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In-vitro fertilisation, known as IVF, is a medical procedure in which a woman has an already-fertilised egg inserted into her womb to become pregnant.

It is used when couples are unable to conceive naturally, and a sperm and egg are removed from their bodies and combined in a laboratory before the embryo is inserted into the woman.

Once the embryo is in the womb, the pregnancy should continue as normal.

The procedure can be done using eggs and sperm from a couple or those from donors.

Guidelines from the National Institute for Health and Care Excellence (NICE) recommends that IVF should be offered on the NHS to women under 43 who have been trying to conceive through regular unprotected sex for two years.

People can also pay for IVF privately, which costs an average of £3,348 for a single cycle, according to figures published in January 2018, and there is no guarantee of success.

The NHS says success rates for women under 35 are about 29 per cent, with the chance of a successful cycle reducing as they age.

Around eight million babies are thought to have been born due to IVF since the first ever case, British woman Louise Brown, was born in 1978.

Chances of success

The success rate of IVF depends on the age of the woman undergoing treatment, as well as the cause of the infertility (if it’s known).

Younger women are more likely to have a successful pregnancy.

IVF isn’t usually recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be too low.

Between 2014 and 2016 the percentage of IVF treatments that resulted in a live birth was:

29 per cent for women under 35

23 per cent for women aged 35 to 37

15 per cent for women aged 38 to 39

9 per cent for women aged 40 to 42

3 per cent for women aged 43 to 44

2 per cent for women aged over 44

It is highly unlikely that you will ever know the actual cause of a one-off miscarriage, but most are due to the following problems:

• ABNORMAL FETUS

The most common cause of miscarriages in the first couple of months is a one-off abnormal development in the fetus, often due to chromosome anomalies. ‘It’s not as though the baby is fine one minute and suddenly dies the next,’ says Professor James Walker, Professor of Obstetrics and Gynaecology at the University of Leeds. 

‘These pregnancies fail from the outset and were never destined to succeed.’ Most miscarriages like this happen by eight weeks, although bleeding may not start until three or four weeks later, which is worth remembering in subsequent pregnancies. ‘If a scan at eight weeks shows a healthy heart beat, you have a 95 per cent chance of a successful pregnancy,’ says Professor Walker.

• HORMONAL FACTORS

A hormonal blip could cause a sporadic miscarriage and never be a problem again. However, a small number of women who have long cycles and irregular periods may suffer recurrent miscarriages because the lining of the uterus is too thin, making implantation difficult. 

Unfortunately, hormone treatment is not terribly successful. 

‘There used to be a trend for progesterone treatment, but trials show this really doesn’t work,’ warns Professor Walker. ‘There is some evidence that injections of HCG (human chorionic gonadotrophin, a hormone released in early pregnancy) can help, but it’s not the answer for everyone.’ The treatment must be started as soon as the pregnancy is confirmed, at around four or five weeks.

• AGE 

For women over 40, one in four women who become pregnant will miscarry. [One in four women of all ages miscarry, but these figures include women who don’t know that they are pregnant. Of women who do know that they’re pregnant, the figure is one in six. Once you’re over 40, and know that you’re pregnant, the figure rises to one in four]

• AUTO-IMMUNE BLOOD DISORDERS

Around 20 per cent of recurrent miscarriers suffer from lupus or a similar auto-immune disorder that causes blood clots to form in the developing placenta. 

A simple blood test, which may need to be repeated several times, can reveal whether or not this is the problem.’One negative test does not mean that a women is okay,’ warns Mr Roy Farquharson, consultant gynaecologist who runs an early pregnancy unit at the Liverpool Women’s Hospital. 

Often pregnancy can be a trigger for these disorders, so a test should be done as soon as possible,’ he adds.But it can easily be treated with low dose aspirin or heparin injections, which help to thin the blood and prevent blood clots forming – a recent trial also showed that women do equally well on either. ”We have a 70 per cent live birth rate in women treated for these disorders,’ says Dr Farquharson, ‘which is excellent.’

• OTHER CAUSES

While uterine abnormalities, such as fibroids, can cause a miscarriage, many women have no problems carrying a pregnancy to term. An incompetent cervix can also cause miscarriage at around 20 weeks. 

While this can be treated by a special stitch in the cervix, trials suggest it is not particularly successful, although it may delay labour by a few weeks.Gene and chromosomal abnormalities, which can be detected by blood tests, may also cause recurrent miscarriages in a small number of couples. 

A procedure known as preimplantation genetic diagnosis can help. After in-vitro fertilisation (IVF), a single cell is taken from the developing embryo and tested for the gene defect. Only healthy embryos are then replaced in the womb.

 It is an expensive and stressful procedure – and pregnancy rates tend to be quite low – but for some this is preferable to repeated miscarriages or a genetically abnormal baby.