As our lifestyles have changed, there has been a veritable explosion in the number of so-called "assisted" hatching since the last 20 years, in most countries. This is not nearly changed because the age of the first child is steadily declining, especially in large cities and our lifestyles increasingly uniform, city dwellers, decline in the age of marriage, all this favors this situation. The desire for a child is there and consciously or not we say that science will help us. If nature has its laws, man has been able to "arrange" so much that in terms of fertility or in vitro fertilization the question is no longer technical but ethical.
Those who can not easily have a baby, or those who simply have problems with their aging can use this extraordinary new branch of medicine but must know the contours and ask themselves the right questions before.
What are the main questions in 2021 a couple or a woman should ask before considering IVF/in vitro fertilization?
1. In Vitro Fertilization: Taking stock of my fertility
Obviously, but this must be done for both partners, both men and women. It is only after standard fertility tests and in particular with a correct semen analysis that the diagnosis must be made. These questions also come naturally if after a while - difficult to estimate but sometimes up to twenty months - the couple has not "managed" to have children.
2. What is the age of the future mother and her management over time?
The age of the woman, unlike the man (who can naturally procreate all his life provided he still has “the essential fertility parameters”) is the key factor. Indeed the ideal age for women is under 25 years. This age has obviously become "young" in our current societies, unlike our ancestors. It is at the age of 35 years on average that we witness a real decline in fertility. After 40 years this is then "problematic" according to averages.
Many women between the ages of 40 and 50 are wondering about IVF. Faced with a science increasingly performing since age is almost no longer a technical problem - just like menopause to another extent - many countries have come to provide an ethical framework to these issues by limiting the possible age in end of quarantine. Laws are almost unified in Europe for example but there are countries where this is possible after 47, 48 and even 50 years.
Management over time means two things: how to put this project in my life, my age and how to resort to an in vitro fertilization "quickly". Indeed one of the keys to "act" is to choose your IVF and do it quickly. Fertility clinics are used by many couples who "think" about IVF without being in a hurry. If there is no urgency, the experience of the clinics over time shows that it is necessary to decide quickly, on the one hand to give more chances "techniques" to the fertilization, on the other hand not to "give up" the project.
3. In Vitro Fertilization and Artificial Insemination
Many couples have the reflex to say that artificial insemination is enough and do not think about in vitro fertilization. You should know that artificial insemination is obviously a service available in most fertility centres but is extremely minor because it does not concern couples who have long sought to have a child. These couples are indeed very rare in proportion and often the problem is not a problem of fertility but other.
It should be known that the very term artificial insemination is almost absent from these centres because one focuses almost exclusively on so-called programs of in vitro fertilization. Programs, which have, in addition to the advantage of favouring a higher birth rate from a technical point of view, especially thanks to the option or technique called ICSI.
4. In vitro fertilization and ethics
We all have our own opinion but the very IVF choice is a decision since by definition we use the science of man to "force" what nature cannot produce. The ethical question is generally not on the choice to have an IVF but on the rest, should I go further and choose criteria for my child, as the donation of sperm and egg can sometimes allow me? Do I have to use a shared maternity clinic during the procedure? Should I have a surrogate? Single or homosexual, is it an obstacle? Should I choose sex as possible (sex selection an option in IVF program)? The law has often come to the rescue of these issues to regulate what could be akin to the beginning of eugenics. It is therefore up to each of us to ask ourselves these questions outside of any family pressure, his entourage and indeed what is deemed to be political or religious.
5. Do I have to choose a standard or ICSI IVF program?
Most in vitro fertilization programs use the same techniques, but one option often comes up, the so-called single sperm selection procedure or ICSI. Intra cytoplasmic injection is a technique that theoretically increases the probability of the success rate by 5% on average.
This technique is often an option and sometimes included in IVF programs with ICSI in some major maternity centres.
6. Do I have to use egg donation?
The most common option, you will know from your point of fertility done with your doctor. This variant of IVF requires asking some questions in terms of time management, especially on the timing of the donor and the recipient but also the role of the partner in this phase. Indeed, technically the couple can travel separately, the man can come and go for a sperm deposit. This one will be frozen since when the time will be there the donor will be able to come at the right moment and the fertilization will take place. The recipient woman can then come later and stay shorter. The couple can of course come for a period of about ten days.
7. Do I need a sperm donation?
Another option that will also affect only certain couples, the sperm donation. Like oocyte donation, the woman or couple will choose a donor based on a certain number of so-called administrative criteria in addition to those determined from the point of view of the laboratories. The choice is made according to the data available in the big sperm banks which gather thousands of donors with the most different characteristics.
8. How long does an IVF program take?
The choice of a program always requires coordination with the doctor responsible for the so-called fertility clinic and so you will have in advance answered questions before arriving, your cycle, the intake of hormones promoting ovulation, in the case of donations, the synchronization of the cycle.
Note that the man is not obliged to be as present as the woman because he can drop his sperm at any time and just count 2h for that while waiting to fill out the forms and know the result of his analysis.
On average if everything is coordinated at best it takes a good week in the best case.
9. Are there any options and services that I need to add to the price?
All options have been discussed here. However, apart from personal options such as gender selection option, it is at the level of the laboratory tests and the genetic tests that you will be able to add these services. Indeed, never included in the programs, during a standard IVF or in particular when choosing an egg donation (able to detect a genetic problem) these tests can be important and are the choice of the couple.
An IVF program never includes the ancillary service part It is important to know the hosting solutions, the duration of your program, the cost of transportation to access the clinic.
Finally, from the beginning you will be asked if you are taking stimulation hormones before leaving or arriving at the clinic? If you can, we advise you to do it before because you will stay several days less.
We also have noticed that there is not so much evolution in 2020 compare to the 2017-2019 period in terms of ivf costs and new techniques.
10. And after?
Science and nature will do their work you tell us but the question of waiting after IVF arises. Generally in order not to stay 3 weeks women or couples leave after their IVF not knowing if she walked. A pregnancy test or a blood test will answer in the following days to this question.
Finally, in case of failure we must also ask the question of what to do in this case and so what is the price of another IVF in the same clinic, must freeze sperm in advance, embryos etc.? Do not hesitate to ask these questions to your adviser from the outset.
Updated 3rd of January 2021