In vitro fertilization (IVF) consists of a series of complex procedures used to help with fertility or prevent genetic problems and assist in conceiving a child.
During IVF, mature eggs are collected (retrieved) from the ovaries and fertilized with sperm in a laboratory. The fertilized egg (embryo) or eggs (embryos) are then transferred to a uterus. A full IVF cycle takes about three weeks. Sometimes these steps are divided into different parts and the process can take longer.
IVF is the most effective form of assisted reproductive technology. The procedure can be done using the couple's eggs and sperm or can involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier—someone who has an embryo implanted in the uterus—may be used.
The chance of having a healthy child using IVF depends on many factors, such as age and the cause of infertility. In addition, IVF can be time consuming, expensive and invasive. If more than one embryo is transferred to the uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy).
Your doctor can help you understand how IVF works, the potential risks, and whether this method of infertility treatment is right for you.
Why is it done?
In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If the reason you want to do IVF is to treat infertility, you and your partner can try other non-invasive methods first before choosing IVF, such as fertility drugs to increase egg production or intrauterine insemination – a procedure in which the sperm is placed directly in the uterus at the time of ovulation.
Sometimes, IVF is offered as a primary treatment for infertility in women over the age of 40. IVF can also be done if you have certain health problems. For example, IVF may be an option if you or your partner have:
Fallopian tube damage or blockage. Damage or blockage of the fallopian tube makes it difficult to fertilize an egg or move the pwr embryo into the uterus.
Ovulation disorders. If ovulation occurs infrequently or absent, fewer eggs are available for fertilization.
Endometriosis occurs when the cyst-like tissue of the uterus grows outside of it – often affecting the function of the ovaries, uterus and fallopian tubes.
Urethral fibroids. Fibroids are benign tumors in the uterus. They are common in women in their 30s and 40s. Fibroids can interfere with the implantation of the fertilized egg.
Previous sterilization or removal of tubes. Tubal ligation is a type of sterilization in which the fallopian tubes are cut or blocked to permanently prevent pregnancy. If you want to get pregnant after tubal ligation, IVF can be an alternative to tubal ligation surgery.
Impaired sperm production or function. Below-average sperm concentration, poor sperm movement (poor motility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If sperm abnormalities are detected, a visit to an infertility specialist may be needed to see if there are correctable problems or health concerns.
Unexplained infertility. Unexplained infertility means that no cause of infertility has been found despite evaluation for common causes.
A genetic disorder. If you or your partner are at risk of passing a genetic disorder to your child, you may be a candidate for pre-implantation genetic testing – a procedure that involves IVF. After the eggs are retrieved and fertilized, they are screened for certain genetic problems, although not all genetic problems can be found. Embryos that do not contain identified problems can be transferred into the uterus.
Fertility preservation due to cancer or other health conditions. If you're about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, fertility preservation IVF may be an option. Women can retrieve eggs from their ovaries and freeze them in an unfertilized state for later use, or the eggs can be fertilized and frozen as embryos for future use.
Women who do not have a functioning uterus or for whom pregnancy poses a serious health risk may choose IVF using another person to carry out the pregnancy (gestational carrier). In this case, the woman's eggs are fertilized with sperm, but the resulting embryos are placed in the uterus of the pregnancy carrier.
Risks of IVF include:
Multiple births. IVF increases the risk of multiple births if more
donate unused frozen embryos to another couple or a research institution. You can also choose not to use the leftover embryos at all.
How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy – which poses health risks for both you and the babies. In some cases, fetal reduction can be used to help a woman give birth to fewer babies and have lower health risks. However, fetal reduction is a major decision with ethical, emotional and psychological consequences.
Have you considered the potential complications associated with using donor eggs, sperm or embryos or a gestational carrier? A specialist in the field can help you understand concerns related to the issue, such as the donor's legal rights. In the case of embryo implantation, you may need the help of a lawyer to help you have full parental rights within the legal framework.
What can you expect?
IVF involves several steps – ovarian stimulation, egg retrieval, sperm retrieval, fertilization and embryo transfer. An IVF cycle can last about two to three weeks. However, more than one cycle may be needed.
Ovulation induction?
The start of an IVF cycle begins with the use of synthetic hormones to stimulate the production of multiple eggs in the ovaries – instead of the single egg that normally develops each month. Several eggs are needed as some of them may not be fertilized or develop normally after fertilization.
Several different medications can be used, such as
Ovarian stimulation medications. To stimulate your ovaries, you may receive an injectable medication that contains follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of the two. These drugs stimulate the development of more than one egg at the same time.
Medications for oocyte maturation. When the follicles are ready to receive eggs – generally after eight to 14 days – you will receive human chorionic gonadotropin (HCG) or other medications to help the eggs mature.
Medications to prevent premature ovulation. Used to prevent early development of eggs.
Medicines to prepare mitrwn. On the day of egg retrieval or at the time of embryo transfer, the doctor may recommend that you start taking progesterone supplements to prepare the uterus for the implantation process.
Your doctor will work with you to determine which medications to use and when to use them.
Usually, you will need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, you may need:
Vaginal ultrasound, an imaging examination of your ovaries to monitor the development of follicles – fluid-filled ovarian sacs where egg maturation takes place.
Blood tests to measure your response to ovarian stimulation medications – estrogen levels usually rise as follicles develop and progesterone levels remain low until after ovulation.
Sometimes IVF cycles need to be canceled before egg retrieval for one of the following reasons:
An insufficient number of developing follicles
Premature ovulation
Many follicles develop, creating a risk for ovarian hyperstimulation syndrome
Other medical issues
If your cycle is cancelled, your doctor may recommend changing your medication or dosage to encourage a better response during future IVF cycles, or you may be advised that you need an egg donor.
Egg retrieval
Egg retrieval can be performed in the clinic 34 to 36 hours after the final injection and before ovulation.
During the egg retrieval, you will be sedated and given pain medication.
Transvaginal ultrasound aspiration is the most common method of retrieval. An ultrasound probe is inserted into your vagina to identify follicles. A thin needle is then inserted into an ultrasound guide to pass through the vagina and then into the follicles to retrieve the eggs.
If your ovaries are not accessible via transvaginal ultrasound, an abdominal ultrasound may be used to guide the needle.
The eggs are removed from the follicles through a needle attached to a suction device. Many eggs can be removed in about 20 minutes.
After taking the eggs, you may experience cramping and feelings of fullness or pressure.
Mature eggs are placed in a nutrient fluid and incubated. Eggs that look healthy and mature will mix with sperm to try to create an embryo. However, not all eggs can be fertilized successfully.
Semen retrieval
If you are using your partner's sperm,
a sperm sample should be given on the morning of egg retrieval. Usually the sperm sample is collected through masturbation. Other methods are sometimes required, such as testicular aspiration – using a needle or surgical procedure to extract sperm directly from the testicles. Donor sperm can also be used. Sperm are separated from the semen in the laboratory.
FERTILIZER
Fertilization can be attempted using two common methods:
Conventional insemination. During conventional insemination, healthy sperm and mature eggs are mixed and incubated overnight.
Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when sperm quality or number is a problem or if fertilization attempts during previous IVF cycles have failed.
In certain situations, your doctor may recommend other procedures before embryo transfer.
Assisted hatching. About five to six days after fertilization, an embryo "hatches" from the membrane (zona pellucida), allowing it to implant in the lining of the uterus. If you are older or if you have had several failed IVF attempts, your doctor may recommend assisted hatching – a technique in which a hole is made in the zona pellucida just before the transfer to help the embryo hatch and implant. Assisted hatching is also useful for eggs or embryos that have been previously frozen as the process can harden the zona pellucida.
Pre-implantation genetic test. The embryos are allowed to develop in the incubator until they reach a stage where a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes, usually after five to six days of development. Embryos that do not contain affected genes or chromosomes can be transferred to the uterus. While preimplantation genetic testing can reduce the likelihood that a parent will pass on a genetic problem, it cannot eliminate the risk. Prenatal testing may also be recommended.
Embryo transfer
Embryo transfer is done in a doctor's office or clinic and usually occurs two to five days after egg retrieval.
You may be given a mild sedative. The procedure is usually painless, although you may experience mild cramping.
The doctor will insert a long, thin, flexible tube called a catheter into the vagina, through the cervix, and into the uterus.
A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter.
Using the syringe, the doctor places the embryo or embryos into your uterus.
If successful, an embryo will implant in the lining of your uterus about six to 10 days after egg retrieval.
After the procedure
After the embryo transfer, you can resume your usual daily activities. However, your ovaries may still be enlarged. Consider avoiding strenuous activity, which may cause discomfort.
Typical side effects include:
Passing a small amount of clear or bloody fluid immediately after the procedure – due to the cervix being wiped before the embryo transfer
Breast tenderness due to high estrogen levels
Slight bloating
Mild cramps
Constipation
If you have moderate or severe pain after embryo transfer, contact your doctor. He will be able to tell if there is a problem, whether it is infection, ovarian torsion, or ovarian hyperstimulation syndrome.
Results
About 12 days to two weeks after the egg retrieval, your doctor will test a blood sample to find out if you are pregnant.
If you are pregnant, your doctor will refer you to an obstetrician or other pregnancy specialist for prenatal care.
If you are not pregnant, you will stop taking progesterone and will likely have your period within a week. If you don't get your period or have unusual bleeding, contact your doctor. If you're interested in trying another cycle of in vitro fertilization (IVF), your doctor can suggest steps you can take to improve your chances of getting pregnant through IVF.
The chances of having a healthy baby after using IVF depend on various factors, including:
Mother's age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women aged 41 and over are often advised to consider using donor eggs during IVF to increase the chances of success.
Embryo status.Transfer of embryos that are more developed is associated with higher pregnancy rates compared to less developed embryos (day two or three). However, not all embryos survive the development process. Talk to your doctor or other care provider about your specific situation.
Reproductive history. Women who have given birth before are more likely to be able to conceive using IVF than women who have never given birth. Success rates are lower for women who have previously used IVF several times but have not become pregnant.
The cause of infertility. Having a normal egg supply increases the chances of getting pregnant using IVF. Women who have severe endometriosis are less likely to be able to conceive using IVF than women who have unexplained infertility.
Lifestyle factors. Women who smoke usually have fewer eggs retrieved during IVF and may miscarry more often. Smoking can reduce a woman's chance of success using IVF by 50%. Obesity can reduce the chances of getting pregnant and having a baby. The use of alcohol, recreational drugs, excessive caffeine and certain medications can also be harmful.
Talk to your doctor about any factors that apply to you and how they may affect your chances of a successful pregnancy.
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