In vitro fertilisation — IVF — has been part of medicine since 1978, and several centres in Sri Lanka now offer it. Yet for most couples who are told "you may need IVF" the process remains a mystery, and the figures quoted online are confusing or frankly misleading. This article walks through what actually happens, who it is for, what success really looks like at different ages, and what to think about if a cycle does not work.

What IVF means

In natural conception, one egg meets sperm inside the fallopian tube. In IVF the ovaries are stimulated to grow several eggs at once; the eggs are collected, fertilised with sperm in the laboratory, grown for a few days as embryos, and one is then placed in the womb. Anything that prevents egg and sperm meeting — blocked tubes, very few sperm — is bypassed. Where sperm are too few or too weak to fertilise an egg on their own, a single sperm is injected directly into each egg: ICSI (intracytoplasmic sperm injection).

Who needs IVF?

  • Blocked or damaged fallopian tubes — IVF is the only realistic treatment when both tubes are closed; the tubes are simply not needed
  • Severe male factor — very low count or motility, or sperm retrieved surgically; this is where ICSI is essential
  • Moderate-to-severe endometriosis
  • Unexplained infertility or ovulation problems that have not responded to tablets and IUI
  • Age and ovarian reserve — when time matters more than cost, IVF is often the right first step rather than the last resort
  • Some couples at risk of passing on a serious genetic condition, where embryos can be tested before transfer

Before any treatment both partners have a full assessment: semen analysis, ovarian reserve (AMH and antral follicle count on scan), a check of the womb cavity, and screening blood tests. Our fertility pathway tool shows where IVF usually sits in the sequence.

The steps of an IVF cycle

  1. Ovarian stimulation (about 10–12 days). Daily hormone injections (FSH, sometimes with LH) make several follicles grow. A second medicine prevents the body from ovulating too early. You attend for two or three scans and blood tests so the dose can be adjusted.
  2. Trigger injection. When enough follicles reach about 17–18 mm, a final injection matures the eggs. Egg collection is timed 34–36 hours later.
  3. Egg collection. A 20–30 minute procedure under sedation or short general anaesthetic. Guided by a vaginal ultrasound probe, a fine needle drains each follicle. You go home the same day; mild cramping for a day or two is normal.
  4. Sperm sample and fertilisation. The partner produces a sample the same morning (or frozen or surgically retrieved sperm is thawed). Eggs are either mixed with prepared sperm (conventional IVF) or each injected with one sperm (ICSI). The next morning the laboratory reports how many have fertilised — typically 60–70%.
  5. Embryo culture (3–5 days). Embryos are grown in the laboratory, ideally to the blastocyst stage at day 5, which allows the strongest to be identified.
  6. Embryo transfer. A short, painless procedure like a smear test: one embryo (occasionally two) is placed in the womb through a fine catheter under ultrasound guidance. No anaesthetic is needed and you can go home straight away. Bed rest afterwards does not improve the outcome.
  7. Freezing the rest. Good-quality spare embryos are frozen (vitrified). Increasingly, all embryos are frozen and transferred in a later, unstimulated cycle — a "freeze-all" approach that reduces the risk of hyperstimulation and lets the womb lining recover.
  8. Luteal support and the test. Progesterone (vaginal pessaries or injections) supports the lining until a blood pregnancy test about two weeks after transfer.

ICSI: when it is — and is not — needed

ICSI was developed for male factor infertility, and for that purpose it is transformative: fertilisation becomes possible with a handful of sperm. It is also used when a previous conventional IVF cycle produced no fertilisation. But for couples with normal sperm, large studies show ICSI gives no higher live birth rate than conventional IVF. It is not an "upgrade", and routine ICSI for everyone is not supported by evidence.

Success rates — the honest version

The single biggest factor is the woman's age, because it determines the proportion of eggs that are chromosomally normal. Using UK regulator data as a benchmark, the live birth rate per embryo transferred is roughly:

  • Under 35: about 30–35%
  • 35–37: about 25%
  • 38–39: about 17–20%
  • 40–42: about 10%
  • Over 42: under 5% with a woman's own eggs

Two points follow. First, a failed first cycle is the usual experience, not a sign something is wrong. Second, because frozen embryos from one egg collection can be transferred one after another, the chance of a baby from one complete cycle (fresh plus all frozen transfers) is considerably higher than any single transfer figure. Ask any clinic for its live birth rate per cycle started, by age band — not its "pregnancy rate", which counts early losses.

Risks

  • Ovarian hyperstimulation syndrome (OHSS) — the ovaries over-respond; mild forms are common, severe OHSS (needing admission) affects about 1% and is now rare with modern protocols and freeze-all strategies. Report severe abdominal pain, swelling, vomiting or breathlessness immediately.
  • Multiple pregnancy — the main avoidable risk, which is why single embryo transfer is the standard of care for most women
  • Egg collection — bleeding, infection or injury to nearby organs, all uncommon
  • Ectopic pregnancy — slightly higher than natural conception, especially with tubal disease; an early scan at 6–7 weeks checks the pregnancy is in the womb
  • Emotional strain — real, under-recognised and worth planning for; counselling is part of good care, not an optional extra

If the cycle fails

Ask for a proper review meeting: how many eggs were collected, how many fertilised, how the embryos developed, how the lining looked. Those details decide what to change next time. Check whether frozen embryos remain — a frozen transfer is simpler, cheaper and at least as successful as a fresh one. After two or more failures with good embryos, a hysteroscopy to inspect the womb cavity and a few further blood tests may be worthwhile. Be wary of expensive "add-on" treatments: most have no good evidence that they increase live births, and you are entitled to ask what the evidence is before paying for one.

Add-ons, costs and choosing a clinic

In Sri Lanka IVF is privately funded, so the questions that matter are the clinic's live birth rates by age, its embryology laboratory standards, how it limits multiple pregnancy, whether it offers freeze-all and single embryo transfer, and what is included in the quoted price (medicines and freezing often are not). A good clinic will answer these without hesitation.

The bottom line

  • IVF bypasses the tubes; ICSI bypasses weak sperm. Neither is a cure-all.
  • A cycle takes about four to six weeks from the first injection to the pregnancy test.
  • Success is driven by age — roughly a one-in-three chance per transfer under 35, falling steeply after 40.
  • Single embryo transfer and freeze-all strategies make IVF safer without lowering the overall chance of a baby.
  • A failed cycle is common; a careful review, not another identical cycle, is the right next step.

If you have been told you may need IVF and want an independent explanation of your options first, you can consult us at Sugabi Clinic Ragama or book a video consultation.

References

  1. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment (CG156) [Internet]. London: NICE; 2013 [updated 2017 Sep 6; cited 2026 Oct 5]. Available from: nice.org.uk/guidance/cg156
  2. Human Fertilisation and Embryology Authority. Fertility treatment 2022: preliminary trends and figures [Internet]. London: HFEA; [cited 2026 Oct 5]. Available from: hfea.gov.uk
  3. Human Fertilisation and Embryology Authority. In vitro fertilisation (IVF) [Internet]. London: HFEA; [cited 2026 Oct 5]. Available from: hfea.gov.uk
  4. Human Fertilisation and Embryology Authority. Treatment add-ons with limited evidence [Internet]. London: HFEA; [cited 2026 Oct 5]. Available from: hfea.gov.uk
  5. NHS. IVF [Internet]. London: NHS; [cited 2026 Oct 5]. Available from: nhs.uk
  6. Royal College of Obstetricians and Gynaecologists. Ovarian hyperstimulation syndrome (Green-top Guideline No. 5) [Internet]. London: RCOG; 2016 [cited 2026 Oct 5]. Available from: rcog.org.uk
  7. Dang VQ, Vuong LN, Luu TM, Pham TD, Ho TM, Ha AN, et al. Intracytoplasmic sperm injection versus conventional in-vitro fertilisation in couples with infertility in whom the male partner has normal total sperm count and motility: an open-label, randomised controlled trial. Lancet. 2021;397(10284):1554–63. doi:10.1016/S0140-6736(21)00535-3
  8. Zaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev. 2021;(2):CD011184. doi:10.1002/14651858.CD011184.pub3
  9. Lensen S, Chen S, Goodman L, Rombauts L, Farquhar C, Hammarberg K. IVF add-ons in Australia and New Zealand: a systematic assessment of IVF clinic websites. Aust N Z J Obstet Gynaecol. 2021;61(3):430–8. doi:10.1111/ajo.13321