IVF: What is In Vitro Fertilization?

What is IVF?

In vitro fertilization (IVF) is a form of artificial insemination in which an egg cell is artificially fertilized with the partner’s sperm or someone else’s sperm. It differs from the more commonly used insemination by the location of the egg cell fertilization . If during insemination the semen is introduced into the woman’s body in order to fertilize the egg there, in IVF this process takes place outside the woman’s body. In the following, the classic IVF process is described first. Below you will find further information on variants of IVF that are used when the classic process is not successful: ICSI, GIFT and ZIFT.

Process of in vitro fertilization

Typically, IVF involves the following steps:

• First, an examination for hereditary diseases is carried out.
• Then the woman is treated hormonally to slow down egg production in the ovaries. Only then can several egg cells mature at once.
• Hormone treatment first stimulates egg cell maturation over several days and then ovulation is triggered.
• After hormone treatment, the egg cells are removed from the woman’s body and placed in a vessel with the man’s sperm. This is the actual process of fertilization. It can be performed according to classic IVF or according to the ICSI, TESE-ICSI or MESA-ICSI methods described below.
• Ideally, the sperm fertilize the egg cells and embryos develop.
• From the second to fifth day after fertilization, several embryos are usually implanted in the uterus. In Germany, Austria and Switzerland there are usually two embryos.
• If at least one embryo is not rejected by the body, there is a good chance that IVF can fulfill the desire to have a baby.

Special form of IVF: Intracytoplasmic sperm injection (ICSI)

A special form of IVF is intracytoplasmic sperm injection (ICSI). It is carried out if the sperm quality is too poor (poor mobility, low sperm count or sperm antibodies). In this method, sperm are first obtained from the man’s semen directly from the ejaculate (ICSI) or through a biopsy of the testicles ( TESE-ICSI ) or epididymis ( MESA-ICSI ). The rest of the in vitro fertilization process is carried out in exactly the same way. You can learn more about ICSI in our article “ Intracytoplasmic Sperm Injection (ICSI) ”.

Special form of IVF: GIFT and ZIFT

GIFT (Gamete Intrafallopian Transfer) is a form of artificial insemination in which the fertilization itself takes place in the woman’s body. With GIFT, the punctured egg cells are implanted together with the male semen via the abdominal cavity into the fallopian tube or flushed into the fallopian tube with a catheter. This method is used when in vitro fertilization was unsuccessful. A variety of this is the ZIFT (intratubal cytogote transfer), in which the egg cell fertilized in the test tube is implanted. In principle, the ZIFT is a form of in-vitro fertilization.

Prerequisites for in vitro fertilization

Unfortunately, there are no clear legal regulations in the field of artificial insemination, but only a guideline from the Federal Committee of Doctors and Health Insurance Companies. Above all, this means a lot of uncertainty for single or homosexual women who want to have children.

In order for in vitro fertilization to be performed on a couple, the following conditions must be met:

• The couple should be married.
• The couple must have received extensive medical and psychological advice from their doctor beforehand.
• The treatment should have a chance of success, otherwise the couple should be advised against the treatment.
• The health insurance company must approve the treatment plan before the treatment.
• Only people with health insurance who have completed the 25th year of life are treated. Men over 50 and women over 40 are no longer entitled to artificial insemination.
• The couple must not be HIV positive and the woman should have rubella protection.

Problematic legal situation in some cases

• Unfortunately, there are some cases where precise legal regulation is missing. The lack of legal regulations primarily affects single and homosexual women who, strictly speaking, according to the guidelines of the committee, may not be subjected to any fertility treatment. However, there are some doctors in Germany who, despite these guidelines, also treat single and homosexual women. Insemination or IVF treatment abroad is also possible at any time, for example in Denmark or the USA.
• The rights of possible sperm donors and their biological children conceived through a donation are also currently unclear. You can find more information on this in our article ” With a sperm donation to the desired child “.
• While in the previous cases there is no clear legal regulation, the German legislation is clear in the case of a desired egg cell or embryo donation and also in relation to surrogacy. They are prohibited in Germany by the Embryo Protection Act. The situation is different in other European countries, for example in Belgium, France or Spain. These forms of fertility medicine are also possible in the USA within certain legal framework conditions.

Chances of success and risks of IVF

The figures for all IVF treatments are collected in a report by the German IVF register. As you can read in more detail in our article, “ Chances of Success of Artificial Insemination ”, their report for 2009 shows a success rate of nearly 30 percent per IVF treatment cycle. The ICSI treatments also show a similar success rate. This means that the chances of getting pregnant with IVF treatment are as good as for a couple trying to get pregnant naturally. Unfortunately, the individual chances of success of a treatment are very dependent on the age of the woman and the reasons for the infertility . This also applies to the respective individual risks of a treatment. It is best to talk to your gynecologist about your fertility diagnosis, risks and prospects.

Cost of IVF

Unfortunately, since the health reform in 2004, only part of the costs of IVF are covered. In our article “ Artificial insemination: what does health insurance pay for? ” you will learn more about the costs to be expected, what the health insurance company may cover and what conditions must be met for this.

Checklist: Ready for IVF?

Still not sure if IVF is really something for you? Then the following questions can help you. It is best to discuss them with your partner and the attending gynaecologist.

• Can hormone treatment help us first?
• Is another form of artificial insemination an option for us ?
• Do we know about the course of the therapy and about the possible psychological stress?
• Do we keep track of all urgent appointments? Have we made as few appointments as possible during the treatment period to keep our backs free?
• Are we willing to bear the costs of this treatment and what is the maximum amount we can or want to spend on the treatments? Do we have enough reserves for other important expenses?
• Who do we want to tell about the treatment and who rather not? Are there friends and acquaintances who can support us in the coming time?
• Which situations can particularly burden us during the treatment period in everyday life and how can we best cope with them?
• How many embryos do we want to transfer? Do we know the risks of a multiple pregnancy? Could we bear the burdens of multiple births?
• Will we agree to prenatal tests in case of pregnancy?
• What do we do if one of us wants to get out of treatment and the other wants to keep trying?
• How do we deal with it if this treatment is unsuccessful? Will we then dare further attempts? When is it over for us?
• Do we have concrete ideas about our future lifestyle if we don’t have a child of our own with this treatment?