The ultimate guide to understanding IVF

In May 2006, Kenya’s first in vitro fertilisation babies were delivered at Avenue Hospital in Parklands, Nairobi. The babies, both girls, were born to women aged 30 and 35 years. Their birth came 28 years after the first test-tube baby was born in the United Kingdom. The two paid at least Sh. 300,000 each for the IVF procedure. Since then, over 2,000 babies have been delivered through IVF. In the first six months of 2020, over 400 babies were born through in vitro fertilization.

In vitro fertilisation is a method of assisted reproduction in which a man’s sperm and a woman’s egg are combined outside the body. Upon fertilisation, one or more fertilised eggs, which are now known as embryos, are transferred into the woman’s uterus where they attach to the uterine lining and begin to develop naturally.

According to an in vitro fertilisation guideline by Mediheal Hospital, the process of IVF involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from the woman’s ovaries, and letting sperm fertilise them in a laboratory. Upon successful fertilisation, the fertilised egg (zygote) undergoes embryo culture for 2 to 5 days. It is then transferred to the woman. The embryo can also be transferred to a different woman who has been nominated by the mother as a surrogate.

The cost of IVF is a major hindrance to couples seeking to follow this route as an alternative to having children. For instance, at the Nairobi IVF Clinic, the cost of the procedure is about Sh. 300,000. Patients who use donated eggs or sperm pay Sh. 390,000 for a single treatment. In the event the procedure fails, repeat treatment will attract the same cost.

IVF is used if a woman has a problem producing an egg, if infertility is the result of genetics if the man has very low sperm count or very low sperm speeds, and if the woman has blocked or damaged fallopian tubes.

On average, about 70 percent of fertility problems are attributed to the woman while 30 percent are attributed to the man. Among women who seek treatment at the Nairobi IVF Clinic, about 50 percent of the causes of infertility are due to blocked tubes. Other causes include advanced age or Polycystic Ovary Syndrome. Among men who seek treatment at the clinic, the main causes of infertility are low sperm count, lack of sperm, and poor sperm motility.

According to John Hopkins Medicine, Polycystic Ovary Syndrome is a condition in which ovaries produce an abnormal amount of androgens. Androgens are male sex hormones that are present in women in small amounts. With this condition, some women develop small cysts or fluid-filled sacs in the ovaries. Also, this condition results in the woman being unable to produce enough hormones to ovulate. “If ovulation doesn’t happen, the ovaries tend to develop small cysts that make hormones called androgens. Women with this condition usually have high levels of androgens which can result in problematic menstrual cycles,” says Johns Hopkins.

When a woman goes for IVF and an embryo is transferred into her uterus successfully, the excess embryos are frozen and only thawed when and if she goes for another baby. If the woman doesn’t return for the embryos within ten years, they are usually donated to another needy couple.

IVF is not always successful. Fertility research by scientists from Rutgers University whose results were published in the journal Proceedings of the National Academy of Sciences detailed why IVF fails. In this research, the scientists created a mathematical model which showed that mistakes in female meiosis (the process of cell division that creates eggs) produce eggs with an abnormal number of chromosomes which leads to repeated loss of pregnancies, the failure of IVF procedures, and the onset of developmental disorders such as Down Syndrome. “Aneuploidy is the leading cause of early miscarriage and the main cause of IVF failure. It occurs when eggs have the wrong number of chromosomes. In the same breath, the majority of eggs with chromosome problems are linked to errors in female cell division that increase as women age,” Dr. Jinchuan Xing a genetics researcher who led the study said. According to the study, reproductive practitioners can use a mathematical model to identify IVF patients who produce an extreme number of abnormal embryos. “Mathematical modeling will also assist in understanding why abnormal numbers of chromosomes arise when cells divide, predict the outcomes of IVF reproduction, and errors in sperm. It can also shed light on the expected number of IVF cycles needed to get a normal conception for every patient,” the study said.

With the rate of success ranging between 35 percent and 50 percent, professional counseling on the possible outcomes and their emotional, psychological and financial implications on a couple are of paramount importance. “In vitro fertilisation is a harrowing procedure. As such, couples have to be emotionally and financially prepared, including being professionally counseled,” says fertility specialist Dr. Charles Muteshi. The success of IVF will largely be dependent on a variety of factors ranging from the age of the woman, hormonal imbalance, high-quality eggs, sperms, and embryos, and luck. For instance, a younger woman seeking IVF has a better chance of producing high-quality eggs that maximise her chance of getting pregnant when compared to an older woman. However, this is not mean that older women seeking IVF always fail.

Stages of IVF

According to the Mediheal Hospital’s IVF guidelines, the steps of an in vitro fertilisation procedure are as follows:

1. Ovarian hyper-stimulation for follicle development: This is done to produce more eggs than usual. There’s a greater chance of obtaining embryos to increase the chances of pregnancy with more eggs. This procedure up until retrieval of the eggs can take up to fifteen days.
2. Egg retrieval: This procedure takes one day and is performed under general anesthesia.
3. Sperm collection: This is usually done on the same day of egg retrieval.
4. Fertilisation: Retrieved eggs are stored in a culture dish. The sperm is prepared for fertilization. The eggs and sperm are then combined for fertilisation.
5. Embryo development: After fertilisation, the fertilised egg (zygote) undergoes embryo culture for 2 to 5 days.
6. Embryo transfer: Between days 3 and 5 after fertilisation, the best embryo with the highest implantation potential is selected for transfer.  The embryo is then inserted into a thin catheter. It is transferred into the uterus through the cervix. The woman is able to resume her normal duties and activities 24 hours after the embryo transfer.
7. Pregnancy test: Blood tests are conducted two weeks after the embryo transfer to confirm pregnancy.

Possible side effects

During and embryo transfer, it is possible for the woman to sustain the following side effects:

• Uterine or tubal infection
• Cervical bleeding
• Cramps
• Backache
• Miscarriage
• Tubal pregnancy

After egg retrieval, the woman may be asked to start taking progesterone medications. These can result in nausea, cramps, fatigue, and bloating. The woman may also have vaginal spotting or bleeding after the embryo transfer and before a pregnancy test is conducted. This spotting does not always mean the pregnancy was unsuccessful.