In vitro fertilization is the oldest method of assisted reproduction. With the birth of Louise Brown, who is now 41 years old (born July 25, 1978), the scientists Steptoe and Edwards succeeded for the first time with IVF in 1978. At that time, however, doctors retrieved the egg during a natural menstrual cycle. Today, by contrast, a woman’s ovaries are stimulated with hormones in the vast majority of cases. In his 2007 paper “Time for a Rethink,” Edwards criticized this new approach, describing modern methods of follicle stimulation and ovulation induction as too extreme and too costly (Edwards 2007). For us, this is reason enough to take a closer look at in vitro fertilization.
Procedure for an IVF
In IVF, fertilization of the egg takes place outside the body.
At the start of in vitro fertilization, the woman’s ovaries need to be stimulated to mature eggs using hormones (gonadotropins). The doctor monitors the process via ultrasound. Once the eggs have matured, ovulation can be induced artificially.
Ideally, between five and ten eggs can then be retrieved through the vagina (transvaginal follicular puncture) and placed in a nutrient medium. There, the eggs are combined with the partner’s prepared sperm, which is usually obtained through masturbation.
After spending a day in a warm incubator, it is possible to check under the microscope whether fertilization has been successful. If so, the reproductive specialist can transfer up to three embryos into the woman’s uterus after one to two days.
The use of reproductive technology and the handling of embryos are regulated in Germany by the Embryo Protection Act. According to this law, a fertilized, developmentally capable egg is considered an embryo from the moment the nuclei fuse.
In Germany, no more than three fertilized eggs are allowed to develop into embryos in the laboratory. Parents must decide in advance whether to transfer one, two, or three embryos — the more embryos, the higher the chance of success, but also the greater the likelihood of twins or even triplets.
What is cryopreservation?
Cryopreservation, the freezing of biological material, makes it possible to also freeze fertilized eggs — for example, when more than three fertilized eggs have been obtained.
Freezing is only permitted at the pronuclear stage, approximately 24 hours after the sperm has entered the egg but before the genetic material has fused.
Success rates of IVF
Artificial fertilization, unfortunately, is no guarantee of becoming pregnant and giving birth to a baby.
The journey to pregnancy is often a difficult one, marked by many setbacks. Several attempts are often necessary before a woman becomes pregnant. This period is extremely demanding, both physically and emotionally.
According to the IVF registry, in 2018, pregnancy was achieved in 28% of treatment cycles following in vitro fertilization. However, the pregnancy rate does not equate to the birth rate, which is somewhat lower due to miscarriages and stands at just under 20% per treatment cycle.
The success of fertility treatments also depends heavily on age. From the age of 36, the pregnancy rate declines, while the miscarriage rate increases. By the age of 45, the pregnancy rate drops to just 5.4%, and the birth rate to 1.7%, due to the high probability of miscarriage (IVF Registry 2018).
Not only a woman’s age but also the type of previous conception and pregnancy outcome significantly influence the chances of success in reproductive medicine. For example, a prior pregnancy increases the success rate of assisted reproductive technologies (ART). Conversely, each previous preterm birth raises the likelihood of miscarriage even with ART treatment (Kupka 2004).
Pros and cons
Pros:
- Chance for Parenthood: For many couples, in vitro fertilization represents a valuable opportunity to fulfill their wish of having a biological child.
- Medical Advancement: IVF provides an option when other fertility treatments have failed, offering hope to couples facing infertility.
- Emotional Relief (if successful): A successful outcome can relieve the emotional burden of childlessness and bring great joy to the couple.
Cons:
- Emotional Strain: The experience of infertility is already a heavy emotional burden — and the IVF process itself can be just as stressful. Couples often experience emotional highs and lows, strongly influenced by the outcome of the treatment.
- Relationship Stress: Infertility and the demands of treatment can lead to sexual problems and strain in the relationship.
- Psychological Impact: Prolonged infertility and unsuccessful treatment attempts can lead to feelings of guilt, inferiority, and mood swings, affecting many aspects of life.
(Goldschmidt 2003)
Risks and complication
Artificial fertilization is an intervention in the body.
Every medical intervention carries certain risks, which means that various complications can occur.
One risk of assisted reproduction is ovarian hyperstimulation syndrome (OHSS). OHSS is a potentially life-threatening complication of ovarian stimulation and represents one of the main complications of assisted reproductive procedures. It is primarily caused by the external administration of hormones (gonadotropins) to stimulate egg maturation. Depending on the severity, various symptoms may occur: a feeling of pressure in the abdominal area, discomfort, nausea, vomiting, enlargement of the ovaries, fluid accumulation in the abdominal cavity, increased blood clotting tendency, impaired blood flow to the kidneys, and liver dysfunction.
Other complications of IVF treatment can include an increased rate of ectopic pregnancies, infections, thrombosis, injury to organs and blood vessels, and more.
Multiple Pregnancies
The transfer of multiple embryos to increase the chances of success always carries the risk of a multiple pregnancy. According to the IVF registry, 21.3% of all births are twin births, while 0.7% are triplet births. Multiple pregnancies can lead to developmental disorders in babies or premature births. Carrying twins or even triplets is an additional and serious risk, especially in combination with the typically higher maternal age.
Moreover, multiple pregnancies are usually delivered by planned cesarean section, which in turn can involve complications. These include significant blood loss, the formation of blood clots, infections, injury to nearby organs, wound healing disorders, anesthesia complications, and even post-traumatic stress disorder in the mother.
Increased Risk of Miscarriage
The risk of miscarriage is higher in women who become pregnant through IVF treatment. This can partly be explained by the generally higher average age of couples undergoing treatment. In addition, specific genetic abnormalities, particularly in cases of severely impaired sperm quality, may also contribute to the risk of miscarriage.
Severe Psychological Stress
Many childless couples underestimate the psychological strain of undergoing hormone-based fertility treatment. The woman, in particular, experiences continuous physical and emotional stress. Additionally, there are often severe side effects from the hormone therapy. If multiple treatment cycles are required, couples constantly fluctuate between hope and disappointment. Studies point to significant side effects and psychological burdens, with stress from IVF being equated to the death of a family member! Studies also show a depression rate of 52% following IVF, regardless of the treatment outcome (Zuber-Jerger 2002).
Other psychological burdens known among specialists include: reduced self-confidence and self-esteem, feelings of loss of control and competence, violation of personal integrity, anxiety and tension — especially while awaiting the treatment result — as well as reactive depression in the case of unsuccessful outcomes (Telus 2001).
Financial Burden
Last but not least, couples face an immense financial burden. Since the healthcare reform of 2004, most public health insurance providers in Germany cover only up to half the costs of artificial fertilization, and only for a maximum of three attempts. The conditions: the woman must not be older than 40, the man not older than 50, and both partners must be at least 25 years old. Public health insurance also requires that couples be married for fertility treatments. Special regulations apply to unmarried couples: they must live in what is termed a “stable partnership” — whether this is the case is left to the discretion of the doctor conducting the consultation.
Artificial fertilization can trigger a true avalanche of costs, as very few women become pregnant on the first attempt. It is not uncommon for three to four attempts to be necessary. Between three rounds of IVF and several prior attempts at insemination, costs can quickly add up to around 10,000 euros. Some health insurance providers cover a higher share of the costs for artificial fertilization than legally required.
Referrals to Fertility Clinics Are Often Premature
Pregnancy is an extremely complex process and a true wonder of nature. In our experience, women are often referred to fertility clinics too early and prematurely. The reason for this is that doctors usually assume a textbook cycle of 28 days. However, studies show that 70% of all women do not conform to this standard. Their individual cycle is either shorter or longer — yet still completely healthy. Ovulation also occurs, just on a different day and almost never exactly in the middle of the cycle.
As a result, early or late ovulations often go undetected by gynecologists, leading to a mistaken diagnosis of anovulatory cycles (cycles without ovulation). The consequence: the patient is referred to a fertility clinic, even though natural conception might have been possible. In this way, couples are unnecessarily subjected to significant emotional and financial strain.
Increase Your Chances of Getting Pregnant with Continuous Cycle Monitoring
Knowing the exact time of ovulation significantly increases the chance of becoming pregnant. By having targeted intercourse during the fertile window of the cycle, 81% of women can conceive within 6 months (Raith Paula 2013). Continuous cycle monitoring offers at least the same success rate for pregnancy as IVF. Chausiaux et al. showed in 2013 that the clinical pregnancy rate after 12 months of using a cycle monitor was 39%, whereas the clinical pregnancy rate with IVF in 2013 was only 33%.
Our tip: First, get to know your individual cycle patterns with OvulaRing and find out whether your cycles are healthy! With continuous cycle monitoring using OvulaRing and precise knowledge of the ovulation time, OvulaRing users become pregnant after an average of just 3.8 months — completely free of stressful side effects. Our OvulaRing expert team is always available to provide advice and support you on your journey to parenthood.
Note: IVF is just one of many methods of assisted reproduction (ART). We will present further ART options elsewhere.
References
Chausiaux et al 2013. Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation/Intracytoplasmic Sperm Injection. In: Assisted Reproduction and Infertility.
Edwards RG.2007. IVF, IVM, natural cycle IVF, minimal stimulation IVF − time for a rethink. Reproductive BioMedicine Online Vol 15. No 1. 106-119; www.rbmonline.com/Article/2789 on web 18 May 2007
Goldschmidt S et al. 2003. Zum Zusammenhang zwischen der Lebenszufriedenheit ungewollt kinderloser Paare und dem Behandlungsausgang nach IVF. Reproduktionsmedizin 19, 30–39.
Gynäkologie und Geburtshilfe. https://www.thieme.de/de/gynaekologie-und-geburtshilfe/ohss-ovarielles-ueberstimulationssyndrom-83106.htm
Journal für Reproduktionsmedizin und Endokrinologie (2019). Deutsches IVF Register. Jahrbuch 2018. https://www.deutsches-ivf-register.de/perch/resources/dir-jahrbuch-2018-deutsch-4.pdf
Kupka MS et al. 2004. Prognosefaktoren der assistierten Reproduktion. In: Der Gynäkologe 37, 686–695.
Raith Paula et al 2013. Natürliche Familienplanung heute. S. 155.
Telus M. 2001. Reproduktionsmedizin: Zwischen Trauma und Tabu. In: Dtsch Arztebl 2001; 98(51-52): A-3430 / B-2889 / C-2685
Zuber-Jerger I. 2002. Reproduktionsmedizin – Zwischen Trauma und Tabu: Zu hohe Risikobereitschaft. In: Dtsch Arztebl 2002; 99(10): A-617 / B-505 / C-476
