What is In Vitro Fertilization?
In vitro fertilization (IVF) is a series of procedures used to treat more advanced infertility and/or genetic problems.
The procedure involves collecting mature eggs, usually by ultrasound, from your ovaries. The eggs are inseminated with sperm provided by your partner, to form embryos. Any resulting embryos are cultured for several days in an incubator. Once the embryos reach full maturity, the healthiest embryo(s) are implanted in your uterus.
IVF is the most effective form of assisted reproductive technology. The procedure can be done using your own eggs (or donor eggs) with your partner’s sperm (or donor sperm. The resulting embryos are carried by you, or in some cases, a gestational carrier if you are unable to carry a pregnancy
Your chances of having a healthy baby using IVF depend on many factors, including age, ovarian reserve, and sperm quality. IVF can be time-consuming, expensive and invasive. One cycle of IVF takes about two months, from start to finish.
Your doctor can help you understand the costs, risks and benefits of IVF, so that you can determine if it fits your needs.
Advanced technology is allowing more and more women struggling with fertility issues to become pregnant.
Indications for IVF
Common reasons for IVF include the following:
- Fallopian tube damage or blockage. Women with a history of chlamydia or gonorrhea may have damaged or blocked tubes, making it difficult for an egg to enter the fallopian tube to be fertilized by sperm.
- Ovulation Disorders. If a woman has difficulty ovulating, she has fewer chances to conceive. Ovulation induction increases the number of eggs released, made available for fertilization.
- Endometriosis. Implants of uterine tissue within the abdominal cavity cause adhesions that may impair the function of the reproductive system.
- Tubal sterilization: Not all types of tubal sterilization can be reversed, leaving IVF as the only option for fertility.
- Impaired sperm production or function. Men with low sperm counts, low motility or abnormal morphology may have insufficient sperm with a quality capable of fertilizing an egg. It may be necessary to use a technique called intra-cytoplasmic sperm injection (ICSI) along with IVF to achieve fertilization of the egg and creation of an embryo.
- Fertility Preservation. Women about to begin cancer treatment may consider collecting eggs (or making embryos) prior to starting chemotherapy or radiation therapy, out of concern that the cancer treatment make decrease future fertility potential.
- Gestational carrier. For women not able to carry a pregnancy, embryos are created from her eggs, fertilized by her husband’s sperm and placed in the uterus of another women to carry for the duration of the pregnancy.
- Genetic Disorders. Prior to implanting embryos, a procedure called pre-implantation genetic screening (PGS) or pre-implantation genetic diagnosis (PGD) can be performed to determine whether an embryo is chromosomally normal (PGS) or carries a specific genetic disorder (PGD). Embryos found to be normal are available for embryo transfer.
- Unexplained Infertility. When no cause for fertility can be found following a workup.
Risks of IVF
Complications specific to IVF include the following:
- Ovarian hyperstimulation syndrome. Gonadotropins used in stimulating large numbers of follicles to increase chances of pregnancy, cause the ovary to hyperfunction, producing factors (VEGF) that can lead to ovarian swelling and fluid shifts into soft tissues and abdomen causing painful ovaries, weight gain, and breathing difficulties.
- Multiple births. If more than one embryo is transferred into the uterus, multiple pregnancies can occur. This can lead to premature labor and low birth weight.
- Egg retrieval complications. Eggs are retrieved under ultrasound guidance with a long needle. Injury to bowel, bladder or a blood vessel may occur leading to hemorrhage and/or infection that may require blood transfusion or additional surgery to repair.
- Ectopic pregnancy. Embryos may wander into the fallopian tubes following embryo transfer. If this happens and the embryo implants in the tube, it causes an ectopic pregnancy, that may require surgery for removal. This occurs in 2 – 5 percent of IVF cycles.
- Stress. IVF can be emotionally and financially stressful. Support from professional counselors, family and friends can help mediate the consequences of the IVF procedure.
- Premature delivery and low birth weight. IVF babies have a slightly increased risk of being born early and having low birth weights.
- Failure to recover eggs. In rare instances, follicles may not release the egg at retrieval.
- Failure of eggs to fertilize. In rare instances, eggs fail to fertilize following insemination.
Preparing for IVF
Before beginning IVF, there are several things to consider:
- The Clinic. If you live in a city with more than one fertility program, you may want to check out the programs within your area to see which have the best success rates by going to the SART (Society for Assisted Reproductive Technology) or CDC websites. You can review the success rates of clinics in your area, with other clinics within the US
- Cost. The cost of fertility treatment can vary depending on the State that you live in and the amount of coverage your insurance plan may provide you. Check out the clinic website to determine what their overall cycle costs are, and make comparisons. If you’re willing to travel, you may find fertility centers with more affordable options.
Once you’ve established the program that you plan to work with, you will need to get an initial consult. You will need to get the following screening studies:
- Semen analysis. You will need a semen analysis as part of your initial workup, and may need a second analysis just prior to your IVF procedure.
- Ovarian reserve testing. Studies such as AMH, FSH and estradiol are used to determine the quantity of eggs remaining in your ovaries. In combination with an ultrasound, these measurement are used to determine the dose of medication needed for ovarian stimulation and to predict the potential outcome for egg retrieval.
- Infectious disease screening. You and your partner will be screened for infectious diseases. These tests are needed in order to store any frozen embryos you might create, in storage tanks with other embryos from other couples. Any potentially infected embryos, are stored in separate quarantine tanks.
- Mock embryo transfer. Your physician may perform a practice embryo transfer to measure uterine depth and determine if there are any factors that might prevent a successful transfer.
- Saline Infusion Sonography. This study is usually done at the same time as the mock embryo transfer. The ultrasound procedure evaluates the uterine cavity for polyps or other masses, by injected saline into the uterus while the ultrasound is performed. This helps to visualize and abnormal structures. If you have polyps or fibroids, they may need to be removed before you can proceed with an embryo transfer.
Prior to embryo transfer, you will be asked to select the embryo(s) to be transferred based on the following:
- Age of the patient. Older women have lower quality embryos resulting in more embryos being transferred.
- Genetic testing. If embryos have been genetically screened and are normal, usually a single embryo transfer is performed. If the sex of the embryo is available, you can choose the sex of the embryo transferred.
What do you do with extra embryos?
- Freezing. Extra embryos are frozen for use in future transfer cycles.
- Long-term storage facility. You may transfer extra embryos to a long-term storage facility if required by the clinic, if you don’t plan on using the embryos within a year. Long-term storage facilities may be less expensive.
- Adoption: Undesired or unneeded embryos can be put up for adoption. Embryo adoptions agencies are available that can help you with the donation process.
- Research: Embryos may be donated for research, depending on the state that you live.
- Discard. Embryos can be discarded in some States, but not all. Check the legal status of embryos in your area.
What if you end up with multiple pregnancies, what can you do?
IVF embryos have a higher twinning rate than normal pregnancies. If you transfer more than one embryo, you have a greater risk of multiples. Fetal reduction is an option for reducing the number of undesired pregnancies and lower the risk to the mother. However, fetal reduction is difficult, ethically, emotionally and psychologically.
Preparing for the Results
About 11-12 days after embryo transfer, you will go to the clinic for a pregnancy test to determine whether you are pregnant.
If your are pregnant: your doctor will repeat the hCG test in 48 hours to determine if you experience a healthy rise in the pregnancy hormone (it should double). If appropriate, you will be scheduled for an ultrasound in about 3 weeks. Once a pregnancy has been confirmed, you will be referred to an obstetrician for prenatal care.
If you are not pregnant; you will stop all medications and await the onset of menses. At that time, you may discuss trying again with a frozen embryo.
Factors affecting success or failure
Chances of having a healthy baby may depend on various factors:
- Embryo status: transfer of more mature, euploid (normal chromosome number) embryos have the highest chance of successful implantation and subsequent delivery
- Maternal age: the younger you are, the greater the likelihood that you will deliver a healthy baby.
- Lifestyle factors: women who smoke or drink typically retrieve fewer eggs and miscarry more often. Obesity can also affect your ability to conceive.
- Reproductive history: Women who have previously delivered a child have a higher rate of success with IVF.