As­sisted re­pro­duc­tion (IVF / ICSI) — pro­ce­dure, risks and costs

In vitro fer­ti­liza­tion is one of the most im­portant me­dical ad­vances and often the only hope for many child­less cou­ples to be­come par­ents after all. IVF has al­ready sup­ported mil­lions of people around the world in get­ting pregnant. In Ger­many alone, 250.000 children have been con­ceived this way [1].

In the me­an­time, se­veral me­thods of re­pro­duc­tion are prac­tised, which are very in­di­vi­dual and should only be used after a de­tailed dia­gnosis of both part­ners. In this ar­ticle we look at the pro­ce­dure, the risks and the costs of the in vitro fer­ti­liza­tion (IVF) and its spe­cial form of in­tra­cy­to­plasmic sperm in­jec­tion (ICSI).

Of all the pos­sible me­thods, in vitro fer­ti­li­sa­tion (IVF / ICSI) is one of the most com­plex and usually takes se­veral weeks. Se­veral steps are car­ried out which, apart from the ac­tual fer­ti­li­sa­tion, are the same for both IVF and ICSI.

Let’s take a closer look.

Hor­mone tre­at­ment (du­ra­tion: ap­prox. 9 — 11 days)

Du­ring a na­tural mens­trual cycle, the fe­male body nor­mally pro­duces a single egg that can be fer­ti­lized by the male sperm after ovu­la­tion.

Ho­wever, in order to in­crease the li­keli­hood of pregnancy du­ring IVF, the woman often has to un­dergo hor­mone the­rapy. This in­volves first sti­mu­la­ting the ma­tu­ra­tion of se­veral eggs by ta­king cer­tain hor­mones, and then in­du­cing ovu­la­tion about nine to eleven days after the sti­mu­la­tion be­gins.

The hor­mone do­sage de­pends on the ova­rian re­serve. How large this re­serve is can be de­ter­mined using the level of the Anti-Mül­le­rian Hor­mone (AMH). You can test your AMH level from the com­fort of your own home with our self-test.

Punc­ture

The next step is to use a fine needle to re­move eggs that are ready for fer­ti­liza­tion (punc­ture).
To avoid pos­sible pain and risks, the woman is often put under a short an­es­thesia or half-sleep. One side ef­fect that could occur is slight blee­ding. But don’t panic, this is quite normal!

Fer­ti­liza­tion in the la­bo­ra­tory

In this step, the ac­tual fer­ti­liza­tion takes place. As men­tioned ear­lier, the pro­cess dif­fers in both me­thods and it de­pends on the qua­lity of the sperm which me­thod is best for the couple.

Fer­ti­liza­tion with IVF

After the punc­ture, the fe­male eggs are put into a test tube with the male sperm, where in the best case they find each other in­de­pendently. Hence the term “test tube fer­ti­liza­tion”.
Thus, the ac­tual fer­ti­liza­tion pro­cess takes place in exactly the same way as in the part­ner’s body [2]. The chances of pregnancy after IVF are about 15 to 20 per cent per tre­at­ment cycle.

Fer­ti­liza­tion with ICSI

The ICSI me­thod of­fers a better chance of ha­ving a child for all cou­ples whose men suffer from fer­ti­lity pro­blems. This me­thod is best suited when…

• there are in­suf­fi­cient sperm in the man’s eja­cu­late
• the sperm are too im­mo­bile and un­li­kely to reach the egg on their own.

In this case, the doctor uses a mi­cro­pi­pette to in­ject in­di­vi­dual sperm into the coll­ected fe­male eggs. Fer­ti­liza­tion takes place under a spe­cial mi­cro­scope and can the­r­e­fore be strictly con­trolled. If the pro­cess is suc­cessful, the fer­ti­lized eggs can be trans­ferred into the wo­man’s body bet­ween two and six days after the punc­ture [2].

This is pro­bably the most im­portant point that con­cerns many in­vol­un­t­a­rily child­less people. Ac­cor­ding to the Fe­deral Centre for He­alth Edu­ca­tion, the birth rate for IVF and ICSI is around 15 — 20% per tre­at­ment cycle. Across Ger­many, 20.3% of all IVF and 19.5% of all ICSI pro­ce­dures ended in suc­cessfully in 2016 [1]. After a cryo­transfer (transfer of the frozen fer­ti­lized egg or frozen sperm) it is still pos­sible to have your own child, but the pro­ba­bi­lity drops to 17.7%.

» Here you can find out more about cryo-transfer and so­cial free­zing.

Ho­wever, it is im­portant to keep in mind that the above va­lues are only in­di­ca­tive and vary from si­tua­tion to si­tua­tion. Among other things, the age of the woman is de­cisive for the suc­cess of both tre­at­ments. For ex­ample, the pro­ba­bi­lity of pregnancy is over 40% per em­bryo transfer up to the age of 30, while from the age of 43 it is only 15% [1].

And here is an­o­ther hel­pful sta­tistic: Since fer­ti­lity tre­at­ment is usually as­so­ciated with a highly emo­tional and fi­nan­cial burden, many pa­ti­ents drop out early. Ho­wever, the most re­cent stu­dies give hope! Ac­cor­ding to the German IVF Re­gister, the pro­ba­bi­lity of pregnancy in­creases after se­veral tre­at­ment cy­cles. It is 30% after one at­tempt, 61% after the third one and rises to 79% after the fourth transfer cycle [1].

The cost of fer­ti­lity tre­at­ment is high and can be up to €4,000 per IVF and up to €5,000 per ICSI tre­at­ment cycle [3]. When you con­sider that many cou­ples need se­veral at­tempts at once, they have to dig pretty deep into their po­ckets. Ho­wever, if you live in Ger­many and have sta­tu­tory he­alth insu­rance, you share 50 % of the costs with your he­alth insu­rance com­pany for a ma­ximum of three at­tempts at IVF or ICSI tre­at­ment.

Nevert­heless, the sta­tu­tory he­alth insu­rers only con­tri­bute under cer­tain con­di­tions. These are:

• In vitro fer­ti­liza­tion must be me­di­cally ne­ces­sary and ve­ri­fiable.
• The couple must be mar­ried.
• Only sperm and eggs from both spouses may be used.
• The age of the part­ners must be bet­ween 25 — 40 years for the woman and bet­ween 25 — 50 years for the men.

Pri­vate he­alth insu­rance com­pa­nies have dif­fe­rent con­di­tions which should be cla­ri­fied in­di­vi­du­ally.

As with any me­dical in­ter­ven­tion, phy­sical and psy­cho­lo­gical com­pli­ca­tions can occur du­ring fer­ti­lity tre­at­ment. The­r­e­fore, the first step would al­ways have to be a de­tailed con­sul­ta­tion and con­side­ra­tion of all the ad­van­tages and di­s­ad­van­tages.

Risks of hor­mone the­rapy

Hor­mone the­rapy can be both emo­tio­nally and phy­si­cally stressful. In some cases, it can lead to so-called over­sti­mu­la­tion, in which the ova­ries “over­react” to the tre­at­ment, by en­lar­ging greatly and pro­du­cing too many hor­mones. It can also lead to water re­ten­tion in the ab­domen and be ac­com­pa­nied by syn­dromes such as nausea, short­ness of breath and ten­sion.

Mul­tiple pregnan­cies

The transfer of mul­tiple em­bryos in IVF and ICSI can also lead to mul­tiple pregnan­cies and place more se­vere de­mands on the wo­man’s he­alth. Ac­cor­ding to the German IVF Re­gister, the pro­ba­bi­lity of car­rying twins is 21.1% and 0.5% for a tri­plet pregnancy. This puts Ger­many well above other Eu­ro­pean count­ries.

Stress

Psy­cho­lo­gical and fi­nan­cial stress are other im­portant aspects that should not be ne­gle­cted under any cir­cum­s­tances.
Will the em­bryo im­plant? How will the pregnancy pro­gress? Is there a risk of mis­car­riage? The un­cer­tain­ties after the em­bryo transfer can un­der­stan­d­ably take a lot out of the couple and cause a real emo­tional rol­ler­co­aster. No wonder, all hopes are often pinned on the tre­at­ment!
In ad­di­tion, life­style, daily rou­tines and even sex life have to be dra­sti­cally ch­anged and ad­apted to the tre­at­ment plan.
To ease this nerve-wracking phase, it may be a good idea to seek pro­fes­sional help and have a psy­cho­lo­gist ac­com­pany you on this journey.

In sum­mary: The de­cision for or against in vitro fer­ti­liza­tion is dif­fi­cult. On the one hand lie the un­cer­tain­ties and chal­lenges that may arise: fi­nan­cial, he­alth and emo­tional bur­dens. On the other hand is the lon­ging for a child of your own. Which of the sides pre­do­mi­nates is very in­di­vi­dual and de­pends en­ti­rely on the po­ten­tial par­ents’ pos­si­bi­li­ties.

Im­portant: Such a life-chan­ging step should not be guided by emo­tions alone. For­t­u­na­tely, you can use data and me­dical tests to make a well-con­sidered de­cision.

Take the time to find a spe­cia­list you can rely on. A good doctor will pro­vide you with all the in­for­ma­tion you need and guide you th­rough this cru­cial phase of your life. We work with the best Fer­ti­lity Cen­ters in Eu­rope and would love to ad­vise you!

Here you can find out more about the pos­si­bi­li­ties of in vitro fer­ti­liza­tion in Ger­many, the Czech Re­pu­blic, Poland or Spain.

At Fer­tilly, we have made it our mis­sion to ac­com­pany cou­ples (ho­mo­se­xual and he­te­ro­se­xual) and sin­gles on the way to ful­fil­ling their child wish. In doing so, it is im­portant to us to create trans­pa­rency in the area of fer­ti­lity ser­vices, to pro­vide in­for­ma­tion and know­ledge on the to­pics of pregnancy and fer­ti­lity and to help you to find the most sui­table Fer­ti­lity Center. Th­rough co­ope­ra­tion with first-class Fer­ti­lity Cen­tres and cli­nics in Eu­rope, en­qui­ries about Fer­tilly are given pre­fe­ren­tial tre­at­ment. This means that our pa­ti­ents avoid the usually long wai­ting times and get ap­point­ments more quickly.

If you would like more in­for­ma­tion about Fer­ti­lity Cen­ters, suc­cess rates and prices, please contact us using this ques­ti­on­n­aire. We will ad­vise you free of charge and wi­t­hout any ob­li­ga­tion.

Sources:

1. DIR (2018): Jahr­buch 2017. In: Journal für Re­pro­duk­ti­ons­me­dizin und En­do­kri­no­logie; Son­der­heft 1.
2. Bun­des­zen­trale für ge­sund­heit­liche Auf­klä­rung (2017), Sehn­sucht nach einem Kind. Mög­lich­keiten und Grenzen der Me­dizin.
3. Passet-Wittig, J., Ruck­de­schel, K., Schu­mann, A., Bu­jard, M. (2018), Re­pro­duk­ti­ons­me­dizin und Fa­mi­li­en­pla­nung.