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In vitro fertilisation (IVF) is a fertility treatment in which fertilisation takes place outside the body. Eggs are retrieved from the ovaries and brought together with multiple sperm cells in the laboratory. A fertilised egg (embryo) is then transferred to the uterus.
IVF, or in vitro fertilisation, is a fertility treatment in which eggs from the intended mother are fertilised in the laboratory with sperm from the intended father or a sperm donor. The resulting embryo is transferred to the uterus in the hope of achieving a pregnancy. If more than one embryo develops, the extra embryos are frozen for transfer at a later time. The IVF process involves stimulation of the ovaries, egg retrieval, fertilisation in the laboratory and embryo transfer.
For couples with unexplained infertility, or when other fertility treatments, such as IUI, have not led to a pregnancy.
If the male partner has severely reduced sperm quality, IVF (or ICSI) can be a way to achieve a pregnancy.
If you have damaged or blocked fallopian tubes, or if you have hormonal disorders that prevent ovulation (for example PCOS).
If you have endometriosis and therefore find it harder to become pregnant.
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus, which can make a spontaneous pregnancy more difficult.
First, we carry out an initial fertility assessment (OFO). If the OFO shows that IVF is the most suitable treatment, the doctor draws up a treatment plan. We discuss this treatment plan with you carefully and then turn it into a treatment schedule and timeline.
During the stimulation phase, the ovaries are stimulated daily with hormones so that multiple follicles grow. This phase lasts 10 to 14 days and is followed by trigger medication (hCG injection) to induce ovulation.
Using FSH medication
Every day you inject yourself with hormones in your abdomen, allowing multiple follicles to grow. How long you need to inject depends on the growth of the follicles. We monitor the growth of the follicles with regular ultrasound scans. When there are enough follicles and they are large enough, we schedule the egg retrieval.
Using hCG medication
Before the scheduled retrieval, you administer the trigger medication (hCG). This induces ovulation , loosening the eggs within the follicles so that they can be collected more easily during the retrieval.
During the retrieval
During the egg retrieval, the eggs are aspirated from the follicles using a thin needle. You lie in the gynaecological chair and the doctor inserts a thin needle through the vagina to puncture the follicles and aspirate the eggs. These are then taken to the laboratory¹ for fertilisation.
After the retrieval
After the procedure, your recovery begins. We give you tailored advice to take home. You will hear the same day how many eggs have been retrieved. Then, as agreed with us, you start using progesterone to prepare the uterus optimally for the embryo transfer. After the procedure, you rest in our recovery room and we let you know how many eggs have been retrieved.
Pain relief
If you wish, you can use pain relief before the egg retrieval. Always discuss this with the doctor.
More information about what happens during an egg retrieval.
¹Nij Clinics Gorinchem does not have its own laboratory and therefore works together with Erasmus MC for heterosexual couples, and with the other Nij Clinics clinics for single women and lesbian couples.
On the day of the egg retrieval, the sperm is prepared; how this is done depends on the situation:
¹Nij Clinics Gorinchem does not have its own laboratory and therefore works together with Erasmus MC for heterosexual couples, and with the other Nij Clinics clinics for single women and lesbian couples.
In the laboratory¹, the IVF lab technician fertilises the eggs with sperm cells from the intended father or sperm donor. Each egg is brought together with 100,000 to 200,000 sperm cells. The strongest sperm cell must penetrate the egg on its own for natural fertilisation to take place.
Fertilisation rates
It is important to know that not all eggs obtained during the retrieval will be successfully fertilised. Even if the sperm cell manages to penetrate the egg, this does not always result in successful fertilisation. Usually around 60–70% of the eggs are fertilised. These fertilised eggs can then develop further into embryos. On average, about half of these fertilised eggs grow into a good-quality embryo, but this can vary considerably from person to person.
¹Nij Clinics Gorinchem does not have its own laboratory and therefore works together with Erasmus MC for heterosexual couples, and with the other Nij Clinics clinics for single women and lesbian couples.
After one day, our embryologists can see whether fertilisation has taken place and whether an embryo has developed. The embryos are cultured in incubators in Petri dishes with a special culture medium. In the EmbryoScope , the temperature, humidity, CO2 and pH are regulated to create the ideal environment for culturing embryos.
EmbryoScope
With this EmbryoScope , our embryologists can use time-lapse technology to monitor the development of the embryos without opening the incubator and disturbing the embryos' environment. A photo of the embryos is taken every 10 minutes. The embryologists use advanced software to review the time-lapse recordings and select the best embryos for transfer and/or freezing.
We allow the embryos to grow for 3 to 5 days under optimised conditions. When the embryos have grown sufficiently and are ready for transfer, we schedule an appointment for the embryo transfer. The embryo with the best assessment is transferred. Any remaining embryos are frozen for a future transfer in a natural cycle.
During the embryo transfer (ET), one embryo is transferred to the uterus to keep the risks as low as possible. In exceptional cases, for women over 38 or after three IVF cycles, two embryos may be transferred, although a multiple pregnancy carries greater medical risks, such as premature birth or pregnancy complications.
After the transfer
After the transfer, the embryo will implant in the wall of the uterus. To prepare the uterus for this, you started using Utrogestan after the retrieval. With a thicker endometrium with a better blood supply, the uterus is optimally prepared for the implantation of the embryo. In principle, you will not feel the implantation; 20 to 30% of women experience implantation bleeding.
You can take a pregnancy test eleven days after the embryo transfer.
Freezing embryos
Any remaining embryos are frozen for a future transfer in a natural or artificial cycle. You will discuss the policy for this with a doctor.
Eleven days after the embryo transfer, you do a pregnancy test at home using morning urine. An exciting moment! Please let us know the result as soon as you have it.
Positive test – Pregnant
Congratulations! If the test is positive, we schedule an ultrasound scan at around 7 to 8 weeks of pregnancy. This is 3 to 4 weeks after the positive test. If the scan shows a well-growing embryo with a beating heart in the uterus, the treatment has been successful. We then refer you to a midwife of your choice for further pregnancy care. In some cases, a referral to a gynaecologist is needed. We would love to hear how your pregnancy and the birth go. Read more.
Negative test – Not pregnant
A negative test or the start of your period is of course disappointing. If your period starts, please contact us on the first day of your period to discuss the next step. If your period does not start and the test is negative, we would also like to hear from you, particularly in connection with stopping the medication. If you still have frozen embryos, you will discuss the policy for the next transfer with a doctor. If there are no embryos left, we can discuss the options for a new IVF treatment.
The success rates of IVF vary depending on various factors, such as age and lifestyle, the cause of the infertility and the quality of the eggs and sperm.
²Not all clinical pregnancies lead to an ongoing pregnancy, as some end early in a miscarriage.
³The statistics shown are averages per transfer. No rights can be derived from them.
The costs of IVF treatment consist of the appointments with specialists, the treatment, the medication and any storage costs for your own or donor material and/or embryos.
For an indication of the costs, please consult our list of fees .
Basic health insurance covers three IVF treatments per ongoing pregnancy (at least 10 weeks after egg retrieval). Reimbursement requires a medical indication, and treatment must start before the intended mother's 43rd birthday. Previous IVF/ICSI treatments (including at other treatment centres) count towards this, so always check with your health insurer about your situation.
Please bear in mind possible additional costs (uninsured care):
The costs of the counselling session and the storage costs for donor material are listed on our list of fees.
IVF can be experienced as painful, especially during certain steps of the treatment. Injecting hormone medication into your abdomen may cause small bruises, but is usually not very painful.
Egg retrieval
The egg retrieval can be painful, because a needle is passed through the vaginal wall and the ovaries cannot be anaesthetised. You may take painkillers before the procedure to relieve the pain. However, the level of pain varies from person to person and depends on individual sensitivity.
No, you cannot choose between IVF and ICSI yourself. The doctor decides on ICSI based on medical indications. ICSI is recommended, for example, if the semen contains fewer than one million motile sperm cells, if antibodies are present in the semen, or if previous IVF treatments did not result in fertilisation.
Your doctor will discuss this indication with you and explain why IVF or ICSI is the best option in your situation.
Your health insurance usually covers 3 IVF treatments. Before starting treatment, make sure to check with your health insurer which reimbursement rates it applies.
Read more about health insurance and personal contribution.
IVF treatment always carries some risks; for example, too many follicles may develop. You can read more about this under overstimulation.
Our doctors will inform you about possible complications before your IVF treatment.
