IVF (in vitro fertilisation)

Assisted reproductive treatment is used to treat Swedish couples with all types of involuntary infertility. Almost two thirds of them have a baby after three attempts.

IVF is short for in vitro fertilisation, and means that fertilisation takes place in a test tube. In IVF treatment, eggs are removed from the woman's ovaries and combined with the man's sperm outside the body. The fertilised egg is then implanted into the woman's womb. Ovaric stimulation, intrauterine insemination and surgery are other possible treatments for involuntary infertility.

Age limits and costs of IVF
The age limit for IVF varies depending on the type of treatment and the public health care resources available in your country of residence. Most clinics in the Swedish public health care system do not start IVF treatment on women aged over 38. Private clinics may perform IVF on women aged up to about 42 years.

The man should not be older than 55.
Private clinics often have a shorter waiting list for IVF treatment, but the couple must pay the full cost of the treatment. IVF is the most expensive and most effective treatment for involuntary infertility, costing around SEK 25,000 per attempt (2014). At public clinics, the couple only pays a patient fee, which can vary, while the actual treatment is covered by the high-cost threshold.

Donor eggs or donor sperm
If a fertility assessment has established that a women has no eggs of a quality suitable for IVF, donor eggs can be used instead. The donor eggs are combined with the man's sperm in a test tube and the process continues as described below.

Donor eggs and donor sperm cannot be combined in the same IVF cycle. Either the eggs or the sperm must come from the couple being treated.
Lesbian couples have been entitled to have IVF treatment with donor sperm since 2005.

IVF treatment - how it works

Ovaric stimulation
To maximise the chances of IVF being successful, more than one egg should be collected and available for use. To achieve this, the woman's ovaries are stimulated with hormones to produce many eggs. The eggs are removed from the ovaries before the women ovulates naturally. There are various ways of making the eggs mature at the right time. One method is for the woman to take a nasal spray to stop her from ovulating. Once this happens, she takes hormones to stimulate egg production.

The eggs mature
The next step is to stimulate the ovaries to form mature follicles. The woman is injected with FSH, a follicle-stimulating hormone. You can easily self-inject the hormones using an injection pen, which looks like an ordinary pen but has a needle instead of a tip.

The FSH injections are taken for about 10 days, the time it takes for the eggs to mature. The dose of hormone needed to stimulate the ovaries varies considerably between women. To guarantee the right dose, several blood tests are carried out during the treatment.
As with all hormone therapy, the treatment can affect both the woman's moods and body. However, the severity of the effects is very individual. Although the treatment increases the chances of pregnancy, the treatment is physically and psychologically stressful for many couples.

Egg and sperm collection
Towards the end of the therapy, an ultrasound scan is performed to check the eggs' maturity. The doctor is able to see the liquid-filled follicle in the ovaries via the vagina and womb. The fluid is retrieved from the ovaries by means of a fine needle at the end of the ultrasound probe. It takes between 20 and 40 minutes and may hurt a little.

The procedure takes place under local anaesthetic. The retrieved eggs are put in a test tube. Hopefully the doctor will have retrieved several eggs – although one is sometimes enough. While the eggs are being retrieved, the man produces a sperm sample. The sperm is washed and only the best-quality sperm are extracted.

Fertilisation takes place in a laboratory dish
The eggs are washed with a nutrient solution to remove blood and other fluids Then the sperm and eggs are transferred to a laboratory dish. The dish is placed in an incubator that replicates the womb environment as closely as possible in terms of temperature, PH and moisture levels. It is here that the sperm fertilises the eggs.

In cases where it is necessary, the sperm can be injected into the eggs with a very fine needle. The first signs of fertilisation can been seen on the following day: two cells quickly merge and start dividing and multiplying. On average, about 80 percent of all mature eggs fertilise in the laboratory dish. 
After about three days, one fertilised egg is selected. If there are several good quality eggs, the rest of the eggs frozen to be used later if needed. The egg is implanted in the uterus, where it will hopefully embed in the womb lining and start developing as in an ordinary pregnancy. Now the couple just has to wait – again.
Taking the pregnancy test after two weeks
All IVF couples know about the two week wait before taking the pregnancy test. They have waited for months for ovulation and menstruation. Then came examinations, test results and finally the IVF treatment. The constant waiting without knowing if the pregnancy will succeed is often psychologically very stressful.

For many, the hardest part of all is the two week wait before performing the pregnancy test to find out if the embryo has implanted. Another challenging time is the wait between discovering you are pregnant and having your first ultrasound scan.

Two out of three couples are successful
The pregnancy test may be negative, in which case the woman's period will arrive. This means no child was conceived and the whole procedure must start again.

About one in three women get pregnant on the first IVF attempt, and the likelihood of success increases with each subsequent attempt. Roughly two out of three women get pregnant after three IVF cycles.

Before starting IVF treatment, you might want to discuss how many attempts you are prepared to make. Although it may be difficult to stick to your decision, it is still important to discuss this in advance.
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