In Vitro Fertilization(IVF)

This is a process by which egg cells are fertilised by sperm outside the body, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy.

IVF may be used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult.
For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed.

IVF can also be used with egg donation or surrogacy where the woman providing the egg isn’t the same who will carry the pregnancy to term. This means that IVF can be used for females who have already gone through menopause. The donated oocyte can be fertilised in a crucible. If the fertilisation is successful, the embryo will be transferred into the uterus, within which it may implant.

IVF can also be combined with preimplantation genetic diagnosis (PGD) to rule out presence of genetic disorders. A similar but more general test has been developed called Preimplantation Genetic Haplotyping (PGH).


Theoretically, in vitro fertilization could be performed by aspirating contents from a woman’s fallopian tubes or uterus with a plastic catheter after natural ovulation, mix it with semen from a man and reinsert into the uterus. However, without additional techniques, the chances of pregnancy would be extremely small. Such additional techniques that are routinely used in IVF include ovarian hyperstimulation to retrieve multiple eggs, ultrasound-guided transvaginal oocyte retrieval directly from the ovaries, egg and sperm preparation, as well as culture and selection of resultant embryos.

Ovarian hyperstimulation

There are two main protocols for stimulating the ovaries for IVF treatment. The long protocol involves downregulation (suppression or exhaustion) of the pituitary ovarian axis by the prolonged use of a GnRH agonist. Stimulation of the ovaries using a gonadotrophin starts once the process of downregualtion is complete generally after 10 to 14 days.

The short protocol consists of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients, injectable gonadotropins (usually FSH analogues) are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontaneous ovulation during the cycle is typically prevented by the use of GnRH agonists that are started prior or at the time of stimulation or GnRH antagonists that are used just during the last days of stimulation; both agents block the natural surge of luteinising hormone (LH) and allow the physician to start the ovulation process by using medication, usually injectable human chorionic gonadotropins. Ovarian stimulation carries the risk of excessive or hyperstimulation. This complication is life threatening and ovarian stimulation using gonadotrophins must only be carried out under strict medical supervision

Transvaginal oocyte retrieval

When follicular maturation is judged to be adequate, human chorionic gonadotropin (hCG) is given. Commonly, this is known as the “trigger shot.”[1] This agent, which acts as an analogue of luteinising hormone, makes the follicles perform their final maturation, and would cause ovulation about 42 hours after injection, but a retrieval procedure takes place just prior to that, in order to recover the egg cells from the ovary. The eggs are retrieved from the patient using a transvaginal technique (transvaginal oocyte retrieval) involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. It is common to remove between ten and thirty eggs. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anaesthesia.

Egg and sperm preparation

In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs with optimial chances of successful pregnancy. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.


The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours. A single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.
Gamete intrafallopian transfer, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man’s sperm. This allows fertilisation to take place inside the woman’s body. Therefore, this variation is actually an in vivo fertilisation, not an in vitro fertilisation.

Embryo culture

Typically, embryos are cultured until having reached the 6–8 cell stage three days after retrieval. In many Canadian, American and Australian programmes, however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates in Europe, transfers after 2 days are common.

Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial coculture (on top of a layer of cells from the woman’s own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media. For example, when culturing to the blastocyst stage, one medium may be used for culture to day, and a second medium is used for culture thereafter.Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage. Artificial embryo culture media basically contain glucose, pyruvate, and energy-providing components, but addition of amino acids, nucleotides, vitamins, and cholesterol improve the performance of embryonic growth and development.

Embryo selection

Laboratories have developed grading methods to judge oocyte and embryo quality. In order to optimise pregnancy rates. Preimplantation genetic diagnosis (PGD) or screening may be performed prior to transfer in order to avoid inheritable diseases

Embryo transfer

Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. The embryos judged to be the “best” are transferred to the patient’s uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.

Pregnancy rates

Pregnancy rate is the success rate for pregnancy. For IVF, it is the percentage of all attempts that lead to pregnancy, which generally refers to treatment cycles where eggs are retrieved and fertilised in vitro. Pregnancies that are delivered with a viable baby are called live birth rate.

Because not each IVF cycle that is started will lead to oocyte retrieval or embryo transfer, reports of live birth rates need to specify the denominator, namely IVF cycles started, IVF retrievals, or embryo transfers. The Society for Assisted Reproductive Technology (SART) summarised 2008-9 success rates for US clinics for fresh embryo cycles that did not involve donor eggs and gave live birth rates by the age of the prospective mother, with a peak at 41.3% per cycle started and 47.3% per embryo transfer for patients under 35 years of age.

IVF attempts in multiple cycles result in increased cumulative live birth rates. Depending on the demographic group, one study reported 45% to 53% for three attempts, and 51% to 71% to 80% for six attempts.

Success or failure factors

The main potential factors that influence pregnancy (and live birth) rates in IVF have been suggested to be maternal age, duration of infertility or subfertility, bFSH and number of oocytes, all reflecting ovarian function. Optimal woman’s age is 23–39 years at time of treatment

Other factors

Other determinants of outcome of IVF include:

  • Tobacco smoking reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.
  • A body mass index (BMI) over 27 causes a 33% decrease in likelihood to have a live birth after the first cycle of IVF, compared to those with a BMI between 20 and 27 Also, pregnant women who are obese have higher rates of congenital abnormality, miscarriage, gestational diabetes, hypertension, thromboembolism and problems during delivery. Ideal body mass index is 19–30.
  • Salpingectomy before IVF treatment increases chances for women with hydrosalpinges
  • Success with previous pregnancy and/or live birth increases chances
  • Low alcohol/caffeine intake increases success rate
  • The number of embryos transferred in the treatment cycle
  • Other factors of semen quality for the sperm provider.


During ovarian stimulation, hyperstimulation syndrome may occur. This results in swollen, painful ovaries and some form of it (mild, moderate or severe) occurs in 30% of patients. Mild cases can be treated with over the counter meds and cases can be resolved in the absence of pregnancy. In moderate cases, ovaries swell and fluid accumulated in the abdominal cavities and may have symptoms of heartburn, gas, nausea or loss of appetite. In severe cases patients have sudden excess abdominal pain, nausea, vomiting and will result in hospitalization.

During egg retrieval, there’s a small chance of bleeding, infection, and damage to surrounding structures like bowel and bladder (transvaginal ultrasound aspiration) as well as difficulty breathing, chest infection, allergic reactions to meds, or nerve damage (laproscopy). During embryo transfer, if more than one embryo is transferred there’s always a risk of multiple pregnancy, infertile couples may see this is good news but there may be risk to the embryos and to the mother such as premature delivery. Ectopic Pregnancy may also occur- fertilized egg develops outside the uterus, usually in the fallopian tubes and requires immediate destruction of the fetus.


The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage

Another risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome, particularly if hCG is used to “trigger ovulation”.

Kabwe woman, 60 years old delivers twins

A 60-YEAR-OLD woman of Kabwe’s Makululu Compound has delivered twins after enduring 30 years of a childless marriage.

Sharon Tembo, a retired accountant, delivered twin girls at the Lusaka IVF and Fertility Clinic in Woodlands on Saturday afternoon.

The new mother told #Kalemba that she has been married to Peter Tembo, a retired environmental health specialist, for over 30 years and had no children.

“We were trying but we failed,” an elated Sharon said. “We went everywhere; we went to UTH and other places but things did not work out. We lost hope of ever having a child.”

She recounted that it was not until she started seeing billboards of Lusaka IVF and Fertility Clinic that sparked her interest in having a child. But because of her advanced age, she remained doubtful.

“But I heard that a certain woman delivered triplets through IVF and I contacted Lusaka IVF and Fertility through email,” Sharon said further. “I inquired from Dr Gilbert if I could have a child at my age through IVF and he said: ‘Yes it is possible, as long as you are physically fit to carry a pregnancy’.”

“I started treatment in August last year. It was successful at first attempt and today I have babies,” said a smiling Sharon. “I am happy. What do you expect? After waiting all this long to have a child! I am happy. This is all I have been looking for for the rest of my life and it has come to pass. I thank God for that.”

And Peter said the birth of his children has strengthened his marriage and the couple will focus their energies on raising the twins.

“Lusaka IVF and Fertility Clinic has done wonders. This is a joyous thing. It cements the relationship, the marriage,” said a visibly delighted Peter. “Our story can be used as a testimony to teach others.”

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Female infertility

Male infertility may be due to

  • A decrease in sperm count
  • Sperm being blocked from being released
  • Sperm that do not work properly

Male infertility can be caused by

  • Environmental pollutants
  • Being in high heat for prolonged periods
  • Birth defects
  • Heavy use of alcohol, marijuana, or cocaine
  • Too little or too much hormones
  • Impotence
  • Infection
  • Older age
  • Cancer treatments, including chemotherapy and radiation
  • Scarring from sexually transmitted diseases, injury, or surgery
  • Retrograde ejaculation
  • Smoking
  • Use of certain drugs, such as cimentidine, spironolactone and nitrofurantoin

In healthy couples under age 30 who have sex regularly, the chance of getting pregnant is about 25 – 30% per month.

A woman’s peak fertility occurs in her early 20s. After age 35 (and especially 40), the chances that a woman can get pregnant drop considerably.

Male infertility

Male infertility may be due to

  • A decrease in sperm count
  • Sperm being blocked from being released
  • Sperm that do not work properly

Male infertility can be caused by

  • Environmental pollutants
  • Being in high heat for prolonged periods
  • Birth defects
  • Heavy use of alcohol, marijuana, or cocaine
  • Too little or too much hormones
  • Impotence
  • Infection
  • Older age
  • Cancer treatments, including chemotherapy and radiation
  • Scarring from sexually transmitted diseases, injury, or surgery
  • Retrograde ejaculation
  • Smoking
  • Use of certain drugs, such as cimentidine, spironolactone and nitrofurantoin

In healthy couples under age 30 who have sex regularly, the chance of getting pregnant is about 25 – 30% per month.

A woman’s peak fertility occurs in her early 20s. After age 35 (and especially 40), the chances that a woman can get pregnant drop considerably.

Natural Conception

Natural conception takes place when the sperm cells, after intercourse, swim up through the neck of the uterus and into the uterine tubes where they meet the egg and fertilise it. After the fertilisation of the egg in the uterine tube the egg cleaves, and after a couple of days the fertilised egg has moved down though the uterine tube and into the uterus. In the uterus the egg adheres to the endometrium and develops into a baby. This process is illustrated below:

In order for this process to take place it is important that the woman produces mature eggs, has an ovulation, has passage through the uterine tubes, and that the man’s sperm quality is all right.

Unexplained Infertility

This is the inability to identify the cause of infertility despite a complete evaluation of semen, ovarian reserve, ovulation, endocrinologic disorders and pelvic anatomy.

How can I prevent infertility?

What you and your partner may not know is that some of the factors that influence fertility are within your control and most of these revolve around your lifestyle.
 Your lifestyle may influence your general outlook, stress levels, and even your fertility potential. If you are ready to take the step into parenthood then it is time to make some sacrifices.

Alcohol and Pregnancy

Certain toxins can prevent you from conceiving, or even cause miscarriage, consider eliminating alcohol. Moderate drinking usually won’t lower sperm count in men or harm fertility in women. But large amounts of alcohol (usually defined as more than two drinks per day for men and more than one drink per day for women) may lower your odds for parenthood. Women who are trying to conceive should stop drinking entirely.

Caffeine and Pregnancy

Can’t give up that hankering for a cup of coffee in the morning? Crave a coke in the afternoon for a little pick-me-up? If you’re trying to become pregnant, now is a great time to kick your caffeine habit… marijuana, cocaine, and anabolic steroids can all contribute to infertility in men. Women trying to get pregnant, of course, should avoid recreational drugs and alcohol because of the potential danger to the fetus.

Smoking and Pregnancy

Don’t smoke. Smoking cigarettes causes hormonal changes that can lead to menstrual irregularities and even an ovulation (menstrual cycles where ovulation fails to occur). It can damage your eggs. Smoking can interfere with virtually every aspect of a woman’s fertility, from ovulation to early development of the embryo. Smoking can slightly lower a man’s sperm count and may even contribute to impotence.

Weight & Fertility

The sex hormones of both men and women are closely tied to weight. The number on the scale plus your body fat percentage can help you calculate the weight that’s healthiest for you. Keep in mind that in order to lose a pound per week, you would need to cut 500 calories per day either through diet, exercise or both. Heavier men may face fertility problems. Part of the reason is that an increase in abdominal fat is associated with insulin resistance and a rise in insulin production, which wreaks havoc on sex hormones. It’s a problem for women, too: When obese women do become pregnant, they are more likely to have miscarriages than lean women of the same age.


Get your exercise, but don’t overdo it. Over exercising that leaves you underweight can lessen your chances of conceiving. Too little exercise, which contributes to an overweight physique, can do the same.

Check your medicine

Check your medicine cabinet. Some prescription drugs can impair fertility in both men and women. For men, the list of potential culprits includes the heartburn medication cimetidine (Tagamet), the rheumatoid arthritis drug (Azulfidine), and several chemotherapy drugs. A woman’s fertility may be hampered by certain antibiotics, painkillers, antidepressants, and hormonal treatments. Ask your doctor if any of your medications could be causing infertility. A change of prescription just might solve the problem.

Antenatal Care

Antenatal care monitors your health during pregnancy, as well as the health and development of your baby. It can help predict possible problems with your pregnancy or the birth, so action can be taken to avoid or treat them.

Your first antenatal appointment will probably be your booking-in appointment and usually happens at about eight to 12 weeks. You can expect to have appointments every four weeks after week 12, every two weeks from week 32, and every week during the last three or four weeks.

You’ll be asked a number of questions about your health, family history and any previous pregnancies. The aim is to get a basic picture of your health and your pregnancy so far. The midwife might discuss issues such as diet, smoking and work; she may also ask about your thoughts on breast or bottle-feeding and give you information on these. You don’t have to make up your mind on this or on any other matter, but it’s a good chance to ask questions and clear up anything you’re worried about.

Routine checks at appointments are likely to include:

  • Blood pressure
  • Weight
  • Palpation – feeling your tummy
  • Listening to your baby’s heart
  • Questions about your baby’s movements
  • Urine tests
  • Checking for any swelling in your legs, arms or face
  • Questions about how you feel

Labour and Delivery

Women who feel able to do so are encouraged to walk during the early stages of labor, which can make them more comfortable. One support person may be present during labor and delivery.

Cesarean birth

There are many reasons why the decision may be made to perform a cesarean section. Sometimes, the cesarean is planned in advance because of an existing medical condition or because there will be more than two babies born. Other times, a cesarean section is performed after labor fails to progress and there is some concern about the health of the baby or mother.

Anesthesia provided before and during a cesarean section allows women to remain comfortable during the procedure. Most remain awake during the birth. Husbands are invited to be present in the cesarean section room. After giving birth, women who have had a cesarean are encouraged to hold their baby, breastfeed and bond.

Recovery from a cesarean section will take longer than a vaginal birth. However, women who have had cesarean sections will generally be up and out of bed within 24 hours, with the help of their nurse, and are encouraged to walk and move around. They stay in the hospital a few extra days. In addition, new moms who have had a c-section should plan on some extra help for when they leave the hospital.

Post-birth Care

Our private recovery rooms are equipped with color televisions, telephones, lavatories and comfortable birthing beds.

After the baby is born, new mothers are encouraged to initiate breastfeeding to encourage bonding during this period. Husbands are invited to be present in both the recovery room.

Right after birth, your baby will be evaluated by a Womens’ Hospital International & Fertility centre health career (obstetrician, nurse practitioner and/or neonatologist), who checks your baby’s vital signs, such as blood pressure and heart rate. This is a judgment of the baby’s activity, pulse, grimace, appearance and color.

Babies are weighed and given treatment to prevent eye infection. Identification bands are placed on the baby and both parents, and the baby’s footprints and mother’s thumbprint are obtained to ensure proper identification.