10 Things to Know About IVF

1. Infertility is a Common Condition

Many couples experience infertility, a common issue affecting approximately 1 in 6 couples in developed countries and up to 1 in 4 in some regions, such as sub-Saharan Africa. Infertility is often attributed to the woman (1/3), the man (1/3), or both (1/3). Around 10% of infertile couples use IVF to address fertility problems. These statistics are steadily increasing in both developed and developing nations. Fertile individuals may also seek Assisted Reproductive Technology (ART) or IVF to conceive additional children later in life, as well as same-sex couples in certain countries, or individuals with genetic conditions. Currently, 2% of babies are born through IVF. Only when all IVF techniques have been exhausted and it is scientifically proven that the couple can no longer have children naturally or with assistance can we speak of sterility.

2. IVF Requires Preparation

In vitro fertilization, or IVF, involves retrieving ovarian follicles containing oocytes (eggs) from the ovaries after the ovulation period. These are fertilized in a laboratory using the partner's sperm. The resulting embryos are then placed inside the uterus. The preparation process can be lengthy, as the woman's body is typically stimulated to facilitate oocyte retrieval. This involves ovarian stimulation, blood tests, and ultrasounds over several days or weeks before oocyte collection. The embryo transfer is performed 2 to 5 days after the oocyte retrieval at the IVF center. In total, the treatment can take about 4-5 weeks.

3. Types of IVF and Associated Interventions

Several IVF techniques exist: Intrauterine Insemination (IUI), also known as artificial insemination; In Vitro Fertilization (IVF); and Intracytoplasmic Sperm Injection (ICSI). The choice of technique is determined by the gynecologist specializing in infertility treatment. The goal is to prepare a healthy egg and assist a sperm in fertilizing the female gamete. Other interventions may be combined with the IVF procedure to prepare the woman, such as removing polyps or checking the uterine cavity with a diagnostic hysteroscopy. For sperm collection, depending on the man's situation, a testicular biopsy may also be performed.

4. The Overall Cost of an IVF Medical Stay Can Significantly Exceed the IVF Cycle Costs

Patients sometimes confuse the cost of the cycle with the total cost of treatment. The overall cost of the in vitro fertilization process includes ultrasounds, egg retrieval, embryo manipulation, and embryo transplantation. However, since treatment is tailored to your individual circumstances, costs associated with blood tests, medications, and additional procedures are not included in the initial price and can vary from patient to patient. Fees must also be paid, and most patients opt for sedation. Be sure to ask a clinic for a complete cost breakdown and consider any additional extras you might want before starting treatment.

Patients sometimes confuse the cost of the IVF cycle with the total cost of the stay. For example, the price of IVF in Tunisia starts at 2700 EUR. This price includes all medical costs, including the mandatory tests before starting the cycle. If we add the couple's stay in Tunisia for at least 15-20 days, transfers between accommodation, clinic, doctor's office, food, and two plane tickets, the overall cost can easily exceed double the cost of the IVF procedure. Before starting the IVF procedure abroad, consider all additional costs.

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5. Woman's Age Matters

Age plays a crucial role in fertility success rates. For women, fertility begins to decline around age 35 and becomes more pronounced in their 30s and 40s. Conception becomes increasingly challenging in one's 40s, and the chances of successful fertility treatment significantly decrease by age 45. This is due to the progressive decline in the number and quality of eggs in the ovaries over time. While male fertility remains relatively stable, it does decrease over time. Decreased testosterone levels lead to reduced sperm production. Similar to women, men's sperm undergoes changes over time, leading to a gradual decline in quality and quantity. However, there's no such thing as a lost cause for older patients. If you are considering fertility treatment, it's best to act sooner rather than later.

Fertility treatment is more effective in younger women. The decrease in female fertility begins at age 35 and accelerates over time. At 40, it becomes much more difficult to conceive, and at 45, the chances of success are almost nil. This is due to the decrease in the number and quality of eggs in the ovaries over time. Although male fertility is more stable, it also decreases with age, due to a decrease in testosterone levels leading to reduced sperm production. Like women, men's sperm undergoes changes over time, leading to a gradual decrease in its quality and quantity. But don't lose hope if you are older, as it is still possible to undergo fertility treatment. However, it is recommended to do so as soon as possible rather than waiting.

6. IVF Center Success Rates Can Be Misleading

Advertised success rates don't account for your individual circumstances and may give a misleading impression of your chances of success. Note that some clinics exclude patients with risk factors such as advanced age, low ovarian reserve, or specific gynecological issues. Therefore, high success rates may not be relevant to your specific case. It's also important to carefully examine exactly what is being measured. Some clinics measure success by positive pregnancy tests, others by clinical pregnancy, and others by live births. Comparing success rates between different clinics is therefore not considered useful; this is supported by regulatory bodies who advise patients not to compare success rates.

Success rates are not tailored to your exact circumstances and may therefore give a misleading picture of your chances of success. Some IVF centers refuse patients who have little chance of conceiving, such as older women or those with low ovarian reserve or specific gynecological problems. This allows for high success rates. Thus, this high success rate may not be relevant to your particular situation. It is also important to carefully examine what is being measured. Some IVF centers measure the success rate by positive pregnancy tests, others by pregnancies, and others by births. It is therefore not useful to compare the success rates of different clinics as long as the calculation methods are not clearly explained.

7. You May Need More Than One IVF Treatment Cycle

IVF success rates hover around 35%, meaning most patients undergo multiple treatments before successfully conceiving. However, success rates are constantly improving with advancements in techniques. If you're starting fertility treatment, it's crucial to think of it as a series of treatments, not just individual cycles. This allows you to mentally prepare for the possibility of undergoing one or more additional cycles.

8. Frozen Embryos Are as Good as Fresh

Recent studies suggest frozen eggs and embryos are just as viable as fresh ones. Extra embryos can be frozen and used in a subsequent IVF cycle. Many couples opt for routine freezing of embryos not transferred to the uterus. For a second IVF attempt, the woman avoids extensive hormonal treatment, requiring only simple preparation for frozen embryo transfer.

9. You're More Likely to Have a Multiple Pregnancy with IVF

Fertility treatment increases the likelihood of multiple pregnancies. High-order multiples (quadruplets and more), often highly publicized, are rarely the result of IVF. They usually occur following high-dose fertility medication combined with IUI. However, twins or triplets are more common with IVF. Typically, two embryos are implanted to increase the chances of pregnancy. Multiple embryo transfers are recommended for patients with a difficult prognosis. Fraternal twins are more likely, perhaps due to IVF techniques such as ICSI where a sperm is injected into an egg.

10. The Embryoscope for Better Embryo Monitoring

Many undergoing IVF seek to maximize their chances of success. Several additional techniques can improve success rates, such as the embryoscope. The embryoscope is a special type of incubator with continuous video recording. Embryos can be monitored at each stage of development without removal from their controlled environment.

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