In Vitro Fertilization (IVF)

In Vitro Fertilization

In Vitro Fertilization. If you’ve been struggling to conceive and treatments like fertility medication or IUI haven’t been successful, there could be another option: IVF. Here’s what you need to know about in vitro fertilization.

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While many couples are able to conceive within a few months of trying, others have more difficulty getting pregnant and struggle with infertility. Luckily there are many options for hopeful parents when it comes to fertility treatments — from medications like Clomid (clomiphene) or Femara (letrozole) to intrauterine insemination (IUI) or surgery.

But some couples need a different kind of help — either because those types of fertility treatments are off the table (such as for same-sex couples) or because they’re not successful. That’s where in vitro fertilization, or IVF, comes in. Here’s a primer on the basics to help you determine if this assisted reproductive technology can help you get closer to having a baby.

What is in vitro fertilization (IVF)?

During in vitro fertilization, eggs are fertilized by sperm outside of the body in a laboratory. Then one (or more) of those fertilized eggs is transferred into the uterus with the hope it will implant and result in a pregnancy — and a baby nine months later.

The first IVF baby was born in 1978, and since then, an estimated 8 million have followed worldwide (born via in vitro fertilization and other reproductive technologies). Today, practitioners perform more than 270,000 IVF cycles annually in the United States, resulting in over 74,000 babies born each year.

How does IVF work?

There are a number of fertility treatments that your doctor may suggest before turning to IVF. But for women who have severe blockages in the fallopian tubes, ovulation disorders, diminished ovarian reserve, poor egg quality, or endometriosis, IVF could be the best option for conceiving a baby.

Ditto for men who have insurmountable sperm deficiencies, some same-sex couples, couples using donor eggs, or those who might need to screen embryos when there are concerns about genetic problems.

What is the IVF process and how long does it take?

A lot is involved in an IVF cycle. Luckily, you’ll have a whole team of doctors and nurses to help you along in the process. One cycle of IVF generally takes about two weeks, though you might need more than one and the whole thing generally lasts four to six weeks from start to finish. Here’s what you can expect:

  • Ovulation suppression. Not all hopeful moms-to-be will start with this step — ask your fertility specialist if your cycle will begin with ovarian suppression. If the answer is yes, you’ll be placed on birth control pills (oh, the irony!) or possibly leuprolide (Lupron) to suppress your natural hormones so that your IVF cycle can be optimally timed.
  • Hormone shots. The vast majority of IVF cycles include hormone injections — usually with follicle-stimulating hormone (FSH), luteinizing hormone (LH) or both, though the precise cocktail used will be unique to you — that stimulate the ovaries. (It’s also possible to do in vitro fertilization without ovarian stimulation in what’s called “natural cycle IVF” or “unstimulated IVF,” but those methods are uncommon.) During this ovary stimulation phase, you’ll receive blood tests to monitor your hormone levels plus ultrasounds to see how many egg follicles are growing and how well they’re developing. The ultrasounds will also monitor how well your uterine lining is thickening.
  • Trigger shot. When your follicles are just about ready for egg retrieval (in about eight to 14 days), you’ll inject human chorionic gonadotropin (hCG) or another drug such as Lupron (leuprolide) to help the eggs mature and trigger ovulation.
  • Egg retrieval. Your eggs will be ready for retrieval approximately 36 hours after the trigger hCG shot. The doctor will retrieve the eggs transvaginally with an ultrasound-guided needle that reaches your ovaries and aspirates the fluid and egg from each follicle. Most doctors try to retrieve 10 to 15 eggs per cycle, though the number could be as low as two or three or higher than 15. Egg retrieval typically takes 20 to 30 minutes and is done under IV sedation, so you won’t feel any discomfort. Because you’ll be groggy after the procedure, you’ll need someone else to drive you home. Once you’re back, plan on taking the rest of the day off, resting and relaxing. Be sure to avoid high-impact activities and even sex until after your pregnancy test.
  • Sperm retrieval. On the same day of egg retrieval, the clinic will prepare donor sperm or your partner’s previously frozen sperm, or your partner may produce a sperm sample that day.  
  • Fertilization. It’s time for fertilization! Your eggs will either be fertilized using an intracytoplasmic sperm injection (ICSI), when a single sperm is injected into an egg, or standard insemination, in which the retrieved eggs are placed in a petri dish with 50,000 to 100,000 sperm in the hopes that the magic of fertilization will happen. The culture dishes are left in a special incubator and checked 12 to 24 hours later to see if fertilization took place. Although there are many factors, by some estimates about 50 percent of mature eggs become fertilized using standard insemination and 60 to 70 percent are fertilized via ICSI. 
  • Checking on the embryos. An embryologist will monitor each developing embryo over the next three to five days, looking for healthy growth and development. By day three after fertilization (cleavage stage), the goal is to have a six- to eight-cell embryo, and by day five, there should be a healthy blastocyst. About 30 to 50 percent of IVF embryos make it to the blastocyst stage. Any extra embryos that aren’t going to be transferred can be frozen for future use.
  • Testing the embryos. If preimplantation genetic diagnosis (PGT) is planned, the embryos are biopsied (a few cells are safely removed from the embryo and genetically tested).
  • Progesterone boost. Soon after fertilization (usually either on the day of the egg retrieval or the day of the embryo transfer), your doctor may start you on supplemental progesterone via injection, vaginal suppository or vaginal gel. This hormone will optimize your uterine lining in anticipation of the embryo transfer and implantation. The medication is usually continued at least until a positive pregnancy test result and often through weeks 8 to 10 of pregnancy.
  • Embryo transfer. Usually three or five days after egg retrieval and fertilization (or if you’re using frozen embryos, whenever your uterine lining is ready for implantation), the embryo or embryos are transferred into your uterus. The number of eggs transferred will depend on your age — it’s recommended that women under 35 have only one or two embryos transferred, for example. Using ultrasound guidance, your doctor will insert a thin, flexible catheter through your vagina and cervix into the uterus, and then gently depress the attached syringe containing the embryo(s), placing it in your uterus with the hope that it will implant and continue to grow just as it would with unassisted conception. Some fertility clinics coat the embryo in “embryo glue” before transfer to help it adhere to the uterine wall during implantation. You will be wide awake for the embryo transfer (no anesthesia necessary) and you’ll likely be able to watch the procedure on the ultrasound monitor if you’d like. Most doctors recommend that you take it easy for the first five days after the embryo transfer. That’s to minimize the chances of uterine contractions that might prevent the embryo from implanting. For the same reason, you’ll likely be advised against having sex.
  • The pregnancy test. About two weeks after the embryo transfer, you’ll have a blood test to confirm whether your IVF was successful. As eager as you’ll be to get an early heads-up, don’t be tempted to use a home pregnancy test before you get your blood test results — testing too soon can give you a false positive (if you had a shot of hCG) or a false negative (because it’s too soon for the pregnancy to generate its own hCG).

What is the IVF success rate?

The likelihood that a cycle of in vitro fertilization will result in pregnancy depends on a number of factors, including:

Your age

The younger you are the better your IVF success rate, especially if you’re under 35. That’s because as you age, it becomes less likely your ovaries will respond well to the hormone-stimulating drugs, which in turn means fewer eggs.

What’s more, when you get older, the quality of your eggs will generally diminish (though there are exceptions), which means they may have a harder time implanting in your uterus. Although it can be complicated to calculate, here’s the approximate odds of a live birth per treatment cycle based on age (assuming the use of the woman’s own eggs):

  • For women under age 35: 53.9 percent
  • For women ages 35 to 40: 26 to 40.2 percent
  • For women ages 41 and over: 3.9 to 12.6 percent

Your ovarian reserve

The better your ovarian reserve (the number of high-quality fertilizable eggs left in your ovaries), the higher the chances for IVF success.

Your fallopian tubes

The healthier your fallopian tubes, the higher your IVF success rates. Women with a fluid-filled blockage in one or both fallopian tubes (called a hydrosalpinx) have lower success rates, even though in vitro fertilization bypasses the fallopian tubes altogether. A simple procedure called salpingectomy before attempting IVF can bump up your odds for success.

Your lifestyle

The less healthy your lifestyle (say you smoke, or you’re obese or underweight), the lower your chances for IVF success.

Keep in mind that different fertility clinics have varying success rates. The Society for Assisted Reproductive Technology (SART) and the Centers for Disease Control and Prevention (CDC) track pregnancy and live birth rate by clinics and publish their findings online, so you can size up the success rate of your prospective clinic before signing up for your treatments.

What are the possible side effects of in vitro fertilization? Is it painful?

For couples unable to conceive, in vitro fertilization can deliver the happiest news of all: The baby of their dreams is finally a reality. And more good news: IVF is a safe and often successful procedure. That said, in vitro fertilization does pose a small chance of side effects and can be somewhat painful. Here’s what to look out for during your IVF cycle:

After hormone shots

Your fertility drug injections come with common side effects:

  • Breast tenderness
  • Mood swings
  • Headaches
  • Abdominal pain
  • Nausea
  • Bloating
  • Bruising (where the shots were administered)
  • Pronounced and unusual fatigue

In rare cases, women may develop mild forms of ovarian hyperstimulation syndrome (OHSS). OHSS can cause your ovaries to become swollen and painful. Symptoms include abdominal swelling, mild to moderate abdominal pain, nausea, vomiting and diarrhea. Call your doctor if you’re experiencing symptoms of OHSS.

After egg retrieval

It’s normal to experience cramping or bloating after egg retrieval, and any pain can be relieved with Tylenol.

After embryo transfer

You might notice some bloody or clear discharge after the transfer. That kind of spotting or discharge is totally normal and not a sign that the embryo(s) is lost. It’s usually just the result of the cervix being manipulated during the procedure. Also not unusual: mild cramping, bloating and even slightly sharp pains a few days post-transfer. Contact your doctor if you have questions about any pain you’re experiencing.

Late OHSS, which develops after a successful implantation (usually a week or more after egg retrieval), is much less common than the already uncommon early OHSS, but it usually is more severe. Symptoms of severe OHSS include the following and warrant a call to the doctor right away:

  • Rapid weight gain (two or more pounds a day)
  • Severe bloating and/or severe abdominal pain
  • Decreased urination
  • Ovarian tenderness
  • Severe nausea, vomiting and diarrhea
  • Shortness of breath
  • Low blood pressure

And though in vitro fertilization is generally safe for both moms and babies, it may present some other risks too:

Risks for babies

The greatest risks to baby’s health come from the possibility that there will be two or more babies. Multiples come with multiple risks, including prematurity and risks that stem from being born too early. Even singleton IVF babies face some increased risks, including premature delivery and low birth weight.

Risks for parents

For moms, an IVF pregnancy includes an increased risk of gestational diabetes, hypertension, preeclampsia, placental abruption, placenta previa, and C-section.

The IVF process can also be physically and emotionally trying for you and your partner, if you have one, especially with such high levels of hormones coursing through your body. If you are experiencing anxiety or depression, talk to your doctor so you can get the help you need.

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