IVF

The National Institute for Health and Care Excellence (NICE) fertility guidelines make recommendations about who should have access to IVF treatment on the NHS in England and Wales.

These guidelines recommend that IVF should be offered to women under the age of 43 who have been trying to get pregnant through regular unprotected sex for 2 years. Or who have had 12 cycles of artificial insemination, with at least 6 of these cycles using a method called intrauterine insemination (IUI).

However, the final decision about who can have NHS-funded IVF in England is made by local integrated care boards (ICBs), and their criteria may be stricter than those recommended by NICE.

If you’re not eligible for NHS treatment, or you decide to pay for IVF, you can have treatment at a private clinic. Costs vary, but 1 cycle of treatment may cost up to £5,000 or more.

If you’re having trouble getting pregnant, you should start by speaking to your GP. They can advise on how to improve your chances of having a baby.

If these measures don’t work, your GP can refer you to a fertility specialist for a treatment such as IVF.

IVF involves 6 main stages:

1. suppressing your natural cycle – your menstrual cycle is suppressed with medicine
2. helping your ovaries produce extra eggs – medicine is used to encourage your ovaries to produce more than 1 egg at a time
3. monitoring your progress and maturing your eggs – an ultrasound scan is carried out to check the development of the eggs, and medicine is used to help them mature
4. collecting the eggs – a needle is inserted through your vagina and into your ovaries to remove the eggs
5. fertilising the eggs – the eggs are mixed with the sperm for a few days to allow them to be fertilised
6. transferring the embryo(s) – 1 or 2 fertilised eggs (embryos) are placed into your womb

Once the embryo(s) has been transferred into your womb, you’ll need to wait 2 weeks before taking a pregnancy test to see if the treatment has worked.

The success rate of IVF depends on the age of the woman having treatment, as well as the cause of the infertility (if it’s known).

Younger women are more likely to have a successful pregnancy. IVF isn’t usually recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be too low.

In 2019, the percentage of IVF treatments that resulted in a live birth was:

• 32% for women under 35
• 25% for women aged 35 to 37
• 19% for women aged 38 to 39
• 11% for women aged 40 to 42
• 5% for women aged 43 to 44
• 4% for women aged over 44

These figures are for women using their own eggs and their partner’s sperm, using the per embryo transferred measure.

The Human Fertilisation and Embryo Authority (HFEA) has more information about in vitro fertilisation (IVF), including the latest success rates

Maintaining a healthy weight and avoiding alcohol, smoking and caffeine during treatment may improve your chances of having a baby with IVF.

IVF doesn’t always result in pregnancy, and it can be both physically and emotionally demanding. You should be offered counselling to help you through the process.

There are also a number of health risks involved, including:

• side effects from the medicines used during treatment, such as hot flushes and headaches
• multiple births (such as twins or triplets) – this can be dangerous for both the mother and the children
• an ectopic pregnancy – where the embryo implants in the fallopian tubes, rather than in the womb
• ovarian hyperstimulation syndrome (OHSS) – where the ovaries overreact to the medicines used during IVF

IVF is only offered on the NHS if certain criteria are met. If you don’t meet these criteria, you may need to pay for private treatment.

The National Institute for Health and Care Excellence (NICE) fertility guidelines make recommendations about who should have access to IVF treatment on the NHS in England and Wales.

But individual NHS integrated care boards (ICBs) make the final decision about who can have NHS-funded IVF in their local area, and their criteria may be stricter than those recommended by NICE.

Women under 40

According to NICE, women aged under 40 should be offered 3 cycles of IVF treatment on the NHS if:

• they’ve been trying to get pregnant through regular unprotected sex for 2 years
• they’ve not been able to get pregnant after 12 cycles of artificial insemination, with at least 6 of the cycles using a method called intrauterine insemination (IUI)

If you turn 40 during treatment, the current cycle will be completed, but further cycles shouldn’t be offered.

If tests show IVF is the only treatment likely to help you get pregnant, you should be referred straight away.

Women aged 40 to 42

The NICE guidelines also say women aged 40 to 42 should be offered 1 cycle of IVF on the NHS if all of the following criteria are met:

• they’ve been trying to get pregnant through regular unprotected sex for 2 years. Or they haven’t been able to get pregnant after 12 cycles of artificial insemination, with at least 6 of the cycles using a method called intrauterine insemination (IUI)
• they’ve never had IVF treatment before
• they show no evidence of low ovarian reserve (where eggs in your ovaries are low in number or quality)
• they’ve been informed of the additional implications of IVF and pregnancy at this age

Again, if tests show IVF is the only treatment likely to help you get pregnant, you should be referred straight away.

NHS trusts across England and Wales are working to provide the same levels of service. But the provision of IVF treatment varies across the country, and often depends on local ICB policies.

ICBs may have additional criteria you need to meet before you can have IVF on the NHS, such as:

• not having any children already, from both your current and any previous relationships
• being a healthy weight
• not smoking
• falling into a certain age range (for example, some ICBs only fund treatment for women under 35)

Although NICE recommend up to 3 cycles of IVF should be offered on the NHS, some ICBs only offer 1 cycle, or only offer NHS-funded IVF in exceptional circumstances.

Find out how many cycles of IVF are funded by the NHS in each area of England on GOV.UK

You can also ask your GP or contact your local integrated care board (ICB) for more information about NHS-funded IVF treatment in your area.

If you’re not eligible for NHS treatment or you decide to pay for IVF, you can have treatment at a private clinic.

Some clinics can be contacted directly without seeing your GP first, but others may ask for a referral from your GP.

The cost of private treatment can vary, but 1 cycle of IVF can cost up to £5,000 or more. There may be additional costs for medicines, consultations and tests.

Make sure you find out exactly what’s included in the price during your discussions with the clinic.

Some people consider having IVF abroad, but there are a number of issues you need to think about, including your safety and the standard of care you’ll receive. Clinics in other countries may not be as regulated as they are in the UK.

• Human Fertilisation and Embryology Authority (HFEA): costs and funding
• Human Fertilisation and Embryology Authority (HFEA): fertility treatment abroad
• Human Fertilisation and Embryology Authority (HFEA): choose a fertility clinic

If you’re having problems getting pregnant, see your GP. They will look at your medical history and give you a physical examination.

They may also recommend some lifestyle changes to help increase your chances of getting pregnant (see planning your pregnancy).

Unless there are reasons that may put you at high risk of infertility, such as cancer treatment, you’ll usually only be considered for infertility investigations and treatment if you’ve been trying for a baby for at least a year without becoming pregnant.

If appropriate, your GP can refer you to a fertility specialist at an NHS hospital or fertility clinic.

The specialist will ask about your fertility history, and may carry out a physical examination.

Women may have tests to check the levels of hormones in their blood and how well their ovaries are working.

They may also have an ultrasound scan or other tests to see if there are any blockages or structural problems.

Men may be asked for a semen sample to test sperm quality.

If IVF is the best treatment for you, the specialist will refer you to an assisted conception unit.

Once you’re accepted for treatment at the assisted conception unit, you and your partner will have blood tests, including tests for HIV, hepatitis B and hepatitis C.

Your cervical screening tests should also be up-to-date.

The clinic should also check that you’ve been offered screening for sickle cell and thalassaemia if your ancestors come from a country where these conditions are more common. Anyone can ask to have this test for free on the NHS from their GP.

If you’re planning to use donor eggs, check that these have been screened. All IVF clinics in the UK are required to screen donor eggs and sperm.

The specialist will investigate the number of eggs in your body (your ovarian reserve) to estimate how your ovaries will respond to IVF treatment.

This can be assessed by measuring a substance called anti-mullerian hormone (AMH) in your blood, or by counting the number of egg-containing follicles, known as your antral follicle count (AFC), using a vaginal ultrasound scan.

Your specialist will then discuss your treatment plan with you in detail and talk to you about any support or guidance you may find helpful.

What happens during IVF may differ slightly from clinic to clinic, but a typical treatment follows these main steps:

Step 1: suppressing the natural menstrual cycle

You’re given a medicine that will suppress your natural menstrual cycle. This can make the medicines used in the next stage of treatment more effective.

The medicine is given either as a daily injection that you’ll be taught to give yourself, or as a nasal spray. You continue this for about 2 weeks.

Step 2: helping your ovaries produce more eggs

Once your natural cycle is suppressed, you take a fertility hormone called follicle stimulating hormone (FSH).

FSH increases the number of eggs your ovaries produce. This means more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.

Step 3: checking progress

The clinic will keep an eye on you throughout the treatment. You’ll have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests.

Before your eggs are collected, you’ll have an injection of a hormone called human chorionic gonadotrophin (hCG) that helps your eggs to mature.

Step 4: collecting the eggs

You’ll be sedated and your eggs will be collected using a needle that’s passed through your vagina and into each ovary under ultrasound guidance.

This is a minor procedure that takes about 15 to 20 minutes.

Some women experience cramps or a small amount of vaginal bleeding after this procedure.

Step 5: fertilising the eggs

The collected eggs are mixed with your partner’s or the donor’s sperm in a laboratory to fertilise them.

In some cases, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI.

The Human Fertilisation and Embryology Authority (HFEA) has more information about ICSI

The fertilised eggs (embryos) continue to grow in the laboratory for up to 6 days before being transferred into the womb. The best 1 or 2 embryos will be chosen for transfer.

After egg collection, you’ll be given hormone medicines to help prepare the lining of your womb to receive the embryo. This is usually given either as a pessary placed inside your vagina, an injection, or a gel.

Step 6: embryo transfer

A few days after the eggs are collected, the embryos are transferred into your womb. This is done using a thin tube called a catheter that’s passed into your vagina.

This procedure is simpler than egg collection and similar to having a cervical screening test, so you won’t usually need to be sedated.

The number of embryos that will be transferred should be discussed before treatment starts.

It usually depends on your age:

• Women under 37 in their 1st IVF cycle should only have a single embryo transfer. In their 2nd IVF cycle, they should have a single embryo transfer if 1 or more top-quality embryos are available. Doctors should only consider using 2 embryos if no top-quality embryos are available. In the 3rd IVF cycle, no more than 2 embryos should be transferred.
• Women aged 37 to 39 years in their 1st and 2nd full IVF cycles should also have a single embryo transferred if there are 1 or more top-quality embryos. Double embryo transfer should only be considered if there are no top-quality embryos. In the 3rd cycle, no more than 2 embryos should be transferred.
• Women aged 40 to 42 years may have a double embryo transfer.

If any suitable embryos are left over, they may be frozen for future IVF attempts.

The HFEA has more on decisions to make about your embryos

Around the time your partner’s eggs are collected, you’ll be asked to produce a fresh sperm sample.

The sperm are washed and spun at a high speed so the healthiest and most active sperm can be selected.

If you’re using donated sperm, it’s thawed before being prepared in the same way.

Once the embryos have been transferred into the womb, you’ll be advised to wait around 2 weeks before having a pregnancy test to see if the treatment has worked.

Some clinics may suggest carrying out a normal urine pregnancy test at home and letting them know the result, while others may want you to come into the clinic for a more accurate blood test.

This 2-week wait can be a very difficult period because of the anxiety of not knowing whether the treatment has worked. Some people find it the hardest part of the treatment process.

During this period, you may find it useful to speak to a counsellor through the fertility clinic, or to contact other people in a similar situation to you through the HealthUnlocked IVF community.

If you do become pregnant, ultrasound scans will be carried out during the following weeks to check things are progressing as expected.

You’ll then be offered the normal antenatal care given to all pregnant women.

Unfortunately, IVF is unsuccessful in many cases and you should try to prepare yourself for this possibility.

You may be able to try again if treatment doesn’t work, although you shouldn’t rush straight into it.

You may find counselling or fertility support groups helpful during this difficult time.

Many women will have some reaction to the medicines used during IVF. Some of the side effects can be mild.

Side effects can include:

• hot flushes
• feeling down or irritable
• headaches
• restlessness
• ovarian hyperstimulation syndrome

Contact the fertility clinic if you experience persistent or worrying side effects during treatment.

If more than 1 embryo is replaced in the womb as part of IVF treatment, there’s an increased chance of producing twins or triplets.

Having more than 1 baby may not seem like a bad thing, but it significantly increases the risk of complications for you and your babies.

Problems more commonly associated with multiple births include:

• miscarriage
• pregnancy-related high blood pressure and pre-eclampsia
• gestational diabetes
• anaemia and heavy bleeding
• needing a caesarean section

Your babies are also more likely to be born prematurely or with a low birth weight, and are at an increased risk of developing life-threatening complications such as newborn respiratory distress syndrome (NRDS) or long-term disabilities, such as cerebral palsy.

National Institute for Health and Care Excellence (NICE) guidelines recommend that double embryo transfers should only be considered in women aged 40 to 42.

Younger women should only be considered for a double embryo transfer if there are no top-quality embryos to choose from.

Read more about the Human Fertilisation and Embryology Authority (HFEA) campaign to reduce multiple births

Ovarian hyperstimulation syndrome (OHSS) is a rare complication of IVF.

It happens in women who are very sensitive to the fertility medicine taken to increase egg production. Too many eggs develop in the ovaries, which become very large and painful.

OHSS generally develops in the week after egg collection.

The symptoms can include:

• pain and bloating low down in your tummy
• feeling and being sick
• shortness of breath
• feeling faint

Severe OHSS can be dangerous. Contact your clinic as soon as possible if you have any of these symptoms.

It may be necessary to cancel your current treatment cycle and start again with a lower dose of fertility medicine.

If you have IVF, you have a slightly higher risk of having an ectopic pregnancy, where the embryo implants in a fallopian tube rather than in the womb.

This can cause pain in the tummy, followed by vaginal bleeding or dark vaginal discharge.

If you have a positive pregnancy test after IVF, you’ll have a scan at 6 weeks to make sure the embryo is growing properly and that your pregnancy is normal.

Tell your doctor if you experience vaginal bleeding or stomach pain after having IVF and a positive pregnancy test.

IVF treatment becomes less successful with age. In addition, the risk of miscarriage and birth defects increases with the age of the woman.

Your doctor will discuss the increased risks that come with age and can answer any questions you may have.

Having IVF can be emotionally and physically draining, but help and support is available if you need it.

Your fertility clinic will offer you an opportunity to talk to a counsellor, and you may find it useful to join a fertility support group or online forum for support.

The National Institute for Health and Care Excellence (NICE) recommends that counselling should be offered before, during and after IVF treatment regardless of the outcome.

It recommends using a counsellor who is not directly involved in the management of the couple’s fertility problems.

Counselling is a type of talking therapy that allows you to talk about your problems and feelings in a confidential and dependable environment.

It can help couples to understand the implications of treatment and offer support at a critical time, such as when an IVF cycle has been unsuccessful.

The Human Fertilisation and Embryology Authority (HFEA) has more information about the benefits of counselling and how to access it

In many instances, IVF treatment is unsuccessful. Under these circumstances, it’s a good idea to wait for a couple of months before thinking about trying again.

This will give you a break from the stresses of treatment and allow your body time to recover.

This break can give you a chance to talk with the clinic about the reasons IVF was unsuccessful, to talk to your partner about how you both feel, and consider your options going forward.

It can also help to talk to other people who have been through IVF. A support group or online forum, such as the HealthUnlocked IVF community, may be helpful.

Some couples who have successfully started a family with IVF can find it difficult to adjust to their new life.

It’s important to get help from healthcare professionals, such as your fertility consultant, GP, midwife or health visitor, if you think you need it.

Read more about services and support for parents.

Contacting a fertility support group and talking with others who can empathise with your experiences can also be helpful.

Fertility Network UK and Fertility Friends both have online forums where you can find other people who have dealt with the same issues.