What Is IVF?
IVF stands for in vitro fertilization, which literally means "in lab conception." With IVF treatment, the egg is fertilized with sperm in a petri dish. Typically, many eggs are retrieved from the biological mother (who may or may not be the intended parent), as not every egg will fertilize, and not every fertilized egg will become a viable embryo.
A few days after fertilization, the best embryo or embryos are transferred to the mother or surrogate's uterus via a catheter through the cervix. Any extra embryos may be cryopreserved for future cycles.
When Is IVF Used?
Because the eggs are retrieved directly from the ovaries, and the embryo is transferred to the uterus via the cervix, IVF does not require open, clear fallopian tubes. Women with blocked fallopian tubes can use IVF to achieve pregnancy.
IVF is also used for cases of male infertility that cannot be overcome with IUI treatment or other treatments. In some cases, men with no sperm in their semen may have sperm retrieved directly from the testicles or vas deferens. Men with low sperm count are more likely to achieve treatment success with IVF.
IVF may also be used along with ICSI, which involves taking a single sperm and directly injecting it into an egg. Despite the sperm directly being injected into the egg, fertilization is still not guaranteed, but the chance of pregnancy success is much higher with ICSI than without for those who need this procedure.
IVF may also be used in cases of unexplained infertility, women who need to use an egg or embryo donor, those who are using a traditional surrogate or gestational carrier, or after multiple failed fertility treatments.
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What Is the IVF Procedure?
The IVF procedure may be slightly different for different people, depending on which assisted reproductive technologies are being used and whether or not donor eggs, sperm, or embryos are involved. There are also some situations that lead to a cycle being cancelled in the middle, either because not enough follicles grow or due to a high risk of serious ovarian hyperstimulation syndrome (OHSS).
That said, this is a basic overview of the procedure.
Usually, the woman will start taking birth control pills or an injectable medication that prevents ovulation the cycle before treatment, shutting down the woman's normal ovulation cycle. This is so the doctor can regulate ovulation and not lose the eggs before the retrieval.
After baseline blood work and an ultrasound, the woman will start taking ovulation stimulation medications, typically gonadotropins. In minimal stimulation IVF, clomid or no ovulation stimulating medications are used, but this is unusual. The clinic will monitor follicle growth and hormone levels with ultrasound and blood work every so many days.
When the follicles look ready, the woman will receive an injection of hCG to mature the eggs. An egg retrieval will be scheduled a very specific number of hours after the injection, during which the woman will receive IV sedation and the eggs will be retrieved via an ultrasound guided needle through the vaginal wall.
While the woman is having the egg retrieval, the man will be providing the semen sample. Sometimes this is done once at the retrieval and also sometime before retrieval day (and frozen), in case of problems or anxiety creating the sample.
The semen will go through a special washing procedure, and the eggs will be placed in a special culture. The sperm will be placed with the eggs, in hopes that fertilization will take place.
A few days later, an embryologist will help select the healthiest of the fertilized embryos, if any, and your fertility doctor will help decide how many embryos to transfer. Leftover embryos may be cryopreserved for a later cycle, donated to another couple, or thrown away.
What Is the Success Rate for IVF?
Your chance for IVF success will depend on a variety of factors, including your age, cause(s) of your infertility, whether or not donor eggs are being used, previous treatment outcomes, and the clinic's expertise in your particular needs.
That said, generally, IVF treatment has excellent success rates. According to the 2009 statistics collected by the Society of Assisted Reproductive Technologies (SART), for women younger than 35, the percentage of live births per IVF cycle was about 41%.
Success rates decrease with age, with a 12% rate of success for women age 41 to 42.
Is IVF Safe?
IVF is generally safe, but as with any medical procedure, there are risks. Your doctor should sit down with you and explain all the possible side effects and risks of each procedure.
Ovarian hyperstimulation syndrome (OHSS) occurs in 10% of women going through IVF treatment. For most women, symptoms will be mild and they will recover easily. For a small percentage, OHSS can be more serious and may require hospitalization. Less than 1% of women going through egg retrieval will experience blood clots or kidney failure due to OHSS.
The egg retrieval may cause cramping and discomfort during or after the procedure, but most women will feel better in a day or so. Rare complications include accidental puncture of the bladder, bowel, or blood vessels; pelvic infection; or bleeding from the ovary or pelvic vessels.
If pelvic infection does occur, you'll be treated with intravenous antibiotics. In rare cases of severe infection, the uterus, ovaries or fallopian tubes may need to be surgically removed.
The embryo transfer may cause mild cramping during the procedure. Rarely, women will also experience cramping, bleeding, or spotting after the transfer. In very rare cases, infection can occur. Infection is typically treated with antibiotics.
There is a risk of multiples, which includes twins, triplets, or more. Multiple pregnancies can be risky for both the babies and the mother. It's important to discuss with your doctor how many embryos to transfer, as transferring more than necessary will increase your risk of conceiving twins or more.
Some research has found that IVF may raise the risk of some very rare birth defects, but the risk is still relatively low. Research has also found that the use of ICSI with IVF, in certain cases of male infertility, may increase the risk of infertility and some sexual birth defects for male children. This risk, however, is still low (less than 1% conceived with IVF-ICSI).
What Happens During an IVF Pregnancy?
IVF has a higher risk of conceiving multiples, and a multiple pregnancy carries risks for both the mother and the babies. Risks of a multiple pregnancy include premature labor and delivery, maternal hemorrhage, C-section delivery, pregnancy induced high blood pressure, and gestational diabetes.
Research has also found that women who conceive with IVF are more likely to experience premature labor, even with a singleton baby.
Women who conceive with IVF are more likely to experience spotting in early pregnancy, though it's more likely for their spotting to resolve without harm to the pregnancy.
The risk of miscarriage is about the same for women who conceive naturally, with the risk going up with age. For young women in their 20s, the rate of miscarriage is as low as 15%, while for women over 40, the rate of miscarriage may be over 50%.
There is a 2 to 4% risk of ectopic pregnancy with IVF conception.
What Does IVF Cost?
The average cost for IVF is $12,000, but this can vary depending on what technologies are being used. IVF with egg donation is the most costly, with one cycle being anywhere from $25,000 to $30,000.
Assisted Reproductive Technologies: A Guide for Patients. American Society of Reproductive Medicine. Accessed online July 24, 2011. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ART.pdf
Clinic Summary Reports. Society of Assisted Reproductive Technologies. Accessed online July 24, 2011. https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0
Risks of In Vitro Fertilization (IVF) Patient Fact Sheet. American Society of Reproductive Medicine. Accessed online July 24, 2011. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/risksofivf.pdf