There are several stages involved in IVF treatment:

information will be provided

you will be offered counselling

you will be asked to give your consent to the use of your eggs, to your treatment and if required, to disclose details about your treatment to your GP or someone else who needs to know

egg development will take place, with or without the administration of drugs

egg collection will be carried out

sperm collection will take place

fertilisation will take place in vitro

up to 3 embryos will be transferred to your womb

However, if it is discovered that either partner is not producing fertile eggs or sperm, or if one carries an inherited disease, then using eggs or sperm donated by another person may be suggested. If you are to receive treatment with donated sperm, sperm collection will not take place. If you are receiving donated eggs, then egg development and collection will be omitted, but you may have to take drugs in preparation for embryo transfer.

a) Information

During the course of treatment a clinic has a legal obligation to collect information, including personal details, such as your name(s) and date(s) of birth and some medical details. This information is passed to the HFEA which holds it in its computer register. The HFEA keeps a register because it has a legal obligation to tell adults who may ask in the future whether they were born as a result of IVF.

Your identities are kept confidential. As mentioned above, before a clinic may give information to others about your treatment, you must give written consent. Except in certain legal proceedings and medical emergencies, the only other people allowed to know the names of IVF patients are the Members and employees of the HFEA, and staff covered by an HFEA licence at a clinic.

b) Counselling

There are many considerations to be taken into account when deciding on fertility treatment. To help you, clinics are required by law to offer you an opportunity to have independent counselling before you consent to treatment. This counselling is different from the processes of receiving information, professional advice and assessment. Implications counselling provides an opportunity to talk with an impartial person about the implications of the proposed treatment, for you, your family and any children born as a result. Support counselling, to give emotional support at times of particular stress, and therapeutic counselling should also be available.

c) Consent

There are three types of consent involved in IVF treatment:

1. Consent to use and storage

Each partner in a couple must give separate consent to the use of their own eggs or sperm and their consent must be 'informed'. This means that the clinic must have provided information about the process and implications of IVF treatment and of storage. You must also be offered counselling about these implications. You or your partner can vary or withdraw consent to the use of eggs or sperm, or to the use of an embryo thereby produced unless the embryo has already been used in treatment services or for research.

If you are having IVF using donated sperm, your partner will not be asked to give this consent. The sperm donor will have given the necessary consent. Similarly, if donated eggs are used, the egg donor will give consent to use, not the woman receiving treatment.

2. Consent to treatment

You will be asked by the clinic to give written consent to your fertility treatment, such as egg retrieval and to the transfer of a specified number of embryos into your womb. If donated sperm or donated eggs are used, you will be asked to give consent to treatment using these and to embryo transfer.

3. Consent to disclosure of identifying information

Finally, the law requires that, before a clinic can tell your GP or someone else who may need to know about your IVF treatment, your written consent to disclose identifying information must be obtained. You may wish to consider what information you may wish to allow to be disclosed and to whom.

d) Egg development and drugs

Normally, every month a woman's ovaries develop several eggs but only one of these becomes fully mature. This egg is released into the fallopian tube where it may be fertilised following intercourse. As egg collection involves a small operation, many clinics prefer to try to collect more than one egg at a time. To do this they give the woman hormone drugs. These cause the ovaries to mature several eggs in one monthly cycle which can be collected. The embryos resulting from these eggs can be used in treatment that same month, or can be frozen for treatment at a later date. Some clinics prefer not to use these drugs, but collect the one, or occasionally two eggs, normally produced in a monthly cycle.

If drugs containing hormones are given, they will usually be of three types:

a nasal spray or an injection given every day throughout the 28 day cycle. These drugs suppress the hormones produced by a woman in a normal menstrual cycle and enable greater control over when the eggs are produced;

an injection given once a day for the first half of the cycle, or tablets to be taken. The injections or tablets are hormones which naturally stimulate the ovaries, but which are given so that more than one egg develops. These are known as superovulatory drugs;

when the ultrasound scanning and/or hormone measurements show that an adequate number of eggs are maturing, a final hormone injection is given which completes the maturing process. This injection must be carefully timed 34-38 hours before collection so that the eggs will be mature, but will not have left the ovary.

Some of the drugs involved in an IVF cycle can be taken as tablets, but many have to be given by injection. Clinics may give the daily injections themselves or they may arrange for a GP or local hospital to give them. Often the timing of the last injection means it is late at night and this may cause some inconvenience. Sometimes training may be given so that the injections can be self-administered.

e) Egg collection

When the eggs have matured and are ready for collection, one of two main techniques may be used.

1. Ultrasound guided egg collection

The most common technique is by using an ultrasound guided needle. This may be done under a general anaesthetic or, more probably, a mild sedative. A fine hollow needle is passed either through the bladder, urethra or vagina and each egg is removed in turn. Occasionally it may be necessary to pass a needle under ultrasound guidance through the abdominal wall.

The operation to remove eggs under ultrasound can be uncomfortable and painkilling drugs can be given before the procedure. Some discomfort may also be experienced for a short time after the operation is over. Women undergoing ultrasound-directed egg recovery may notice a small amount of blood in their urine or from their vagina for a day afterwards. This is quite common and should not cause concern unless the bleeding is heavy and continues in which case medical advice should be taken.

2. Laparoscopic egg collection

The second technique is called laparoscopy, for which a general anaesthetic will normally be necessary. A small cut is made just below the navel for a laparoscope (an instrument for looking into the abdomen) to be inserted and a fine, hollow needle is inserted separately to remove the eggs.

Laparoscopy carries the usual minor risks and side-effects of any procedure requiring a general anaesthetic. Some women experience soreness in the stomach, chest or shoulders, or vaginal bleeding for a few days after the operation. There may be some abdominal pain which is similar to that of a painful period. This usually disappears in a short time. More severe or persistent pain requires review by a doctor.

f) Sperm collection

A couple of hours before the egg collection procedure is performed your partner will be asked to produce a sample of sperm. The sample will be prepared to be combined with the eggs. If donor sperm is to be used, the sample will be taken from frozen storage and will be prepared for fertilisation.

g) Fertilisation

The eggs are also prepared and placed in an incubator. After about 3-6 hours, depending upon their maturity, the eggs and sperm will be placed together in a dish in the incubator and carefully labelled. The dish will be inspected the following day to see whether the sperm have fertilised the eggs. If they have, the resulting embryos will be left to grow for up to a day longer. The embryologist will check that the embryos are developing normally and up to three of them may be transferred into the woman's womb.

h) Embryo transfer

Embryos are transferred through the cervix into the womb by using a fine plastic tube (a catheter). Usually more than one embryo is transferred to give a better chance of having a baby. A clinic cannot transfer more than three embryos. This is to reduce the chance of pregnancies involving several babies which can be dangerous.