In-vitro fertilisation (IVF)

In-vitro fertilisation (IVF) is an option in a range of infertility conditions and can use a couple’s own or donor gametes (oocytes and sperm). Controlled hyperstimulation of the ovaries is required so that multiple follicles mature, in contrast to ovulation induction, in which the goal is to promote maturation of a single follicle.

Gonadotrophins are used in higher doses in IVF compared with ovulation induction. Combinations of gonadotrophins can be used, and gonadotrophins can also be used with other drugs. Treatments used include:

• gonadotrophin-releasing hormone (GnRH) agonists or antagonists, to prevent premature oocyte release
• high-dose human chorionic gonadotrophin (hCG) ‘trigger injection’, to release the oocytes (given 36 hours before oocyte collection)
• vaginal progestogen or hCG, to support the luteal phase of the menstrual cycle (by ensuring the endometrium is ready for implantation).

After oocytes are matured in the follicles, they are collected by transvaginal fine needle aspiration with ultrasound guidance. Fertilisation is facilitated in the laboratory by putting oocytes and sperm together. Embryos are selected according to morphology; in some situations, testing for chromosomal or genetic anomalies is warranted—see the Victorian Assisted Reproductive Treatment Authority for more information. The embryo(s) resulting from IVF are placed in the uterus via the transvaginal route, usually as a single embryo transfer to minimise the risks of multiple pregnancies.

Intracytoplasmic sperm injection (ICSI) involves IVF with the additional step of injecting each harvested oocyte with a single sperm to overcome problems such as poor sperm motility or very low sperm count. ICSI is used in 60 to 80% of IVF treatments in Australia. The incidence of congenital anomalies is slightly increased with ICSI compared to IVF alone.