What is IVF?
In vitro fertilization, or IVF, is a method of infertility treatment that involves the fertilization of an egg by a sperm in a laboratory and not in a woman’s body. This method of assisted reproductive technology offers the highest rate of success out of all treatment options for infertility. Although it is the most complex (and costly) treatment option, IVF is not necessarily the best option for every couple and individual with infertility.
Dr. Louis Weckstein gives an overview of IVF
History of IVF
In vitro fertilization, which means “fertilization in glass,” was originally intended as a way for women with blocked fallopian tubes to conceive a child. The treatment has been successfully used to assist those struggling with infertility for over four decades. Louise Brown, the first IVF baby, was born in 1978. At that time, Louise was referred to as the “test tube baby.”
In the 40 years since Louise’s birth, IVF technologies, doctors and methods have greatly improved. IVF is now used to treat a number of infertility causes, not only blocked fallopian tubes. Accordingly, success rates for assisted reproductive technology (ART) have risen, and are reported annually by the Society for Advanced Reproductive Technology, or SART.
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What is the IVF process?
The IVF process includes several steps and can take one to two months to complete the treatment cycle.
Typically, the ovaries stimulate the release of a single egg each month. In IVF the woman receives fertility medication, such as follicle stimulating hormone (FSH) or luteinizing hormone (LH), in order to increase the number of eggs developed. This process is known as superovulation induction. Having multiple eggs is preferable, as some may not be high quality or develop into embryos after fertilization. Multiple eggs also allow us to possibly create more than one embryo, giving the patient more options for a successful pregnancy as well as additional pregnancies in the future with one IVF procedure.
Using a needle, the eggs are retrieved through a transvaginal ultrasound aspiration. During this minor surgical procedure, the patient is heavily sedated to minimize discomfort. Multiple eggs may be gathered at this time.
Sperm may be collected through ejaculation, a special collection condom or in some instances directly from the testicle. When providing a sperm sample, it is advised that the man refrains from ejaculating for two to three days before in order to increase the sperm count. After collection, the sperm and semen are separated and washed.
During this portion of the IVF process, the sperm and egg are combined for fertilization “in glass” (a lab dish) and are then stored in an incubator overnight. The result of successful fertilization is called an embryo.
If there is a problem with sperm count or motility (ability to move to the egg), intracytoplasmic sperm injection, or ICSI, may be performed. ICSI uses a needle to inject a single sperm cell directly into the cystoplasm area of the egg where fertilization occurs. This process increases the chance of fertilization if there are abnormal sperm parameters.
At this point, genetic testing can also be done on the embryos. Preimplantation genetic testing (PGT) is an option most often utilized by women over age 37 and patients with known genetic diseases, previous IVF failures or with a history of recurrent miscarriages. This type of testing can determine if there are any genetic abnormalities that could lead to complications, birth defects, miscarriage and genetic diseases. Genetic problems are a leading cause of failed embryo implantation and miscarriage.
An embryo is then transferred into the uterine cavity. Using a speculum, a physician will insert an embryo into the womb. This process is guided using ultrasound equipment.
eSET, or elective single embryo transfer, can be used during IVF to voluntarily implant only one embryo. This procedure has become more common as the concern over the risks of multiple birth pregnancies, twins or more, has grown. The American Society for Reproductive Medicine (ASRM) has established that the goal of assisted reproductive technology is a healthy singleton pregnancy.
Cryopreservation may be done in order to preserve the patient’s ability to have children at a later time. Fertility preservation can include freezing eggs, sperm or embryos created through IVF. Eggs and embryos are generally frozen through a process of vitrification. This is a rapid process that brings the tissue to subzero temperatures without creating ice crystals that can damage the egg or embryo. The eggs, sperm or embryos can be unfrozen and used at a later date.
Learn more about embryo freezing.
What causes of infertility can IVF treatment overcome?
IVF is often not the first line of treatment for those dealing with infertility. Treatments such as intrauterine insemination may be considered first. But if other treatments do not result in a successful pregnancy, IVF may be the next step.
IVF can help those suffering from problems such as:
- Low sperm count.
- Uterus or fallopian tube abnormalities.
- Ovulation disorders or problems.
- Unexplained infertility.
In vitro fertilization can also help those who otherwise could not experience pregnancy and biological parenthood. This includes women in their late 30s or early 40s who tend to have poor egg quality, same sex couples, single mothers by choice or people who need donor eggs or sperm to conceive.
Learn more about our LGBTQ+ resources.
What are the risks of IVF?
According to the American Pregnancy Association, serious complications from in vitro fertilization are rare, but as with all medical procedures, there are some risks. These potential risks include the following.
- Problems with medication: Typically, the side effects of the ovulation induction medication used during IVF are mild. In some cases, these symptoms can become more severe and include abdominal pain, shortness of breath, weight gain, severe nausea or decreased urinary frequency.
- Egg retrieval: This procedure carries a very slight risk of damage to the bladder or bowel, internal bleeding or infection.
- Embryo transfer: During embryo transfer, there may be spotting, cramping or bleeding following the procedure.
- Risk of multiples: If multiple embryos are transferred, there is a higher chance of a multiple pregnancy. This increases risks for the mother, such as labor complications, and the baby, such as developmental problems.
- Psychological stress: IVF, and all assisted reproductive treatments, can cause emotional and psychological stress. This can be exacerbated by unsuccessful treatments or miscarriage.
Choosing an IVF clinic
There are a number of factors to consider when looking for an IVF clinic. Each patient will face unique challenges when undergoing fertility treatment. Success rates and cost are important aspects to research.
Understanding success rates may be a challenge, as there are a number of ways to interpret IVF outcome statistics. But the most valuable resource for this task is SART. This organization helps maintain the standards for assisted reproductive technology and reports birth data on participating clinics.
In selecting a clinic, it may be beneficial for potential patients to have a preliminary meeting to answer any additional questions they may have. Some examples of questions to ask a potential fertility practice include:
- How much does the procedure cost, including fertility medications?
- How much does cryopreservation and frozen embryo storage cost?
- What are other related details, for example, is there a time limit on storage?
- Does the clinic allow unused embryos to be donated to research or other infertile couples?
- Does the clinic allow and perform disposal of unused embryos?
- Is egg donation an option at this clinic, if necessary?
Because the IVF process is complex and can take a toll financially, prospective patients should ask about financing and payment options. Often insurance does not cover the full cost of IVF. Because of this high price, many clinics offer financing options. Identifying clinics that offer these types of options can help patients find the best clinic for them.
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