In Vitro Fertilization is a one assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
Why is IVF used?
IVF can be used to treat infertility with the following patients:
- Blocked or damaged fallopian tubes
- Male factor infertility including decreased sperm count or sperm motility
- Women with ovulation disorders, premature ovarian failure, uterine fibroids
- Women who have had their fallopian tubes removed
- Individuals with a genetic disorder
- Unexplained infertility
What is involved with in vitro fertilization?
There are five basic steps in the IVF and embryo transfer process:
- Monitor and stimulate the development of healthy egg(s) in the ovaries.
- Collect the eggs.
- Secure the sperm.
- Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
- Transfer embryos into the uterus.
Step 1: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Transvaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.
Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.
Step 3: The male is asked to produce a sample of sperm, which is prepared for combining with the eggs.
Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory to encourage fertilization. In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
Step 5: The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.
Although you may need to take it easy after the procedure, most women can resume normal activities the following day.
Some side effects after IVF may include:
- Passing a small amount of fluid (may be clear or blood-tinged) after the procedure
- Mild cramping
- Mild bloating
- Breast tenderness
If you experience any of the following symptoms, call your doctor immediately.
- Heavy vaginal bleeding
- Pelvic pain
- Blood in the urine
- A fever over 100.5 °F (38 °C)
What are the risks associated with in vitro fertilization?
As with most medical procedures, there are potential risks. Fertility medications can have various side effects including headaches, mood swings, abdominal pain, hot flashes, and bloating, amongst other side effects. Although it is rare, fertility medications may cause ovarian hyper-stimulation syndrome (OHSS). Symptoms of OHSS may include abdominal pain or a feeling of being bloated. More severe symptoms include the following:
- Nausea or vomiting
- Decreased urinary frequency
- Shortness of breath
- Severe stomach pains and bloating
- Ten pound weight gain within three to five days
If you experience any of these symptoms above, contact your doctor right away.
Additional risks of IVF include the following:
- Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder.
- The chance of a multiples pregnancy is increased with the use of fertility treatment. There are additional risks and concerns related to multiples during pregnancy including the increased risk of premature delivery and low birth weight.
- Assisted reproductive technology (ART) involves a significant physical, financial, and emotional commitment on the part of a couple. Psychological stress and emotional problems are common, especially if IVF is unsuccessful.
- IVF is expensive, and many insurance plans do not provide coverage for fertility treatment. The cost for a single IVF cycle can range from at least $12,000-$17,000.
How successful is in vitro fertilization?
The success rate of IVF clinics depends on a number of factors including reproductive history, maternal age, cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates.
In the United States, the live birth rate for each IVF cycle started is approximately:
- 41-43% for women under age 35
- 33-36% for women ages 35 to 37
- 23-27% for women ages 38 to 40
- 13-18% for women ages over 40
What if I don’t produce healthy eggs or my husband is sterile?
You may choose to use donor eggs, sperm, or embryos. However, make sure to talk with a counselor experienced with donor issues. You will want to be informed about various legal issues related to gamete donation including the legal rights of the donor.
How many embryos should be created or transferred?
The number of embryos transferred typically depends on the number of eggs collected and maternal age. As the rate of implantation decreases as women age, more eggs may be implanted depending on age to increase the likelihood of implantation. However, a greater number of eggs transferred increases the chances of having a multiples pregnancy. Make sure to talk with your doctor before the procedure so you both agree on how many embryos to implant.
How do I choose an infertility clinic?
There are a number of questions to ask regarding the cost and details of specific centers and fertility programs. Some suggested questions are available online in Selecting Your ART Program.
American Society for Reproductive Medicine. (2014). Gamete and embryo donation: Deciding whether to tell. Retrieved from https://www.asrm.org/FACTSHEET_Gamete_Donation_Deciding_Whether_To_Tell/
Human Fertilisation & Embryology Authority. (2014). IVF- What is in vitro fertilisation (IVF) and how does it work? Retrieved from http://www.hfea.gov.uk/IVF.html
Human Fertilisation & Embryology Authority. (2014). Risks of fertility treatment. Retrieved from http://www.hfea.gov.uk/fertility-treatment-risks.html
MedlinePlus. (2014). In vitro fertilization (IVF). Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm
Mayo Clinic. (2013, June 27). In vitro fertilization (IVF). Retrieved from http://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/basics/definition/prc-20018905
RESOLVE: The National Infertility Association. (n.d.) IVF/ART. Retrieved from http://www.resolve.org/family-building-options/ivf-art/