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In vitro fertilisation (IVF)

In vitro fertilisation - Artificial insemination

In vitro fertilisation (IVF) is a form of assisted fertilisation. In this procedure, the egg and sperm cells do not merge inside the female body, but in a test tube in the laboratory instead. This is why this method is referred to as ‘in vitro’, which simply means ‘in glass’.

In vitro fertilisation (IVF) infographic showing treatment stages in and around the uterus

When is in vitro fertilisation useful?

IVF can be used if, for example:

A woman has obstructed fallopian tubes or none at all (tubal infertility)
A man’s sperm quality is impaired
The lining of the uterus grows outside the uterus (endometriosis)
No cause for infertility is found during the diagnosis (idiopathic infertility).

What happens during in vitro fertilisation?

1. Hormonal stimulation

The chances of success in IVF treatment increase significantly if several eggs are matured simultaneously (usually by means of hormone treatment). If this is no longer possible or not desired (due to a later stage in life, a limited egg reserve, or sensitivity to hormones), IVF treatment cycles can also be carried out with one or only a few eggs (‘mild stimulation IVF’).

2. Eggs are removed and prepared

As soon as the eggs are mature, the doctor uses a delicate needle to remove them from the ovaries with ultrasound guidance. This procedure is called follicular aspiration. It usually takes only a few minutes. The woman may be given a mild sedative for the procedure. The retrieved eggs are then prepared for fertilisation in the laboratory.

3. Sperm sample from the man

The sperm from the man’s sperm sample are prepared in the laboratory. In the process, the motile sperm are separated from the non-motile and dead sperm. If no sperm are found in the ejaculate, material from a testicular biopsy (TESE) can also be used. If the partner has no sperm capable of fertilisation, cryopreserved sperm material from a sperm bank (donor sperm) is used.

4. Fusion of eggs and sperm in the test tube

The prepared sperm from the man are then brought together with the woman’s eggs in a test tube, where they swim in a special nutrient solution. The sperm must then fertilise the eggs independently and without any further assistance. The day after the follicular aspiration, the eggs are checked to see if they have been fertilised. The fertilised eggs develop into embryos, which are then stored in an incubator for two to five days.

5. Embryo transfer

On the day of the embryo transfer, the doctor, in consultation with the patient, inserts the embryos in the uterine cavity in accordance with the applicable statutory provisions. This is done with a soft plastic catheter. The transfer of the embryos is painless and takes only a few minutes. The embryos can then implant in the lining of the uterus where they can continue to develop.

To determine whether the procedure was actually successful or not, the woman takes a pregnancy test about two weeks after the procedure.

What are the chances of success for in vitro fertilisation?

The chance of a woman becoming pregnant through in vitro fertilisation is largely dependent on her age. The pregnancy rate for women aged 30 is about 40% per embryo transfer, while the chances for women aged 40 are just under 30%. On average, one in three procedures results in pregnancy.

If the fertilised eggs cannot be transferred, it is possible to freeze them (cryopreservation) for later use. This will save the woman from having to undergo hormone treatment and egg retrieval during the next attempt.

Are there any risks or side effects of in vitro fertilitsation?

As with any medical procedure, in vitro fertilisation involves certain risks. Complications are rare – but they can be quite serious in individual cases. For example, the hormone treatment can sometimes have side effects – such as hyperstimulation syndrome. This can cause abdominal pain, nausea or shortness of breath, and the risk of an ectopic pregnancy is slightly increased. When the eggs are removed, it is possible that organs may be accidentally injured, and even anaesthesia is never without risk. The physician treating you will be able to provide you with detailed information on the opportunities and risks of treatment, explain the course of treatment to you and discuss the possibility of a multiple pregnancy.

Do health insurance companies pay for IVF treatment?

In Germany, statutory health insurance companies usually cover 50% of the costs of in vitro fertilisation under very specific conditions (country specific). However, this is only for three attempts. They do not cover the cost of cryopreservation.