IVF: update on this method of assisted reproduction

La in vitro fertilization was developed by Robert Edwards, British biologist, which led to the birth of first test tube baby in 1978 in England (Louise) and in 1982 in France (Amandine). According to a survey by the National Institute for Demographic Studies, published in June 2011, out of 100 couples who begin treatment by in vitro fertilization in a center for ART (medically assisted procreation), 41 will have a child thanks to to IVF treatment, within an average of five years. Since July 2021, these reproductive techniques have also been available in France to single women and female couples.

What is the principle of in vitro fertilization (IVF)?

IVF is a medical technique that involves inducing fertilization outside the human body when it does not naturally allow it.

• First step: we stimulates the ovaries of the woman by hormonal treatment in order to then be able to collect several ripe oocytes for fertilization. During this first phase, hormonal blood tests are carried out every day and an ultrasound should be performed in order to monitor response to treatment.
• Once the number and size of follicles are sufficient, a injection d’hormone is done.
• 34 to 36 hours after this injection, the sex cells are collected by puncture in women, and sperm by masturbation in men. It is also possible to use the previously frozen sperm of the spouse or that of a donor. For women, 5 to 10 oocytes are collected and stored in an incubator.
• Fourth step: the meeting between an egg and a sperm, which is ” vitro », That is to say in a test tube. The objective being to achieve fertilization in order to obtain embryos.
• These same embryos (their number is variable) will then be transferred to the uterine cavity of the woman. two to six days after incubation. 

This method is therefore long and cumbersome – particularly for the body and the health of the woman – and requires very precise medical and even psychological support.

IVF: what is the percentage of success?

IVF success rates vary greatly depending on the health of the people involved, their age, and the number of IVFs they have already had. On average, in each cycle of IVF, a woman has a 25,6% chance to get pregnant. This figure rises to around 60% on the fourth attempt at IVF. These rates drop below 10% from a woman’s fortieth year.

What are the methods of IVF?

La FIV ICSI

Today, 63% of in vitro fertilizations are ICSI (intracytoplasmic sperm injection). Derived from IVF, they are particularly indicated in severe male infertility problems. Sperm are collected directly from the male genital tract. Then we inject a sperm into the egg to be sure to fertilize it. This therapy is also offered to men suffering from a serious disease that can be transmitted to their spouse or to the unborn child, as well as to couples with unexplained infertility after failure of other ART techniques. If IVF by ICSI is therefore the most used, it is not the only method used today in France. 

IVF with IMSI

THEintracytoplasmic injection of morphologically selected spermatozoa (IMSI) is another method where sperm selection is even more precise than with ICSI. The microscopic magnification is multiplied by 6000, even 10 000. This technique is practiced in particular in France and in Belgium.

In vitro maturation (IVM)

While oocytes are collected at a mature stage for traditional in vitro fertilization, they are collected at an immature stage during IVF with in vitro maturation (IVF). The end of maturation is therefore carried out by the biologist. In France, the first baby conceived by MIV was born in 2003.

Who is in vitro fertilization for?

Following the adoption by the National Assembly of the bioethics bill on June 29, 2021, heterosexual couples but also female couples and single women can recover for medically assisted procreation, and therefore in vitro fertilization. Those affected must undergo health tests and consent in writing to the protocol.

What is the cost of IVF in France?

Health insurance covers 100% four attempts in vitro fertilization, with or without macromanipulation, until the woman reaches 42 years of age (ie 3000 to 4000 euros per IVF). 

When to resort to in vitro fertilization?

For heterosexual couples, the question of IVF often arises after an already long journey, two years on average, to try to conceive a baby. To rule out any anatomical cause preventing fertilization (malformation of the tubes, uterus, etc.), gynecologists and doctors advise couples to perform a preliminary assessment. Other factors, such as poor quality sperm, low sperm production, ovulation abnormalities, the age of the couple, etc. may also come into play.

IVF: do you need to be accompanied by a shrink?

According to Sylvie Epelboin, doctor jointly responsible for the IVF center of Bichat Claude Bernard in Paris, “ there is a real violence in the announcement of infertility, whose words are often seen as demeaning “. Throughout this ordeal, marked by medical examinations and sometimes failures, it is important to talk. Consulting a specialist allows you to avoid being pressured by those around you, to isolate yourself in your suffering and daily management (emotional, sexual life, etc.). It is also important to diversify your interests, to have fun with activities as a couple and with friends, and not to focus on the sole desire for a child. Sexual life could then become a source of stress because it tends to be only procreative.

Where to go to benefit from IVF?

When faced with infertility, couples can turn to one of the 100 centres d’AMP (assistance with medical procreation) from France. There are 20 to 000 requests each year, but this could increase with the expansion of access to this method and the new anonymity modalities for gamete donation.

Why doesn’t IVF work?

On average, the failure of IVF is due either to an absence of oocytes during ovarian puncture, or to their poor quality, or to an insufficient or too important response of the ovaries during hormonal stimulation. You usually have to wait 6 months between two attempts of IVF. This process can be very guilty on a daily basis for the person trying to carry the unborn child and it is also for this reason that support is recommended on all levels: medical, psychological and personal. There will certainly also be a need for rest after each examination and it is therefore necessary to be aware of this on a professional level.