IVF

Who IVF is for

IVF is for people who have not conceived after a reasonable stretch of trying. That usually means a year under thirty-five, six months over it. It is also for anyone whose test results make natural conception unlikely from the start. Blocked or absent tubes, severe sperm problems, endometriosis, ovulation disorders that tablets have not fixed, and unexplained infertility after simpler treatment has failed.

It is also the route for people who need it for structural reasons rather than medical ones. Single women using donor sperm. Female couples, and male couples working with a surrogate where the law allows. Anyone using frozen eggs or embryos they banked earlier.

What a clinic asks about first is age. Then ovarian reserve, usually an AMH blood test and a count of the small follicles on a scan. Then a semen analysis, and the shape of the uterus and tubes. Age is the single strongest predictor of everything that follows, and no clinic can improve it. If simpler options have not been tried, a good clinic will say so rather than start you on injections.

Before your first appointment

Write down when you started trying, in months, and bring any test results either of you already has. Clinics restart the clock on tests that are older than a year, and knowing which of yours still count can save you a month and a repeat bill.

Choosing between them

Most of this is decided by your test results rather than by you. Sperm quality decides whether the eggs are fertilised conventionally or by ICSI, where a single sperm is injected into each egg. Ovarian reserve and how your body has responded before decide whether you are offered a standard stimulated cycle or a gentler mini IVF. Whose body provides the eggs and whose carries the pregnancy decides whether you are doing reciprocal IVF.

The one genuine choice most people get is whether to start with something less involved. IUI is cheaper and gentler, and far less successful per attempt. It makes sense where the tubes are open and the sperm is reasonable. That is often single women and female couples using donor sperm.

Where it goes wrong is when it is repeated too many times. Three or four unsuccessful attempts is usually the point to move on. I have watched people spend a year, and a lot of money, finding that out the slow way.

Everything in the second group is a decision about the embryos rather than about how they were made. Whether to transfer fresh or freeze everything and come back, and whether to test embryos before transferring. The tests are where the clinic's incentives and yours are least aligned, so read PGT-A before you agree to it.

At the first consultation

Ask what the clinic would do differently on a second cycle if the first one does not work. The answer tells you whether they have a plan or a package, and it is much easier to ask before you have paid for anything.

The IVF procedures

These pages are not alternatives to one another in the way that surgical techniques are. One of them, conventional IVF, is the core treatment, and it is the page to read first because everything else assumes it. Read that one even if your clinic has already named a different acronym.

The first group is about how the egg and sperm are brought together, and how hard the ovaries are pushed to get there. The second group is about what happens to the embryos afterwards. Read those once you have embryos to make decisions about, not before.

IVF recovery

IVF is not surgery, but a cycle takes more out of people than the leaflets suggest. Roughly two weeks of daily injections. Scans every few days, in clinic hours. A sedated egg collection that writes off a day, and then a wait. Most people work through it and most people find the last fortnight the hardest part.

Physically, the pattern is the same whichever treatment you are having. Bloating and tenderness build through the injections and peak around collection. Then period-like cramping and some spotting for a day or two. Then nothing much.

The exception is ovarian hyperstimulation, where the ovaries over-respond and fluid shifts into the abdomen. Mild versions are common and settle. The severe version is uncommon and is the one real medical risk of a cycle.

The part nobody plans for is the attrition between stages. Eggs collected, eggs mature, eggs fertilised, embryos that keep growing to day five. The number falls at every step, and each fall arrives as a phone call.

IVF cost

Almost nowhere does IVF come as one price. A quoted cycle fee usually covers monitoring, egg collection, the laboratory work and one transfer. It usually excludes the drugs. Those are the most variable line, and they can add a third again to the bill. Freezing, annual storage, later transfers of those frozen embryos, ICSI, embryo testing and donor sperm are all priced separately.

Broadly, self-pay in the United States runs around $12,000 to $20,000 a cycle before drugs. The United Kingdom is roughly £5,000 to £8,000, again before drugs. Spain and central Europe sit around €4,000 to €7,000, and Thailand near $6,000 to $12,000 with ICSI often included.

Funding varies more than price does. Several European systems fund two or three cycles. The NHS funds by local policy, so how many cycles you get depends on where you live. Australia rebates a chunk through Medicare. In the United States it depends on your employer and your state.

The question I would ask is what a second and third cycle would cost, not what the first one costs. That is the number that matches how IVF actually gets used.

Where it fits

Testing comes first, always. A full picture of ovarian reserve, sperm and tubes changes which treatment you start with often enough that skipping it usually costs more than it saves. See fertility testing.

After that the usual order is the least involved thing that has a reasonable chance, then IVF. Ovulation tablets or IUI first, where the tubes are open and sperm is adequate. IVF straight away where they are not. IVF straight away too where age means there is no time to spend on a treatment with lower odds per attempt.

Past the late thirties, the case for going straight to IVF gets stronger every year. Each attempt is worth more when you have fewer of them.

If your own eggs are not producing embryos after a few well-run cycles, the next conversation is donor conception. Worth knowing before you start that it exists. The odds change completely when the eggs are younger.

Eligibility

Clinics set their own limits and countries set some too. Most private clinics have an upper age for treatment with your own eggs, commonly somewhere in the mid to late forties. The limit for donor eggs is higher. Many set a BMI range. Most want both partners screened for infectious diseases, and UK clinics are required to consider the welfare of any child born.

Funded treatment is stricter than private treatment everywhere it exists. Age caps are lower. There are usually rules about existing children, previous self-funded cycles and BMI. In the UK the criteria change across the country.

Single people and same-sex couples can be treated in most of Europe, the UK, the United States, Canada and Australia. Not everywhere, though. Some countries restrict donor use, embryo testing or surrogacy in ways that would not occur to you. If you are travelling for treatment, check what is legal at the destination before you book anything.

Frequently asked questions

How likely is IVF to work?

It depends far more on age than on anything a clinic does. Roughly a quarter to a third of cycles started end in a live birth under thirty-five. That falls steeply through the late thirties, and into single figures by the early forties with your own eggs. See choosing between them and the IVF page for what the different measures mean.

How many cycles do most people need?

More than one. Cumulative chances keep climbing over the first three cycles, which is why budgeting for a single cycle is the most common planning mistake. See cost.

Do the add-ons work?

Most have no good evidence of improving live birth rates, and they are charged for separately. See choosing between them.

Is a frozen embryo transfer as good as a fresh one?

For most people, yes, and for high responders it is safer. Many clinics now freeze everything as standard. See frozen embryo transfer.

Can we choose the sex of the embryo?

Only where the law allows it, which in most of Europe, the UK and Australia means only to avoid a serious inherited condition. Thailand prohibits it. It is permitted in parts of the United States.