Today, in vitro fertilization (IVF) is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as “test-tube babies”.
Unlike the simpler process of artificial insemination, which is when sperm is placed in the uterus and conception happens otherwise normally, in vitro fertilization involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. In vitro fertilization is a complex and expensive procedure; only about 5% of couples with infertility seek it out.
When it comes to infertility, IVF may be an option if you or your partner has been diagnosed with:
- Low sperm counts
- Problems with the uterus or fallopian tubes
- Problems with ovulation
- Antibody problems that harm sperm or eggs
- The inability of sperm to penetrate or survive in the cervical mucus
- An unexplained fertility problem
Here are some things to think about before moving forward with in vitro fertilization:
Table of Contents
In Vitro Fertilization Overview
1. Know about fertility drugs and the IVF procedure
Before you undergo the IVF procedure, fertility pills or hormones may be prescribed to stimulate follicle production. The goal is to stimulate your ovaries so multiple eggs can be harvested, thus increasing the chances of fertilization, pregnancy, and a live birth.
Fertility drugs can be given in multiple sessions while your fertility specialist closely monitors you. Your doctor may take multiple blood tests and do ultrasounds to monitor possible egg production.
2. Know how fertilization takes place
Once your eggs have been harvested with the in vitro fertilization procedure, the best eggs are placed in incubators in a controlled lab. The sperm and eggs are mixed together and monitored closely.
Sometimes with the IVF procedure, embryos can be cryogenically frozen for later use. Also in cases of extreme male infertility, individual sperm can be injected individually, a procedure called Intracytoplasmic Sperm Injection (ICSI).
3. Know about egg transfers
After the embryo has developed in the lab for a few days, the doctor will choose the best candidates for transfer. Then, using a catheter guided by ultrasound, the doctor will then transfer the embryo through the cervix and into your uterus.
Sometimes with the in vitro fertilization procedure, multiple embryos are implanted into the womb, increasing the chances of a successful pregnancy and live birth. This also increases the chances of multiple births.
Because of the extreme manipulation of the ovaries that has taken place, you will receive additional supplements of human chorionic gonadotropin (hCG) and/or progesterone to provide the optimum environment for implantation.
4. Know the risks with an IVF procedure
Rarely, your ovaries can become hyperstimulated, resulting in great pain. This is called ovarian hyper stimulation syndrome (OHSS). You may also have side effects from the anesthesia used in the IVF procedure. Some women have occasional bleeding and nausea after the IVF procedure.
5. Know the success rates with IVF procedures
It may take several IVF cycles before you get pregnant. Success rates with the in vitro fertilization procedure can vary depending on your age and health status, the virility and health of your male partner, and other environmental factors.
Women in their mid-30s are at a higher risk of infertility. This risk increases as women reach age 40. There’s a greater risk of IVF procedures not resulting in a full-term pregnancy with women over 40. When donor eggs are used, however, your age does not affect the success rates of an in vitro fertilization procedure. There is a 55 percent transfer success rate regardless of the woman’s age.
Also, a young healthy woman has an excellent chance of progressing from stimulation to follicle aspiration and from pregnancy to delivery. However, an older woman may have a much greater rate of cycle cancellation and pregnancy loss before delivery.
The above differences are not due to the fertility center performing the IVF procedure, but rather to the difference in couples (their age, health and infertility status) accepted into their program, and little can be changed to alter success rate.
6. Know the cost of an IVF procedure
IVF procedures can be expensive. Because of the cost, in vitro fertilization procedures may be chosen when other less-expensive ways to get pregnant have been unsuccessful.
Remember, when you commit to the IVF procedure, you are making both an emotional and financial commitment. But knowing the chances of making a baby are on their side, most couples who undergo the IVF procedure strongly believe that it’s a commitment worth making.
In vitro fertilization is never the first step in the treatment of infertility. Instead, it is reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination have not worked.
If you think that in vitro fertilization might make sense for you, carefully assess any treatment center before undergoing the procedure. Here are some questions to ask the staff at the fertility clinic:
- What is your pregnancy ratio per embryo transfer?
- What is your pregnancy rate for couples in our age group and with our fertility problem?
- What is the live birth rate for all couples who undergo this procedure each year at your facility?
- How many of those deliveries are twins or other multiple births?
- How much will the procedure cost, including the cost of the hormone treatments?
- How much does it cost to store embryos and how long can we store them?
- Do you participate in an egg donation program?
The first step in in vitro fertilization involves injecting hormones so you produce multiple eggs each month instead of only one. You will then be tested to determine whether you are ready for egg retrieval.
Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won’t develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The in vitro fertilization facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.
During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour.
Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner’s sperm, which he will have donated on the same day. While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage.
Once the embryos are ready, you will return to the in vitro fertilization facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most in vitro fertilization experts recommend transferring up to three embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.
Following the procedure, you would typically stay in bed for several hours and be discharged four to six hours later. Your doctor will probably perform a pregnancy test on you about two weeks after the embryo transfer.
In cases where the man’s sperm count is extremely low, doctors may combine in vitro fertilization with a procedure called intracytoplasmic sperm injection. In this procedure, sperm is taken from semen or in some cases right from the testicles and inserted directly into the egg. Once a viable embryo is produced, it is transferred to the uterus using the usual in vitro fertilization procedure.
Success rates for IVF depend on a number of factors, including the reason for infertility, where you’re having the procedure done, and your age. Any embryos that you do not use in your first in vitro fertilization attempt can be frozen for later use. This will save you money if you undergo in vitro fertilization a second or third time. If you do not want your leftover embryos, you may donate them to another infertile couple, or you and your partner can ask the clinic to destroy the embryos. Both you and your partner must agree before the clinic will destroy or donate your embryos.
Using budget IVF clinics can affect success. These have been described as “cheap and nasty” by some in the industry but that is certainly not the case. You just need to know what you are getting into.
Basically, budget clinics use low-dose hormone stimulation protocols so patients spend less on the drugs. But it is generally only suited to younger patients. It also produces fewer eggs. This means fewer resources are required to perform lab procedures and that’s probably the real reason it is so cheap.
In budget IVF, doctors aim to get about seven to ten eggs per patient. If the patient responds well, this number is fine. But that is not always the result. If you get only a couple of eggs, you need to be aware you may not get an embryo for transfer or anything to freeze. Then you will have to start again.
If you and your partner have been trying to conceive for a long time and every method has failed, then you may be eager to try in vitro fertilization. It is extremely important to do your research. It is also extremely important to find a doctor you trust and are able to have a comfortable relationship with.