In Vitro Fertilization

updated September 6, 2017

In vitro fertilization, or IVF, is a popular treatment among couples seeking to overcome infertility, from younger couples to those who are choosing to have children later in life. "In vitro" is Latin for "in glass," because the process involves fertilizing an ovum in a laboratory dish and then transferring the embryo to a woman's uterus. Many doctors also prescribe medications to boost the patient's fertility and ovary production throughout the course of treatment.

IVF is a form of assisted reproductive technology (ART) and is generally suitable for couples suffering from most types of infertility, including:

• Tubal factor infertility
• Endometriosis
• Genetic issues
• Male factor infertility
• Unexplained infertility

A precise procedure, IVF has the highest success rates of any ART methods. In vitro fertilization is also versatile treatment; depending on your unique circumstances, you may use donor eggs, donor sperm, or a gestational carrier (also sometimes called a surrogate). A fertility specialist can help you learn more about IVF and help you determine whether it is right for you.

Candidacy

Many couples that are having difficulty conceiving can benefit from in vitro fertilization. IVF statistics suggest that couples under the age of 35 who have been trying to conceive for more than a year without results are ideal candidates for in vitro fertilization.

Couples over the age of 35 who have been trying to conceive for six months may also be good candidates for IVF treatment, but it is important to consult a qualified fertility specialist to determine whether it is appropriate for you. Although there is no established age limit on in vitro fertilization, many infertility clinics and hospitals consider age as part of the candidate screening process.

Eligible Infertility Problems

The following causes of infertility may be treated with in vitro fertilization:

• Ovulation disorders. Producing healthy ova is a complex process and, unfortunately, a number of things can go wrong. About a quarter of women who struggle with infertility have ovulation disorders, making them one of the top causes of difficulty conceiving. To diagnose these issues, the doctor may measure progesterone or follicle stimulating hormone (FSH) levels. An ultrasound or endometrial biopsy may also help determine the source of an ovulation disorder. There are three basic types: anovulation, oligo-ovulation, and luteal phase defects.
  • Anovulation occurs when a woman's eggs never grow or release properly. Some women with this condition do not menstruate, but others still do. Common causes of anovulation include polycystic ovarian syndrome (in which the follicles that usually become ovaries do not, leaving the patient with cysts) or damage from cancer treatment. Some women are also born without ovaries, have ovaries that contain no eggs, or experience premature menopause, all of which can result in anovulation.
  • In the case of oligo-ovulation, a woman occasionally releases ova, but on a very inconsistent basis, which can cause irregular menstruation. Weight changes, particular drugs, tumors, intense stress, thyroid issues, or adrenal problems can cause oligo-ovulation.
  • Luteal phase defects, or "LPD," are the least common cause of ovulation disorders. The luteal phase of ovulation comes between ovulation and menstruation. During this time, the uterus should produce a thick, healthy lining of mucous and tissue, or "endometrium," which is then cleared out during menstruation. Women with LPD do not produce an adequate endometrium for egg implantation. Patients with this condition may produce healthy ova, but they cannot properly conceive.
• Blocked or damaged fallopian tubes. Tubal issues are another common source of infertility, affecting between 15 and 25 percent of women who struggle to become pregnant. The fallopian tubes transport a fertilized zygote to the uterus for implantation, an important step in the conception process. Since tubal problems are often asymptomatic, many women do not realize they suffer from this condition until they have difficulty conceiving. Infection, adhesions from a previous surgery, a prior ectopic pregnancy (in which the egg implants within the tube), congenital issues, or hydrosalpinx (a tube blocked by an accumulation of fluid from infection) can cause tubal issues.
• Premature failure of ovaries. Sometimes, women younger than 40 years old lose the healthy function of their ovaries. These patients experience lowered estrogen levels and do not routinely produce eggs. Unlike in premature menopause, women with this condition may occasionally ovulate normally. Typically, ovarian failure or insufficiency results from exposure to toxins, chromosomal issues, or autoimmune diseases that cause the body to mistakenly attack the ovaries.
• Uterine fibroid tumors. Up to 75 percent of women have these benign growths in their uterine muscles at some point, but never know it because they do not create noticeable symptoms. Most fibroids do not interfere with fertility, but, depending on where and how they grow, they can obstruct the fallopian tubes, prevent sperm from passing from the cervix, or prevent proper egg implantation. Submucosal fibroids, which develop in the uterus' inner cavity, are often most problematic for conception.
• Prior sterilization or removal. IVF may be able to help women who have had their ovaries removed or fallopian tubes surgically modified become pregnant.
• Endometriosis. Unfortunately, as many as half of women struggling with infertility, and up to 10 percent of all women, suffer from this disease. Endometriosis occurs when the mucous membrane that develops during a woman's monthly cycle grows outside the womb. During menstruation, these cells break down, but since they cannot release, they form cysts filled with blood, cause inflammation, and create scar tissue. These can block or warp the fallopian tubes and make sex painful. Endometriosis may also interfere with other steps of the fertilization process, from ova development to implantation.
• Low sperm count. Conception may be difficult if a male partner does not produce enough sperm. If a woman's partner isn't producing enough sperm for IVF from ejaculation, the doctor can extract sperm from his testicle or epididymis. In severe cases, the doctor may be able to harvest sperm from a testicular biopsy.
• Sperm problems such as poor sperm motility. Even with a normal sperm count, low motility or abnormally shaped sperm may make fertilization difficult. In this case, a fertility specialist can perform ICSI, or intracytoplasmic sperm injection. In traditional IVF, the doctor places sperm and eggs in the same dish and waits for fertilization to occur. With ICSI, your doctor will insert a sperm directly into an egg. According to the most recent findings of the Society for Assisted Reproductive Technologies, over two thirds of patients who use IVF opt to perform ICSI.
• Genetic disorders. Some couples that are able to conceive normally opt for IVF because this allows for PGD, pre-implantation genetic diagnosis. If you or your partner is concerned about passing on a hereditary disorder to your baby, PGD can screen for these issues. Your doctor can then implant only the healthy fertilized eggs.

IVF can also help couples for which the cause of infertility has not yet been explained, even after routine exams and tests. While IVF can be successful for couples with all of the above conditions, your rate of pregnancy may be lower if you suffer from uterine fibroids, irregular hormone levels, uterine abnormalities, or ovarian dysfunction. Depending on the exact nature of your condition, you may choose to use an egg donor, sperm donor, or gestational carrier for implantation.

Of course, before beginning IVF you should have realistic expectations for treatment. You and your partner should also be physically, mentally, and emotionally committed to the process.

Fertility Preservation

If you suffer from a medical condition or are about to undergo treatment that may impact your fertility, harvesting and freezing your eggs for IVF may help you preserve your ability to conceive. Many women use IVF fertility preservation to protect their eggs from the harmful effects of cancer treatment.

Ready to take the next step? Find a fertility doctor in your area.

Cost

On average, the cost of in vitro fertilization is about $12,000 per cycle; this price should include:

• The cost of fertility drugs
• Ultrasounds
• Blood tests
• Other medical expenses that are directly related to the in vitro fertilization procedure

Additional treatments such as ICSI (intracytoplasmic sperm injection) for sperm issues or PGD (pre-implantation diagnosis) to prevent passing on genetic disorders will raise the price of your IVF. The high cost of IVF reflects the fact that the procedure is complex and can be performed only by highly trained medical professionals.

The number of IVF cycles needed will vary by patient. Several factors play a role in the success of IVF treatments, including:

• The age of the patient
• The degree of infertility
• The quality of the embryo and semen

Some women will only require one treatment before successfully conceiving, while other women may need to undergo as many as six IVF cycles. Each additional IVF cycle has been estimated at about $7,000. Unfortunately, some women are unable to conceive even after undergoing multiple IVF cycles.

If your fertility issues are less severe, you may opt for mini-IVF, which costs less (approximately $5,000 total) because it involves lower doses of fertility drugs and less comprehensive oversight for your cycle. If your fertility issues do not result from ovulation issues, you may be eligible for natural cycle IVF, which involves no fertility medications.

You should discuss your chances for success with IVF with your fertility specialist to determine which type of treatment may be right for your health and budget. Be sure to inquire about any additional costs that may arise during treatment, such as extra testing or psychological counseling, so that you can be prepared. Some fertility clinics offer financial planning assistance to help patients afford treatment.

IVF and Health Insurance

Depending on the type of plan you have and the state in which you live, your insurance coverage may be applied toward the cost of in vitro fertilization. Some states have laws requiring insurance carriers to offer coverage for infertility diagnosis, treatment, or both. While it is unlikely that your health insurance company will pay for the cost of IVF cycles, as IVF is considered an elective procedure, most health insurance companies will cover all or a portion of the cost of infertility testing and diagnosis fees.

You may also be able to purchase specialized fertility insurance for your IVF needs from a company like New Life Agency, which offers ten different insurance plans to suit your unique needs. Patients enroll with the company for 18 months and if you do not conceive, you may be eligible for credits to your account or a partial refund.

Before you commit to IVF, you should thoroughly research your health insurance provider's policies and, if possible, procure a written copy of your coverage benefits.

Payment

Of course, if you have saved up enough money to pay for IVF upfront, this is the simplest option, and will save you the cost of interest. However, given the time-sensitive nature of fertility and the expense of IVF, many patients appreciate alternative payment options.

IVF Financing

There are numerous IVF financing options for patients looking to afford treatment. Many independent clinics provide their own financing programs, some of which may include partial refunds for unsuccessful IVF. Banks and other traditional third-party lenders may also offer financing.

Health care financing companies understand the unique needs of women and couples going through IVF, so many patients choose to use their programs. Note that with most financing options, the consumer will have to pay interest on the loan; the applied interest rates typically depends on the amount of time it takes the consumer to pay off the loan and the consumer's credit score.

How to Choose an IVF Specialist

The in vitro fertilization process is complicated and very personal, so finding a good doctor is important. Most likely, you will begin your journey toward IVF at your gynecologist's office. He or she will run basic fertility tests and conduct exams to diagnose your condition before making a recommendation. Your gynecologist may suggest your partner see an urologist. Once you and your partner have decided that IVF is the right treatment option, you'll need to choose a specialist.

Finding a Clinic

There are close to 500 IVF clinics in the United States, so narrowing down your choices is an important, potentially difficult process. Since IVF is such an involved procedure, you'll need to find a clinic where you feel comfortable with the staff and confident in your chances of conception.

The Centers for Disease Control and Prevention keep an online database with the statistics that fertility centers have to report

First, you should do your research. Obviously, each woman's fertility status and chances of conception are unique, but understanding potential clinic's success rates can help you choose. The Centers for Disease Control and Prevention keep an online database with the statistics that fertility centers have to report every few years to the federal government. While the numbers are certainly important, the clinic with the highest statistics isn't necessarily the right one for you, although any rates lower than the nationally reported average (also found on the CDC database) are a bad sign.

In addition to looking at conception rates, search online to find more information about a clinic's quality control and customer service. Nowadays, even fertility clinics have a Yelp page where you can read about other patients' experiences. You can also take your doctors' referrals or recommendations from friends and family into account as you research your options.

Asking the Right Questions

Once you've narrowed your options down to a few clinics, try to get in touch with them, either in person or over the phone. Infertility experts recommend asking these basic questions before committing to a clinic:

• How expensive is a cycle of treatment? Obviously, you may have to pay a bit more to receive the best care, but it is important to understand your costs from the outset. Also, find out if the clinic offers financing options or any sort of refund for unsuccessful treatment.
• How many patients do you see each year? While the most popular clinics might have a lot of patients for good reason, you're more likely to receive personalized care if the clinic is not overburdened with other clients.
• Which treatments do you offer? If your partner suffers from low sperm count, you'll want to find out if the clinic provides sperm extraction. If you're concerned about hereditary diseases, you should ask about PGD (pre-implantation genetic diagnosis). In general, the more treatments the clinic provides, the better.
• How much control does the patient have over treatment decisions? Sometimes, the length of your cycle, types of fertility medications, and number of eggs implanted are entirely at the discretion of the doctor, which might make some women uncomfortable. This is particularly prevalent in fertility specialists who are concerned about improving their statistics, and therefore take an overly aggressive approach to care.
• Who is eligible for IVF at your clinic? This is an important question because it allows you to determine your candidacy. In addition, clinics that do not provide any parameters (age, general health, fertility conditions) for treatment might not be as trustworthy or ethical.

Choosing a Doctor Who Understands Your Needs

The clinic you find may employ multiple specialists (as well as nurses and lab technicians), so you should choose the doctor you'd prefer to work with based on his or her:

• Qualifications and certifications - Is he or she well trained in the procedures you need performed?
• Approach to IVF - Is it more or less aggressive? Does it align with your wishes?
• Personality and communication style - You will be working with this person for months through a physically and emotionally taxing process, so you want to make sure you are comfortable with your doctor.

Finding a clinic and specialist who make you feel secure is an important step in your IVF process.

Ready to take the next step? Find a fertility doctor in your area.

The Initial Consultation

Unless you are receiving treatment as a single woman using a sperm donor, both you and your partner will attend the initial consultation for IVF, since you will both be actively involved in this process.

Preparing for Your Appointment

To make the most of your consultation, many doctors require you to fill out a questionnaire before coming in. This typically involves providing:

• Records of previous fertility exams or tests
• Results from any prior treatments
• Information about either partner's prior children
• Details of any of the woman's previous pregnancies
• Both partners' complete medical history
• A summary of your present family situation (married, single, in a domestic partnership, etc.)
• Answers to questions about your lifestyles, which include
• Where you work and what kind of labor you perform
• Which vitamin supplements and non-prescription drugs you take
• Whether or not you smoke
• What alcoholic beverages you consume
• Weight and BMI
• Your folic acid levels
• Stress levels
• Exercise regimen
• Basic dietary information
• Written consent from your general practitioners that the clinic may access your files
• Signed forms that protect your privacy

Either before or during your initial consultation, your specialist may have you complete a "Welfare of the Child" assessment, which evaluates your medical history, criminal background, and psychological history to ensure that you will not put your future child at physical, medical, or psychological risk.

During Your Consultation

You and your partner will most likely meet with your specialist for about an hour, where he or she will go over your questionnaire, answer any questions you may have about treatment, and give you instructions about how to prepare for this process, such as any lifestyle changes you need to make. Your doctor will also outline your treatment plan and schedule with you so that you know what to expect.

After meeting with the fertility specialist, a fertility nurse will meet with you to explain the specifics of the procedures and how they will be performed. You will go over your insurance coverage and financing options with an administrator. At some clinics, you may meet with a fertility counselor, a therapist who is there to help you through the emotional and psychological implications of IVF.

Finally, you will schedule your next appointment for your first treatment.

Preparing for IVF

IVF is an extensive process that can be physically, mentally, and psychologically draining, but very rewarding. The more prepared you are, the smoother your IVF cycle will be.

Further Testing

Based on the information discussed during your initial consultation, you or your partner may need to undergo additional medical testing. These exams may fill in the gaps left by previous fertility exams, or they could be more intensive evaluations only a fertility specialist can perform. These can include:

You or your partner may need to undergo additional medical testing

• Testing your reserve ova. Before beginning IVF, your fertility specialist will need to know the quality and quantity of your remaining eggs. To do so, he or she might measure your FSH (follicle stimulating hormone), which helps your ovarian follicles become eggs. Your doctor may also measure your estrogen and antimullerian levels, both of which are important hormones. These exams might also involve an ovarian ultrasound. Ovarian reserve testing will influence your specialist's recommendations about how much medication you may need and whether or not you should freeze eggs for later cycles.
• Uterine cavity exam. Your IVF specialist will need to examine the structure of your uterus to plan for implantation and diagnose any uterine conditions that could interfere with IVF, such as fibroids. He or she will likely use one of two methods. In a hysteroscopy, your doctor will insert a small, flexible telescope through your cervix to look at your uterus. He or she may also inject special fluid into your uterus to look for any deformities with an ultrasound. This called a sonohysterography.
• Infectious disease testing. To make sure you are both healthy and to diagnose any diseases that could interfere with IVF, your doctor will screen you and your partner for infectious diseases, such as HIV.
• Semen analysis. In most cases, your partner will have undergone semen analysis before you begin the IVF process. However, if he has not, the clinic will complete an evaluation of his semen to ensure he does not suffer from low sperm count, low mobility, or irregularly shaped sperm. If he is diagnosed with these conditions, your fertility specialist will discuss your options for harvesting healthy sperm.
• Mock embryo transfer. Transferring the fertilized egg is one of the most delicate and pivotal steps of the IVF process, so your doctor will complete a mock transfer as a rehearsal. This will also help him or her measure the size of your uterine cavity and determine which technique will work for your body.

Once your specialist completes these tests and the mock embryo transfer, he or she will create a treatment protocol with you, including a tentative treatment schedule you will follow as closely as possible. Sometimes, fertility specialists recommend that women take oral contraceptives for several days before beginning the first stage of treatment.

Go Over the "What If's"

IVF is a complicated process, so it helps to be prepared for a variety of contingencies. That way, you and your partner won't be forced to make significant decisions in a hurry. Here are some basic questions you should know your answers to:

• What do we want to do with additional embryos? Answering this question also involves determining how many embryos you plan to implant. Typically, women under 40 years old transfer two and women over 40 transfer three or four. It is possible for more than one embryo to implant in the uterus lining (endometrium) after transfer. The more embryos transferred, the greater the chance of a multiples pregnancy. If you have more fertilized eggs than you plan to implant, you have three options. An embryo or embryos that are not selected for immediate transfer may be frozen for use at a later date through a process known as cryopreservation. If you freeze them, this can lower the cost of future cycles, but frozen eggs have a slightly lower success rate. You can also choose to donate them to another woman at the same clinic, if you are comfortable with this. You also have the option to simply throw them out.
• What if you have multiples? IVF specialists often implant more than one egg to increase the chances of success, but this can lead to multiples pregnancy. Unfortunately, multiples pregnancy carries further health risks for you and your children during pregnancy and labor. You have the option to use fetal reduction to lower these risks, but this is obviously a serious decision. You should talk to your doctor about weighing potential risks and decide with your partner what your course of action would be.
• Are you legally and emotionally prepared to use a gestational carrier or donor embryos, eggs, or sperm? Some couples utilizing IVF require the use of donor eggs and sperm or a gestational carrier. While this can be an excellent option, it can become emotionally and legally complex. Make sure you understand your rights, have filed the appropriate paperwork, and are fully committed to this decision.
• How many cycles are you willing to complete? Unfortunately, IVF can take many cycles, and is never effective for some couples. Although you should be optimistic upon beginning treatment, you should set limits for the number of cycles you are willing to complete, for your health and your budget. Your fertility specialist can make recommendations about this decision.

Develop Your Support System

Understandably, many couples are very private about their fertility concerns. However, as you go through IVF, it is important to have a solid support system of family and friends who can help you through the process. It is important that you have someone to turn to other than your partner during this emotional journey. Developing a support system is also practical-you may need someone to help you with injections or drive you to the clinic while your partner is at work or away.

Know Your Cycle

Each woman's body and menstrual cycle are different. To prepare for IVF or other fertility treatments, make sure you precisely track your cycle. You can do this by noting when you menstruate and using an ovulation kit, which measures hormones in your urine to predict your ovulation. You can also more accurately measure your cycle by evaluating your cervical mucus or using a fertility monitor, a device that detects hormones using your body temperature, saliva, vaginal fluid, or urine. Collecting this information will help your fertility specialist diagnose your condition and plan your treatment.

Embrace a Healthier Lifestyle

Your fertility involves more than just your eggs or sperm-your overall bodily health can affect your ability to conceive. Implementing certain daily health habits can prime your body for pregnancy and give your cells more nutrients. In addition, improving your lifestyle can help you prepare for chasing a toddler around the house and ensure that you're there for your child for many years to come. Here are some ways you can boost your health:

• Normalize your sleep schedule before you begin your first cycle. Sleeping for eight or more hours in total darkness can help you produce melatonin, which helps your follicles develop properly.
• Begin taking omega 3 fish oil supplements, which may benefit embryo growth.
• Quit smoking, as this can interfere with both male and female fertility. Most fertility specialists recommend stopping smoking at least three months before your first cycle begins.
• Avoid highly processed foods, sugars, and alcohol.

The IVF process can spur you to lead a healthier life and benefit your wellbeing.

Stages of IVF

The in vitro fertilization, or IVF, procedure requires highly skilled medical professionals and sophisticated laboratory equipment. The full IVF process is composed of four steps, including ovulation induction, egg harvesting, fertilization, and embryo transfer. A full cycle, including all of these steps, is completed in about a month.

Step One: Ovulation Induction

During the first stage of the IVF process, women are given fertility medication to stimulate simultaneous development of multiple ovarian follicles, which contain the eggs that are released during ovulation. Some of the drugs used for this purpose are clomiphene citrate (Clomid®, Serophene®), human chorionic gonadotropin (hCG), and gonadotropin releasing hormone (GnRH) analog.

These fertility drugs are typically administered via injection over a period of seven to ten days and may be used alone or in combination with each other. The goal of the fertility drugs is to produce the simultaneous maturation of multiple eggs, which must be harvested prior to ovulation. This step also typically involves the use of Lupron, a drug that prevents women from ovulating too early, which could jeopardize proper egg harvesting.

During ovulation induction, also called controlled ovarian hyperstimulation, the fertility specialist carefully monitors the growth of a woman's ova by measuring her hormones and using ultrasound technology. When she nears your estimated ovulation date, she comes in to the fertility clinic for daily assessments.

Step Two: Egg Harvesting

Once the ova are sufficiently primed, they must be harvested. About a day and a half before ovulation, the IVF specialist will administer a final large dose of hCG. This should cause ovulation to occur approximately 36 hours later. This has to be perfectly timed, because a woman's eggs will not fertilize appropriately if they are premature or too old.

If the patient ovulates before her hCG injection, the cycle will unfortunately be cancelled. Up to one in five women have to cancel their cycles due to early ovulation. In some cases, a spontaneously occurring luteinizing hormone (LH) surge can trigger premature ovulation.

The most common technique used for egg harvesting is called ultrasound-guided aspiration

The most common technique used for egg harvesting is called ultrasound-guided aspiration. This method involves inserting an ultrasound probe into the vagina, and is typically performed under IV sedation and local anesthesia, so you remain comfortable. The probe emits sound waves, which are used to form an image of the reproductive organs. The fertility specialist guides a tiny needle through the vagina and into a follicle, where gentle suction draws the ovum into the needle.

The aspiration procedure can also be performed through the abdominal wall or bladder. In some cases, a laparoscopy, a procedure using a lighted tube inserted through the abdomen, may be needed for successful egg harvesting. The aspiration process usually takes about a half an hour.

Once the eggs have been harvested, the IVF lab will hold them in a special incubator until they are ready for insemination.

Step Three: Insemination and Fertilization

The level of egg development determines when sperm may be added in a process called insemination. The patient's husband, partner, or donor provides the sperm for insemination. If her partner has low sperm count, low motility, or abnormally shaped sperm, the specialist can perform treatments to improve the chances of extracting healthy sperm.

Before sperm collection, the male will need to abstain from sex for two days, but should not have gone without for over five days. A woman's partner or donor may provide the sperm on the day of the egg harvesting, or the sperm can be collected in advance and frozen until it is needed. If he can get to the fertility clinic in under an hour, a partner or donor may collect the sperm at home rather than at the facility.

Motile sperm are separated from the rest of the semen using a process known as "sperm washing." A fertility lab technician will remove the sperm from the seminal fluid, which contains chemicals that could inhibit implantation. Normally, a woman's cervix would filter out these chemicals, called prostaglandins, before they reach the egg.

A specific number of sperm are placed with each of the eggs in a separate laboratory dish. Typically, the eggs and sperm are placed within the same petri dish, where the sperm naturally fertilize the eggs. If the partner or donor has sperm fertility issues, the embryologist may perform ICSI, intracytoplasmic sperm injection, to directly place the sperm within the center of the egg.

After the sperm inseminate the eggs, the lab dishes are left in an incubator for approximately 18 hours. After fertilization is complete, it takes about 12 hours for the fertilized cell to divide in two. After 48 hours, the pre-embryos consist of two to four cells each and are ready for embryo transfer into the uterus.

Step Four: Embryo Transfer

Embryo transfer is typically performed as an outpatient procedure, and typically occurs three to seven days after insemination, depending on the health of the embryos. This procedure is usually similar to the mock embryo transfer your specialist would have performed during preparation. The physician uses a transfer catheter to carefully deposit the embryo or embryos into the uterine cavity.

Most patients remain awake during the procedure and can watch the transfer happen on a sonogram monitor. While the embryo transfer procedure takes only 10 to 20 minutes, some IVF clinics recommend that patients rest for a period of time immediately afterward.

To eliminate the risks associated with multiples pregnancies, some women may be eligible for eSET, or elective single embryo transfer. In this case, your embryologist will allow your embryos to develop for longer before transfer, usually on day five. During this time, more cells will develop, transforming the embryo into a blastocyst.

Generally, blastocysts have a higher implantation rate, so just one can be transferred. eSET is becoming more popular among IVF patients, with about 20 percent of patients using this method. In clinical studies, it has yielded a 60 percent success rate. To be an ideal candidate for eSET, you should:

• Be 37 years old or younger
• Have a high quality blastocyst, as determined by your embryologist
• Be in your first cycle of IVF, or have a previous successful IVF treatment

After undergoing embryo transfer, patients are given daily progesterone injections to increase the chance of successful embryo implantation. The success rate of the IVF procedure is approximately 20 percent per treatment cycle.

Results

Currently, IVF is the most common form of assisted reproductive therapy performed. In fact, 99 percent of ART (assisted reproduction techniques) pregnancies are the result of IVF treatment. In the United States, due to advanced fertility medicine, IVF success rates have been relatively high. By the end of 2002, nearly 300,000 babies conceived through assisted reproductive technology had been born. Worldwide, more than four million babies have been born from successful IVF.

However, there are many factors that play a role in the success of IVF treatment, including the viability of the embryos, the age of the mother, and the quality of the sperm. Your fertility specialist can discuss your potential results with you at your initial consultation.

Benefits

As one of the most popular ART (assisted reproductive technique) procedures, IVF offers many benefits. With IVF:

• Patients who suffer from a variety of infertility issues can conceive successfully. Whether difficulty getting pregnant results from male or female conditions, couples can improve their chances for conception with IVF. Since being unable to have a child can put stress on a relationship, IVF can improve both patients' emotional and psychological wellbeing.
• Nontraditional families can have children. Gay and lesbian partners, as well as single women, can become parents. This is due to the fact that IVF allows for sperm and egg donors, as well as gestational carriers.
• Couples can time their pregnancies according to their ideal schedules. Some people who do not suffer from infertility issues use IVF to become pregnant because it improves their chances of predictable fertilization, allowing them to become pregnant efficiently when the time is right.
• People with genetic issues can avoid passing these conditions to their children. Many people with genetic disorders or chromosomal deficiencies choose to use IVF to ensure their children's health. With PGD (pre-implantation genetic diagnosis), they can pick only the healthiest embryos for implantation.
• Women can preserve their eggs for future use. If a woman plans to get pregnant later in life, but wants to save healthier eggs for this time, she can complete the first two stages of an IVF cycle, freeze her eggs, and wait until she is ready to become pregnant.
• Post-menopausal women can become pregnant. Either through using their own frozen eggs or an egg donor, women who have gone through menopause can carry a child, since the uterus typically remains intact. This is especially beneficial for women who go through premature menopause.
• Women and couples can expect higher success rates than with other ART treatments. IVF is the most popular ART treatment because it offers higher success rates than many of its alternatives.

IVF has helped many patients fulfill their dream of becoming a parent. In many ways, the emotional benefits of having a child are unquantifiable. An added benefit of IVF is that, as it becomes increasingly popular in the United States and abroad, the technology and success rates used are only improving.

Ready to take the next step? Find a fertility doctor in your area.

Risks

Of course, as with any medical treatment, IVF carries some potential risks. Many of these are the same as the health risks associated with natural conception. These can include:

• Unsuccessful treatment. Some women never become pregnant with IVF, which can be both financially and emotionally damaging. IVF requires a large investment of money, time, and effort, so women and couples must be prepared to deal with the potential for ineffective treatment. Fortunately, many providers and financers now offer partial or complete refunds for patients whose treatments have not been successful. In addition, many fertility clinics employ fertility counselors, who can help you cope with the entire IVF process.
• Ovarian hyperstimulation syndrome. The purpose of fertility drugs, like hCG used in the first stage of IVF is to stimulate ovary production, but sometimes these drugs can create a condition called ovarian hyperstimulation syndrome, causing the ovaries to swell and become painful. Patients who suffer from ovarian hyperstimulation syndrome also usually experience nausea, vomiting, abdominal pain, and diarrhea. These symptoms usually do not last more than few weeks. In extreme cases, however, this condition can persist and lead to kidney failure or blood clots. If you experience symptoms of ovarian hyperstimulation syndrome, contact your fertility specialist immediately for treatment and monitoring.
• Damage from aspiration. The aspiration needle used in egg harvesting can damage blood vessels, the bladder, or the bowel.
• The stress of the treatment process. The IVF process is often stressful for everyone involved, given its large expense, the emotional difficulty of fertility issues, and the comprehensive physical treatment it requires. To mitigate the effects of stress during IVF, turn to friends, family, and counselors for support.
• Higher miscarriage rates. Compared to natural conception, the miscarriage rates for IVF are very similar. However, they may be slightly increased for women who use frozen eggs. Of course, older women who become pregnant through IVF have an increased risk of miscarriage, just as they do with a natural conception.
• Ectopic pregnancy. An ectopic pregnancy occurs when the fertilized embryo implants in the fallopian tubes rather than in the uterus. Ectopic pregnancies can be dangerous to a woman's health and usually must be terminated, as the baby cannot survive. Between approximately two and five percent of IVF pregnancies are ectopic, about the same as the rate for natural conception.
• Premature delivery and low birth weight. Clinical studies have indicated that IVF pregnancies have a slightly higher chance of premature delivery or low birth weight. Pre-term or low weight babies may have:
  • Gastrointestinal issues, such as necrotizing enterocolitis
  • Difficulty regulating their temperature
  • Infection due to a weak immune system
  • Hypoglycemia (low blood sugar) due to metabolism issues
  • Anemia (low red blood cell count)
  • Difficulty breathing
  • Bleeding in the brain due to hemorrhaging
  • Heart problems, such as hypotension (low blood pressure) or PDA (patent ductus arteriosus)
  • Increased risk for cerebral palsy

However, modern medicine can often save and treat pre-term or low birth weight babies.

• Slightly increased risk of birth defects. Some studies have found that children conceived using IVF have a slightly increased rate of birth defects. This may be correlative rather than causative; couples that have certain fertility issues may naturally have an increased chance of birth defects, due to abnormalities in ova and sperm.
• Potential risk of ovarian cancer. Past research indicated that IVF procedures and medications might be associated with the growth of a particular ovarian tumor, but the latest studies report that this is not the case.
• Multiple pregnancy issues. While many women and couples using IVF to become pregnant might welcome the idea of becoming parents to more than one child at once, multiple pregnancy carries distinctive risks, which are exacerbated for the older women who typically use IVF. Multiple pregnancy risks include all of those associated with premature delivery and low birth weight, as well as maternal hemorrhage (excessive bleeding), high blood pressure during pregnancy, gestational diabetes, and the risks associated with cesarean sections, through which many multiples must be delivered. If you are concerned about the health risks associated with multiples pregnancies, you may opt for fetal reduction.

Temporary Side Effects

The procedures and medications used in all four stages of IVF can create temporary adverse effects. These can include:

• For injectable fertility medicines
  • Slight aching or bruising at the site of injection, which can be abated by varying the area of treatment
  • Fatigue
  • Mood swings
  • Increased or abnormal vaginal discharge
  • Tender breasts
  • Short-term allergic reaction, such as rash, itching, or redness
  • Nausea and vomiting
• Cramping and infection due to egg transfer. During the last step of IVF, the fertility specialist uses a special catheter to insert the embryo. After this procedure, some patients experience mild bleeding or spotting. Sometimes, an infection develops, which requires antibiotics to treat.
• Disorientation and nausea from sedation or anesthesia. Any time a patients go under IV sedation or general anesthesia, they face certain risks, such as breathing problems, localized swelling, amnesia after the procedure, and over-sedation, in which too much of the sedative or anesthetic is applied and the patient must be revived. Working with a trained anesthetist can minimize these risks.

Safety Data

Millions of women have had healthy babies through IVF. However, providing definitive answers about the safety of IVF is difficult, since it is such a multifaceted process and even natural conception pregnancies can have a number of complications. In addition, IVF is a relatively new procedure, given that the first ever implantation took place just over 40 years ago.

As increasing numbers of women conceive and give birth due to IVF, scientists will be able to collect more data about its overall safety for mother and child. Given the clinical studies that have been performed, the safety of IVF pregnancies is generally comparable to natural conception.

Your individual safety and results during IVF treatment will depend on your unique circumstances and the expertise of the fertility specialist you choose. To learn more about whether or not IVF may be safe for you, discuss your concerns with your doctor.

Statistics

Examining the national statistics for IVF can allow patients to make a more informed decision about treatment. However, your specific medical history and fertility conditions will affect your particular outcome.

Age and IVF Success Rates

The age of the woman undergoing in vitro fertilization does affect the pregnancy success rate. As a woman ages, her chances of becoming pregnant via IVF decrease. The following statistics may help you determine whether IVF is right for you:

• Approximately 46 percent of women under the age of 35 who undergo IVF experience a successful pregnancy.
• The success rate of IVF treatment for women aged 35 to 37 is 37 percent.
• In women over the age of 40, IVF treatment is successful approximately 19 percent of the time.

Natural Pregnancies versus In Vitro Pregnancies

Women who conceive via IVF generally have normal pregnancies.

In general, IVF pregnancies have similar success rates to natural pregnancy through copulation.

The rate of miscarriage following IVF is also comparable to the rate of miscarriage after natural conception, although it is slightly increased since mothers are typically older.

Ectopic pregnancies occur in roughly 3 to 5 percent of in vitro fertilization cases, the same rate as in pregnancies achieved naturally.

As previously discussed, IVF pregnancies are much more likely to be multiple, since more than one egg is typically transferred. For example, while the rate of twins from natural conception is about four percent, it is between 24 and 31 percent for IVF pregnancies.

The Society for Assisted Reproductive Technology maintains a comprehensive database with local and national statistics, if you are interested in learning more.

Alternatives to IVF

IVF is a costly, intensive, and sometimes unsuccessful fertility treatment. Although IVF is the most popular ART (assisted reproductive technique), your fertility specialist may recommend that you attempt alternatives before or after IVF.

Oral Medications

Oral fertility medications are a less extreme version of the injections given during the first and second steps of IVF. These lower dose medications help a woman's body produce FSH (follicle stimulating hormones) so she releases healthier (and often more) eggs than she typically would, raising her chances of conception.

The most common brands are Femara (letrozole) and Clomid (clomiphene citrate). Women looking to improve their fertility with oral medications usually take these pills once a day for five days at the beginning of their menstrual cycle. While administering these drugs, some women experience side effects such as impaired vision, slight headache, vaginal dryness, mood swings, and, occasionally, ovarian cysts. As with IVF, a fertility specialist monitors ovarian growth using ultrasound during treatment.

Once proper eggs have developed, a woman's partner inseminates them naturally with vaginal penetration. Doctors often recommend that the patient watch her menstrual cycle closely to time fertilization optimally. Since more eggs can develop with oral medication, women who conceive with this method have an increased risk of multiples pregnancy, up to 10 percent.

Most women who become pregnant with oral medications find success within the first several months. Women who have not conceived within the first few months of this treatment should consult with their fertility specialist about other options.

Acupuncture

People have been using Chinese medicine to treat a variety of health issues for centuries, and women struggling to conceive have recently begun finding improvement with acupuncture. This treatment involves the precise placement of tiny needles that stimulate the physical, mental, and spiritual flow of energy within the body. In a recent clinical study, women who used acupuncture along with IVF improved their chances of conception by about half as compared to an IVF control group. Acupuncturists also argue that this treatment can take the place of oral medications.

Artificial Insemination

Fertility specialists have been practicing artificial insemination for over 100 years. This procedure, also known as IUI, for "intrauterine insemination," involves some of the same steps as IVF, but is generally less invasive. IUI is suited for couples in which the male partner has sperm issues or fertility issues are unexplained. Often, the doctor will recommend combining IUI with oral medications to maximize the chances of conception.

The patient usually takes oral medications for approximately a week before her ovulation is due. With a combination of ultrasound imaging and ovulation detection tests, she and her doctor will track her cycle to determine when insemination should occur. At this time, her partner provides the sperm, which the fertility specialist then purifies with sperm washing, as in IVF. Next, the fertility specialist will inject the sperm into the uterus. This procedure is usually completed in about an hour.

GIFT or ZIFT

GIFT (gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer) are very similar to IVF, but with slight changes that may help some women become pregnant who were not able to conceive with IVF. The steps are the same as with IVF, except that, once the sperm and egg have been harvested, the doctor will allow them to develop for less time.

With GIFT, the fertility specialist will combine the sperm and eggs in a petri dish before inserting the mixture almost immediately, so that fertilization occurs more naturally within the fallopian tubes.

With ZIFT, the sperm and egg will develop for 24 hours before insertion into the fallopian tubes. These procedures more closely resemble natural conception, but they do require a more intensive surgery, since placing an egg and sperm mixture into the fallopian tubes is more complex than depositing an embryo directly into the uterus.

GIFT and ZIFT account for less than 2 percent of ART procedures, since most patients prefer to use IVF.

IVM (In Vitro Maturation)

In vitro maturation is a relatively new fertility treatment based on a modified form of IVF. In fact, the first IVM cycle was performed in the United States in 2013. If you are not eligible for IVF because you suffer from severe polycystic ovarian syndrome or are at high risk for ovarian hyperstimulation syndrome, IVM may allow you to conceive.

Women undergoing IVM do not take drugs or use injections. Instead, a fertility specialist surgically removes immature eggs and develops them in an incubator in the laboratory. Once they are ready, they are fertilized and placed within the uterus using the same techniques as IVF. Since ova are extracted before they mature, the doctors often have fewer healthy eggs to transfer, but women can avoid the risks associated with oral and injected fertility medications.

Donors

Some patients begin the IVF process using a gestational carrier, sperm donor, or egg donor. However, if you have not been able to conceive with IVF using your own eggs, sperm, or uterus, turning to donors could help. Talk to your fertility specialist about your options.

Adoption

Many people pursue IVF because they want to conceive and carry their own children, but if fertility treatments have not been successful, adoption is an excellent option. Like IVF, adoption can be expensive, but it can give low fertility couples the opportunity to raise a child. In addition, adoption allows the patient to provide a better life for a child whose parents could not care for him or her, which many patients appreciate.

Frequently Asked Questions

Does egg retrieval damage the ovaries?

Some women are concerned that the egg retrieval process might damage their ovaries, but so far, research has indicated that it does not. Many women go through multiple cycles of IVF, which they would not be able to do if retrieval impaired their ovarian function.

Do you extract an egg from every follicle?

Typically, fertility specialists will not retrieve an egg from each follicle, only those that have matured properly and appear healthy. This improves the chances of conception.

Does everyone who does IVF have multiples?

No, although the ratio is much higher than couples who conceive with copulation. Up to 31 percent of women have twins, up to five percent have triplets, and about one half of one percent have quadruplets with IVF. If you become pregnant with more than one baby and want to avoid the health problems that can result from multiples pregnancy, your fertility specialist can perform fetal reduction.

How many cycles should I plan to do?

This depends on many factors, including your budget, age, physical condition, and specific fertility issues. Many women complete multiple cycles. Fertility clinics and health financers often provide discounted rates or even refunds for patients who purchase a package of cycles at once. You should discuss the number of cycles you are willing to complete with your fertility specialist and partner before beginning treatment.

How soon can I take a pregnancy test?

Given the fertility medications, such as hCG, that you take in preparation for egg retrieval, your pregnancy tests may be false positives if you take them too soon. Most doctors recommend taking a pregnancy test about two weeks after egg retrieval to limit the hormonal distortion from these medications.

How long should I wait between cycles?

Many women want to immediately restart the IVF process after a failed IVF cycle, but most fertility specialists suggest waiting about two menstrual cycles before beginning treatment again. This allows your body to heal and regulate after prior procedures. In addition, some fertility clinics may require additional testing between cycles to maximize your potential for conception or modify the techniques used.

Am I depleting my eggs?

No. Women have approximately 300,000 usable eggs after puberty and only about ten percent of these will ever be released during ovulation.

If I become pregnant, should I work with a high-risk obstetrician?

Women who conceive with IVF do not necessarily need to work with a high-risk OBGYN to monitor their pregnancies. However, if you are pregnant with multiple babies or have a condition that puts your child at risk during pregnancy, we recommend working with a high-risk obstetrician to ensure your and your baby's health.

Can I exercise during the IVF process?

Yes. You should engage in gentle physical activities like walks or yoga, but avoid strenuous exercise during this treatment.

Consult a Fertility Specialist

To answer all your questions about IVF and whether or not it may be right for you, talk to a fertility specialist. During a consultation about in vitro fertilization, your doctor will be able to go into greater detail about the various risks and benefits of in vitro fertilization. Find a fertility doctor near you to schedule an appointment.