using assisted reproductive technology has increased steadily from 14.3 percent in 2002 to 26.6 percent in 2008 - that is, one in four women currently undergoing IVF treatment is over 40. The average age of women using donor eggs or embryos in 2008 was 4.
• of the treatment cycles in Australia and New Zealand, 23 percent resulted in a pregnancy and 17 percent led to at least one baby being born, resulting in a total of 11,528 IVF babies. In 2008, assisted reproductive technology was responsible for around 3.3 percent of all babies born in Australia.⁶
• studies suggest women who have a single embryo transfer have more successful pregnancy outcomes compared to women who have a double-embryo transfer. The rate of multiple births due to IVF continues to drop in line with the corresponding change in practice - down from 16.4 percent in 2004 to 8.4 percent in 2008.⁶
• another recent development has been the tendency to transfer the embryos to the uterus on Day 5 of the treatment instead of on Day 3. On Day 5, the dividing cells have reached the blastocyst stage and may be better for achieving a successful pregnancy.⁷ This practice accounts for a growing number of embryo transfers in recent years⁶ but may not be suitable for all women.

What are the main drawbacks of IVF? 

Hormones are usually given to stimulate the ovaries and enable egg collection. For some women, these hormones (such as oestrogen) can cause breast tenderness, slight nausea, dizziness and abdominal swelling. Occasionally, too many follicles develop and a condition called ovarian hyperstimulation syndrome (OHSS) may occur. Although the risk is low, IVF can lead to organ damage, infection or bleeding due to the collection needle.²

In instances where IVF doesn't result in pregnancy, it's common for couples to feel emotional distress about not being able to conceive as well as discomfort while going through the hormone stimulation treatment. IVF treatment is also expensive, although part of the cost may be met through Medicare subsidies or health insurance.

Further information 

For more information about IVF and assisted reproductive technology, talk to your GP, who can refer you to a specialist.

For general information on infertility causes, prevention, support and treatments there are several websites that may help:

Access Australia - Australia's national infertility network

www.access.org.au

Fertility Society of Australia

www.fertilitysociety.com.au

Jean Hailes Foundation - Emotional wellbeing and fertility

www.endometriosis.org.au/emotional-wellbeing/fertility

Sexual Health and Family Planning Australia

Sources 

1. The Fertility Society of Australia [Internet]. 2011. Available from:  http://www.fertilitysociety.com.au/
2. Better Health Channel, Victorian Government. In Vitro Fertilisation (IVF) [Internet].  2010. [Last reviewed Oct 2009, accessed 21 Jun 2011]. Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/In_vitro_fertilisation
3. AccessA . [Internet]. 2011. Available from: http://www.access.org.au
4. Better Health Channel, Victorian Government. Infertility - Male [Internet] [Last reviewed May 2011, accessed 21 Jun 2011] Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Infertility_male
5. Better Health Channel, Victorian Government. Infertility - Female [Internet] [Last reviewed Jul 2010, accessed 21 Jun 2011] Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Infertility_female
6. Australian Institute of Health and Welfare. Assisted Reproductive Technology in Australia and New Zealand 2008 [Internet]. 2010. [accessed 24 Jun 2011] Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458980
7. Wang YA, Kovacs G, Sullivan EA. Transfer of a selected single blastocyst optimizes the chance of a healthy term baby: a retrospective population based study in Australia 2004-2007. Human Reproduction. Jun 2010; 25(8): 1996-2005.

Last published: 30 July 2011

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