In vitro fertilization is also known as fertilization in a jar and corresponds to one of the most important procedures for artificial insemination, in which a doctor removes eggs from a woman under hormonal stimulation, which are brought into contact with the sperm of the man in a test tube. After fertilization, the fertilized eggs are cultured in an incubator and transferred back to the mother on the second or fifth day, who carries the resulting fetus to term with a probability of between 20 and 40 percent. In addition to the risks of surgery, the mother also takes on the side effects of hormone treatment during in vitro fertilization and also risks her partnership, as unsuccessful artificial insemination treatments in particular have a high impact on the partnership relationship, in addition to depression.
What is in vitro fertilization?
In vitro fertilization is also known as fertilization in a jar and corresponds to one of the most important procedures for artificial insemination. In this procedure, eggs retrieved from the woman are brought into contact with the sperm of the man in a test tube. In vitro fertilization is a method of artificial insemination. The method has existed since the 1960s and 1970s, when Nobel Prize winner in medicine Robert Edwards and his colleague Patrick Steptoe laid the foundation for the method. Within Germany, there are certain requirements for approval for in vitro fertilization treatment. For example, the spouses must have had regular unprotected sexual intercourse for one year without being able to initiate a pregnancy. In common parlance, the procedure of in vitro fertilization is also called fertilization in a jar. This expression refers to the classical form of the method, in which the sperm is brought into contact with the egg in a test tube and the egg thus fertilized is transferred back to the mother. In Germany, there are currently more than 100 specialized centers for in vitro fertilization, which perform more than 50,000 treatments per year at individual treatment costs of around 4,000 euros. Cost sharing by health insurance is possible for married couples between the ages of 25 and 40. Unmarried couples must pay for the full cost out of pocket.
Function, effect, and goals
In vitro fertilization is intended to help couples fulfill their desire to have children when fertilization by conventional means is unsuccessful. The treatment begins with sperm and egg retrieval. In this process, the genetic material of the partners is first checked for errors in order to exclude hereditary diseases for the subsequent fetuses. In the course of the so-called downregulation, the activity of the maternal ovaries is reduced by medication in order to be able to obtain more eggs by later hormone administration. The hormones are usually administered in the form of FSH preparations, which are injected under the skin for about 11 days and allow several eggs to mature. From the sixth day of the cycle, the eggs are usually observed by ultrasound, and on the ninth day, depending on the results of this observation, the decision is made for a specific day of retrieval. At about the same time, the man’s sperm are checked for motility, density and bacteria. By administering the hormone HCG, the attending physicians induce ovulation. Transvaginally, the doctors puncture the follicles and thus extract follicular fluid. In parallel, sperm are obtained by masturbation or microsurgery. The eggs obtained by puncture are then fertilized with the sperm thus obtained. Four methods are available for this purpose, the classical method being spontaneous fertilization in a test tube. However, in the case of impaired sperm quality, fertilization can also be performed with the help of a pipette inserted into the attached oocyte. The fertilized eggs are cultured in the jar, placed in an incubator and subjected to quality tests. Ideally, embryo transfer of two fertilized eggs takes place on the second or fifth day after fertilization. About two weeks after the puncture, a pregnancy test is performed, and if the in vitro fertilization is successful, the result is appropriately positive.
Risks, side effects and dangers
The rate of births after in vitro fertilization is relatively low.It is between 20 and 40 percent and depends strongly on the age of the mother, the respective time for egg retrieval and the total number of fertilized eggs. Since the eggs are retrieved during surgery, in vitro fertilization involves all the associated risks for the woman. These risks include, above all, infection as well as complications due to injury to internal organs. Continued hormone treatment may include side effects for the mother such as weight gain, severe mood swings, edema, or increased risk of heart attacks. High-risk pregnancies are also conceivable as a result of in vitro fertilization. Because such pregnancies pose health risks for both the mother and the fetuses, German specialized centers and clinics are allowed to transfer a maximum of three fertilized eggs back to the mother, which keeps the risk of multiple pregnancies low. The psychological consequences of treatment should not be underestimated. Failed in vitro fertilizations in particular can trigger severe depression and cause partnership problems. In individual cases, the partnership breaks apart with the treatment. A legal and ethical peculiarity of the fertilization method is the question of the whereabouts of superfluous oocytes that were fertilized in this way. In Germany, it is illegal to kill them because of the Embryo Protection Act. The same applies to the onward transfer of the fertilized oocytes to ethnically controversial embryo test series. Therefore, clinics usually preserve the fertilized eggs to save them for follow-up treatment at a later point in life.
