Treatment Spotlight:

• In-vitro fertilisation (IVF) was first used in 1978, and has become the most effective treatment available for those struggling with infertility.
• IVF uses strong hormonal medication to grow multiple eggs in a female reproductive cycle, before they are retrieved and fertilised outside the body in an embryology lab.
• There are different forms of IVF available, but it typically takes 6-9 weeks to complete one cycle.
• Understanding success rates is complex, and results vary significantly based on many factors. The average chance of a live birth from an embryo transferred during IVF is 22% [1].
• Access to IVF can be challenging: NHS eligibility criteria vary depending on where you live in the UK, while private treatment costs are high and differ between clinics.

IVF is an assisted reproductive technique (ART) that helps improve your chances of conception. Essentially, IVF mimics what happens naturally - where sperm meets and fertilises an egg released at ovulation. The big difference is that in IVF, this process happens outside the body in a controlled lab.

There are 3 main steps involved in IVF:

1. Ovarian stimulation

Medication is used to boost the number of mature eggs produced by the ovaries. The eggs are then collected in a surgical procedure.

2. Embryo creation

Eggs are fertilised in the laboratory using partner or donor sperm. Fertilised eggs develop into embryos.

3. Embryo transfer

After 3-5 days of embryo development in the lab, one embryo is transferred into the uterus to develop naturally - resulting in pregnancy.

IVF is an assisted reproductive technique (ART) that helps improve your chances of conception. Essentially, IVF mimics what happens naturally - where sperm meets and fertilises an egg released at ovulation. The big difference is that in IVF, this process happens outside the body in a controlled lab.

IVF is used when people can't conceive naturally. This could be due to infertility, or because they can't use sex to conceive - like solo parents or same sex couples.

In most cases, IVF is the preferred treatment offered to people struggling to conceive. However, sometimes, people may first choose intrauterine insemination (known as IUI or artificial insemination) because it is less invasive and cheaper.

• IVF is invasive. Hormone medication can have side effects. You'll also need surgery (under deep sedation or general anaesthetic) to retrieve your eggs. Rest is very important.

• A live birth isn't guaranteed. IVF is the most effective fertility treatment [2] - but remember that the average chance of a live birth from an embryo transferred during IVF is 22% [3].

• IVF is time consuming. Be prepared to free up your schedule. During ovarian stimulation, for example, you might need weekly or even daily tests to monitor your follicle development. Follicles are found inside your ovaries, and each has the potential to release an egg.

• Donor eggs or sperm could help. Age (as well as infections and other medical conditions) can cause our fertility to decline. Using donated eggs or sperm could improve your chances.

• Be prepared to change plans. Your treatment plan can change at any point until your embryo transfer, as your clinician may adapt your treatment in response to ongoing tests.

• IVF isn't free for most people. NHS England only covered 24% of all IVF cycles in 2021 [4]. Everyone else paid privately, and costs vary significantly across clinics.

Time: Varies, but approx. 2 weeks

Location: Clinic

For females, or those assigned female at birth (AFAB), your clinic will run pre-treatment blood tests and ultrasound scans. These predict your body's response to treatment and help to understand the number and quality of eggs available (this is known as your ovarian reserve [5]).

Tests include:

• Blood tests for Anti-Müllerian Hormone (AMH) and Follicle Stimulating Hormone (FSH). These are used to understand the number of eggs you have available.

• A pelvic scan, which involves an Antral Follicle Count (AFC). This looks at the number of immature follicles that can be matured (and develop eggs) in the IVF cycle.

For men, tests check the quantity and quality of sperm. This is measured as motility (movement) and morphology (shape). Depending on the results, you may need additional treatments, such as intracytoplasmic sperm injections (ICSI).

Both partners undergo mandatory screening for blood-borne viruses, like HIV and hepatitis [6].

Next, you'll need a follow-up consultation with a doctor to discuss the results and prepare for your cycle. You'll be given a treatment plan - or protocol - and a nurse will show you how to administer the medication.

Some clinics may also ask you to monitor your natural cycle before starting IVF. This involves regularly coming into the clinic for blood tests and ultrasounds throughout your normal cycle and can extend the process by a month.

Time: 2-4 weeks

Location: Home, with in-clinic monitoring

Now it's time to begin your treatment - or protocol.

Most protocols start on day 1-2 of your period, directly after your bleed. This is when you will begin stimulation. The process typically takes two weeks, during which you inject medication such as Gonadotrophin into your abdomen. This encourages follicles in your ovaries to grow and develop multiple eggs at the same rate. This is different to a natural cycle, where only a 'lead' follicle develops an egg, and increases your chances of conception.

The size of the follicle is how your doctor determines whether the egg is ready (since eggs are too small to assess otherwise). To monitor the development of your follicles, the doctor will use hormonal blood tests and a trans-vaginal ultrasound.

Sometimes, a protocol includes a period of hormonal down-regulation before you start stimulation. This involves using medication to first shut down your natural cycle. It typically starts at day 21 after your period, just after ovulation, and lasts a few weeks. Oral medication, such as Buserelin, is taken. When your bleed comes on day 1 of your next cycle, you will stop down-regulation and begin stimulation.

Time: 36 hours

Location: Home and clinic

When follicles are the right size, your doctor will advise you to take your 'trigger shot'. This is an injection containing hCG - a hormone that helps your follicles mature, and encourages them to release multiple eggs at the same time.

36 hours after the trigger shot, you will undergo a 15-30 minute surgery at your clinic to retrieve your eggs. On the same day as your egg retrieval, a sperm sample - whether from a partner or donor - is prepared.

Time: 3-5 days

Location: Home and clinic

Following retrieval, your eggs are combined with the prepared sperm in a lab. Fertilisation occurs over the next few hours, and embryo culturing - where the egg cell begins to divide - occurs over the next 3-5 days.

During this time, your uterus lining will be prepared using progesterone you take at home, also called luteal support medication. This ensures your uterus is healthy and ready to receive an embryo.

Time: 20 minutes

Location: Clinic

Assuming multiple embryos survive, an embryologist will pick one to transfer to your uterus.

Transferring the embryo is a fairly quick procedure, and is usually done without anaesthetic. A catheter is inserted through the cervix, and an embryo is transferred through this into your uterus.

Time: 2 weeks

Location: Home

After the transfer, your embryo will hopefully implant successfully into the lining of your uterus and continue to develop - leading to pregnancy. The 'two week wait' refers to the intensely stressful period before a pregnancy test can provide you with a reliable result.

Your clinic should provide counselling and additional scans to help reassure you during this part of your journey.

Typical timeline: 6-9 weeks

This is based on a single round of IVF, from pre-treatment to taking a pregnancy test.

The length of your treatment can vary depending on the protocol used, and whether your doctor needs to carry out additional tests before starting the cycle. Many people also choose to take a break after their pretreatment testing, so IVF timelines vary from person-to-person.

Like other fertility treatments, success rates are not the same for everyone. Age, the protocol you use, any underlying conditions, and the quality of care at your clinic all play a big factor.

However, the average live birth rate for IVF per embryo transferred, is 22% [7].

Women are born with all the eggs they will ever have. Unlike other cells in the body, like skin cells, eggs don't regenerate. This means our eggs age like the rest of us, reducing the number and quality of eggs available over time.

This means that older women are likely to have fewer eggs collected, and the quality of these eggs is also likely to be lower. Lower quality eggs often show lower rates of fertilisation and development, and the chance of successful pregnancy using them is also smaller.

Below we've provided a breakdown of the live birth rates across different maternal ages [8].

But it's not just women who experience an age-related decline in fertility.

Emerging research shows age affects sperm. Men over 30 are more likely to have decreased sperm motility compared to younger men, and men over 40 are more likely to have lower sperm counts [9].

There's also mounting evidence that sperm quality has been declining generally over recent generations [10]. The exact cause is unknown, but thought to be caused by greater levels of pollutants and changing diets [11].

Life after an IVF cycle looks different for everyone.

If your cycle was unsuccessful, we know how heartbreaking that can be. Many people may feel the need to take a break before trying another cycle, while some go straight back into planning. Your clinic should provide follow up appointments and counselling sessions to help support you.

IVF can be a lonely process - and multiple cycles can make it even more isolating. Whilst your clinic can offer excellent support along the way, connecting with the fertility community online or in offline groups can offer invaluable friendship, connection and support.

Overall, IVF is considered safe. It's estimated that 12 million babies have been born from IVF since it was first introduced in 1978 [12]. However, it's important to be aware of the risks involved.

• Mental wellbeing. From medication side effects to money worries and uncertain outcomes, undergoing IVF can have a big impact on your mental health. It's important you have appropriate support throughout your treatment journey.

• Ovarian Hyperstimulation Syndrome (OHSS). OHSS occurs when your ovaries become overactive in response to hormonal medication, and start releasing their own chemicals. However, this is rare and, if it does occur, can usually be treated at home. In rare cases, it can lead to hospitalisation and pregnancy complications.

• Surgical risk. As with any surgical procedure, egg retrieval surgery carries a small risk of infection and complications. So, too, does the embryo transfer, as it involves inserting a catheter through the cervix and into the uterus - although it is far less invasive.

• Multiple pregnancy. Very occasionally during the embryo transfer stage, two embryos, rather than one, will be transferred. While this is often done when a doctor believes there is a low chance of pregnancy, multiple embryo transfers can sometimes lead to multiple pregnancies.

  Multiple pregnancies are associated with a heightened risk of health problems for both mother and babies - such as late miscarriage, premature delivery, gestational diabetes, stillbirth and death. The Human Fertilisation and Embryology Authority (HFEA)'s 'One at a Time' campaign in 2007 significantly reduced the incidence of multiple births in the UK, making IVF safer now than it was.

IVF is available on the NHS, however to access treatment you must be eligible based on the criteria in your local area. Unfortunately, this criteria (as well as the number of treatment cycles you can receive), can vary a lot depending on where you live. This is known as the NHS Postcode Lottery. Overall, in the UK, this means that only 37% of IVF patients used NHS funding in 2021 [13].

If you aren't eligible for treatment under the NHS, you'll need to fund your IVF privately.

The average advertised cost of an IVF package in the UK is £4,090 per cycle, but it varies considerably from clinic to clinic - so it's important to do your research. And beware: this price usually doesn't include the cost of preliminary tests, in-treatment blood tests, medication, or the storage and transfer of any additional frozen embryos.

IVF is one of the most popular and effective forms of assisted reproductive treatment. It's allowed many people to become parents who might not have been able to otherwise.

But it's also important to remember that IVF doesn't work for everyone, and that factors like our age can significantly affect the outcome. There are risks involved, and IVF isn't easy, either, for many people to access. From the NHS Postcode Lottery to the high costs of private treatment, it pays to do your research - and that's what Fertility Mapper is here to help you with.