In vitro fertilisation (known as IVF) is the name given to a technique where eggs are fertilised with sperm outside the body in a test tube. Despite the fact that it is widely practised throughout the world and has enabled thousands of couples to successfully conceive and give birth, it still remains a controversial technique, both from a medical and ethical point of view.

IVF is a method of assisted conception, which may be considered necessary after a couple have gone through investigations for infertility. Among the reasons why it may be used are:

• where the fallopian tubes are blocked or absent.

• where there are other medical or physical reasons, which prevent the egg and sperm from joining naturally within the woman's body.

Couples undergoing IVF must first participate in a counselling programme, the aim of which is to give them realistic expectations about the procedure.

Once the couple are deemed suitable for IVF, the woman will be given special fertility medication or hormonal preparations to help stimulate ovulation and to support the development of the uterine lining in preparation for pregnancy. This medication is usually taken daily and can be administered by injection.

Fertility medication suppresses normal hormone function and reduces the risk of eggs being released from the ovary before they can be retrieved. Mid-way through the menstrual cycle, more medication is given to the woman to enable her ovaries to produce several mature eggs at the same time. At this stage, the woman is carefully monitored by way of ultrasound and blood tests to assess the maturity of the eggs and the body's response to the medication.

When is it decided that enough eggs have matured, further medication is given to stimulate the release of the eggs from the ovary.

The egg retrieval process often referred to as 'harvesting' is always done under strict medical supervision. In this country, the woman is usually admitted to hospital for this procedure. She is sedated to make her comfortable and a special ultrasound device is inserted into the vagina to see the follicles in the ovaries, which house the mature eggs. A needle is inserted through the vaginal wall and the eggs are withdrawn. The entire procedure can take up to an hour to complete and usually only causes mild pelvic discomfort.

Once the eggs have been retrieved, they are incubated for several hours under strict laboratory supervision before a freshly donated sample of the partner's semen is added. The semen sample is usually donated by masturbation.

The fertilised eggs are replaced into the woman's uterus about three to five days later in a short procedure, which feels similar to a smear test. No anaesthesia is used for the procedure, which involves the use of a soft flexible catheter attached to a syringe.

The woman will be asked to take it very easy after the embryos have been transplanted. This may involve complete bed rest for several hours or a few days. A pregnancy test is performed about 10 to 14 days later to confirm if a pregnancy is present or not. If a pregnancy has been confirmed, an ultrasound scan will be ordered to confirm if one or more embryos are present. The woman will be monitored very carefully for the remainder of her pregnancy.

Between 20 and 30% of all IVF pregnancies result in multiple births. While this in itself is not regarded as a complication, it does impose additional strain on the woman and she needs to get plenty of rest during her pregnancy.

With IVF, there is also a slight risk of a pregnancy developing outside the womb (ectopic or tubal pregnancy). If this occurs, it will be detected when an ultrasound scan is performed. Ectopic pregnancies rarely survive beyond 12 weeks.

Other complications, which may arise with IVF, include:

• bleeding.
• Infection.
• accidental damage to other organs near the ovaries and uterus during the egg harvesting.
• allergic reaction to any of the many medications which are used during the treatment.

It is a medical fact that approximately 20% of all pregnancies fail regardless of the way in which they were conceived. However, the trauma of losing a pregnancy, which is conceived through IVF, is often far greater than one might expect. One of the reasons for this is because childless couples sometimes see IVF as being their last chance of being able to give birth to their own child. The rewards of IVF are great when it succeeds, but the risk of failure is also very great.

In some European countries and in the UK, in-vitro fertilisation is available on the National Health Service. It is only available on a private basis in Ireland and can work out very expensive because of the high costs of medication and the length of time it takes to complete the IVF procedure - from the initial consultation and counselling process right through to the egg retrieval and fertilisation process. The pregnancy must then be monitored closely and this may involve hospitalisation for some women who are carrying twins or triplets.

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