Fertility Treatments: In vitro fertilization (IVF)

Fertility Treatments

Fertility Treatments: In vitro fertilization (IVF) is a sophisticated set of treatments used to aid in the creation of a child, to help with fertility, or to prevent genetic abnormalities.

In IVF, mature eggs are extracted (retrieved) from the ovaries and fertilized in a laboratory with sperm. The fertilized egg (embryo) or eggs (embryos) are then transported to the uterus for further development. IVF takes roughly three weeks to complete. When these steps are broken down into smaller chunks, the process can take longer. The most effective form of assisted reproductive technology is in vitro fertilization (IVF). A couple’s own eggs and sperm can be used in the operation. Eggs, sperm, or embryos from a known or anonymous donor may be used in IVF. A gestational carrier, or someone who has an embryo implanted in their uterus, may be employed in some instances.

Many factors, such as your age and the cause of infertility, influence your chances of having a healthy baby through IVF. Furthermore, IVF can be time-consuming, costly, and intrusive. IVF can result in a pregnancy with multiple fetuses if more than one embryo is transplanted to the uterus (multiple pregnancy). Your doctor can explain how IVF works, the dangers involved, and whether this kind of infertility treatment is right for you.

Fertility Treatments

Fertility Treatments: Why is it done?

In vitro fertilization (IVF) is a method of treating infertility and genetic disorders. If IVF is used to treat infertility, you and your spouse may be able to try less intrusive treatment options first, such as fertility medicines to boost egg production or intrauterine insemination, which involves placing sperm directly in the uterus near the time of ovulation. Infertility in women over the age of 40 is sometimes treated using IVF as the main treatment. If you have specific medical issues, IVF may be an option. IVF may be a viable option if you or your partner has:

  • Blockage or injury to the fallopian tube: Damaged or blocked fallopian tubes make it difficult for an egg to be fertilized or for an embryo to reach the uterus.
  • Problems with ovulation. When ovulation is irregular or non-existent, there are fewer eggs accessible for fertilization.
  • Endometriosis: Endometriosis is a condition in which tissue that is comparable to the uterine lining implants and grows outside of the uterus, causing problems with the ovaries, uterus, and fallopian tubes.
  • Fibroids in the uterus: Fibroids are uterine tumors that are benign. Women in their 30s and 40s are more likely to have them. Fibroids can prevent the fertilized egg from implanting.
  • Tubal sterilization or removal in the past: Tubal ligation is a method of sterilization that involves cutting or blocking the fallopian tubes to prevent conception for good. IVF may be an option to tubal ligation reversal surgery if you want to conceive following tubal ligation.
  • Sperm production or function issues. Sperm concentrations that are below average, sperm motility that is poor, or abnormalities in sperm size and shape can all make it difficult for sperm to fertilize an egg. If abnormalities in the sperm are discovered, a visit to an infertility specialist may be required to determine whether there are any correctable issues or underlying health concerns.
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  • Infertility that isn’t explained: Unexplained infertility refers to a situation in which no cause of infertility has been identified after a thorough examination for typical reasons.
  • A genetic condition: If you or your partner are concerned about passing on a genetic condition to your child, you may be a candidate for preimplantation genetic testing, which is an IVF process. After the eggs have been retrieved and fertilized, they are checked for genetic abnormalities, albeit not all of them may be detected. Embryos that do not have any known abnormalities can be implanted in the uterus.
  • Fertility preservation due to cancer or other illnesses. If you’re going to begin cancer treatment that could affect your fertility, such as radiation or chemotherapy, IVF for fertility preservation may be a possibility. Women’s eggs can be retrieved from their ovaries and preserved unfertilized for later use. Alternatively, the eggs can be fertilized and saved as embryos for use in the future. Women who don’t have a functioning uterus or for whom pregnancy poses a major health risk may choose IVF and have the baby carried by someone else (gestational carrier). The woman’s eggs are fertilized with sperm in this situation, but the resulting embryos are implanted in the uterus of the gestational carrier.

Fertility Treatments: What are the risks?

The risks of IVF include:

  • Multiple Births: If more than one embryo is transplanted to your uterus during IVF, you’re more likely to have several children. Pregnancy with multiple fetuses increases the risk of early labor and low birth weight compared to a single fetus pregnancy.
  • Premature birth with a low birth weight: According to research, IVF modestly increases the likelihood of a baby being born prematurely or with a low birth weight.
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  • Ovarian hyperstimulation syndrome is a condition in which the ovaries are overstimulated. Using injectable fertility medicines to promote ovulation, such as human chorionic gonadotropin (HCG), can result in ovarian hyperstimulation syndrome, which causes enlarged and painful ovaries. Mild abdominal pain, bloating, nausea, vomiting, and diarrhea are common symptoms that last a week. However, if you become pregnant, your symptoms may linger for several weeks. Rarely, a more severe form of ovarian hyperstimulation syndrome can occur, resulting in rapid weight gain and shortness of breath.
  • Miscarriage: Miscarriage rates for women who conceive through IVF with fresh embryos are similar to those for women who conceive spontaneously, ranging from 15% to 25%. However, the rate rises with maternal age.
  • Complications during the egg retrieval procedure: When collecting eggs using an aspirating needle, there is a risk of bleeding, infection, or damage to the intestine, bladder, or blood vessels. Sedation and general anesthesia, if administered, are also associated with risks.
  • The occurrence of an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, generally in a fallopian tube, in about 2% to 5% of women who undergo IVF. The fertilized egg will not survive outside the uterus, and the pregnancy will be terminated.
  • Birth Defects: No matter how the kid is conceived, the mother’s age is the greatest risk factor in the development of birth abnormalities. More research is needed to see if babies conceived through IVF are more likely to have certain birth abnormalities.
  • Cancer. Although some early research revealed a link between some egg-stimulating medicines and the development of a certain form of ovarian tumor, more recent research contradicts these findings. After IVF, the risk of breast, endometrial, cervical, or ovarian cancer does not appear to be considerably elevated.
  • Stress. IVF can be costly, physically demanding, and emotionally stressful. Counselors, family, and friends can offer support to you and your partner as you navigate the ups and downs of infertility treatment.
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How you prepare

Individual pregnancy and live birth rates at U.S. clinics are available online from the Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology. The success rate of a clinic is determined by a variety of factors. Patients’ ages and medical concerns, as well as the clinic’s treatment population and treatment procedures, are all factors to consider. Inquire about the charges involved with each phase of the operation in detail. You and your spouse will almost certainly need a variety of tests before starting an IVF cycle with your own eggs and sperm, including:

Fertility Treatments
  • Examination of the ovarian reserve: During the first few days of your menstrual cycle, your doctor may test the concentrations of follicle-stimulating hormone (FSH), estradiol (estrogen), and anti-mullerian hormone in your blood to evaluate the quantity and quality of your eggs. The findings of your tests, when combined with an ultrasound of your ovaries, can help you forecast how your ovaries will react to fertility drugs.
  • Examination of sperm. A semen analysis will be performed shortly before the start of an IVF treatment cycle if it was not done as part of your first fertility evaluation.
  • Screening for infectious diseases: Infectious diseases, including HIV, will be screened for both you and your companion.
  • Experiment with (mock) embryo transfer. A “mock embryo transfer” may be performed by your doctor to establish the depth of your uterine cavity and the most likely approach for successfully implanting the embryos into your uterus.
  • A uterine examination. Before you begin IVF, your doctor will check the interior lining of your uterus. A sonohysterogram—in which fluid is injected into your uterus through the cervix—and an ultrasound to create images of your uterine cavity may be used. It could also entail a hysterectomy, in which a thin, flexible, illuminated telescope (hysteroscope) is introduced into your uterus through your vaginal and cervix.

Consider the following critical questions before starting an IVF cycle:

  • What is the expected number of embryos to be transferred? The number of embryos transferred is usually determined by the age of the patient and the quantity of eggs recovered. Because older women have a reduced chance of implantation, more embryos are normally transplanted unless they are using donated eggs or genetically screened embryos.

To avoid a higher-order multiple pregnancy, such as triplets or more, most doctors adhere to strict rules. In several countries, the number of embryos that can be transplanted is limited. Before the transfer operation, make sure you and your doctor agree on the number of embryos to be transplanted.

Fertility Treatments
  • What are your plans for any extra embryos? Extra embryos can be frozen and kept for several years for future use. Although most embryos will survive the freezing and thawing process, some will not.

Having frozen embryos on hand can reduce the cost and invasiveness of future IVF cycles. You could even donate any remaining frozen embryos to another couple or a research center. You can also choose to toss out any embryos that aren’t being used.

  • How will you handle a multiple pregnancy? IVF can result in a multiple pregnancy if more than one embryo is transplanted to your uterus, posing health hazards to both you and your infants. Fetal reduction may be utilized to help a woman birth fewer infants with fewer health concerns in some instances. However, pursuing fetal reduction is a significant decision with ethical, emotional, and psychological ramifications.
  • Have you considered the risks of using donated eggs, sperm, or embryos, as well as the use of a gestational carrier? A skilled counselor with experience in donor issues can assist you in understanding your concerns, including the donor’s legal rights. You may also require the services of an attorney to file court papers on your behalf in order to become the legal parents of an implanted embryo.

What you can expect:

Ovarian stimulation, egg retrieval, sperm retrieval, fertilization, and embryo transfer are all milestones in the IVF process. IVF cycles might take anywhere from two to three weeks to complete. It’s possible that more than one cycle is required.

Ovulation induction

Synthetic hormones are used to stimulate the ovaries to generate numerous eggs rather than the solitary egg that normally develops each month at the start of an IVF cycle. Because some eggs will not fertilize or develop normally following fertilization, many eggs are required. There are a variety of drugs that can be used, including:

Fertility Treatments
  • Ovarian stimulation medications: You may be given an injectable medicine containing follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of both to activate your ovaries. These drugs cause more than one egg to grow at the same time.
  • Oocyte maturation medications You’ll take human chorionic gonadotropin (HCG) or other medications to help the eggs mature when the follicles are ready for egg retrieval, which usually takes eight to 14 days.
  • Anti-ovulation drugs to prevent ovulation prematurely: These drugs prevent your body from prematurely releasing the developing eggs.
  • Medications to help your uterus’ lining prepare: Your doctor may recommend that you start taking progesterone supplements on the day of egg retrieval or on the day of embryo transfer to make the lining of your uterus more receptive to implantation. Your doctor and you will decide which drugs to take and when to take them. Before your eggs are ready for retrieval, you’ll require one to two weeks of ovarian stimulation. You may need to do the following to figure out when the eggs are ready to be collected:
  • Vaginal ultrasound, which is an imaging scan of your ovaries to track the growth of follicles, which are fluid-filled ovarian sacs where eggs mature.
  • Blood tests to see how well you’re responding to ovarian stimulation medicines As follicles form, estrogen levels rise, while progesterone levels stay low until after ovulation. For one of the following reasons, IVF cycles may need to be canceled before egg retrieval:
  • Inadequate number of follicles growing
  • Premature ovulation
  • Too many follicles develop, raising the risk of ovarian hyperstimulation syndrome.
  • Other medical issues
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If your cycle is canceled, your doctor may suggest that you change your drugs or their doses to improve your chances of a successful IVF cycle in the future. You may also be told that you require the services of an egg donor.

Fertility Treatments

Egg retrieval

Egg retrieval can be done 34 to 36 hours after the final injection and before ovulation in your doctor’s office or a facility.

  • You’ll be sedated and given pain medication during egg retrieval.
  • Transvaginal ultrasound aspiration is the most common method of retrieval. An ultrasound probe is put into the vaginal canal to locate follicles. The eggs are then extracted using a small needle put into an ultrasound guide that travels down the vaginal canal and into the follicles.
  • If transvaginal ultrasound can’t reach your ovaries, an abdominal ultrasound may be utilized to guide the needle.
  • A needle coupled with a suction device is used to retrieve the eggs from the follicles. In around 20 minutes, you can retrieve many eggs.
  • You may suffer from cramps and a sense of fullness or pressure after egg retrieval.
  • Mature eggs are incubated in a nourishing liquid (culture medium). Healthy, mature eggs will be combined with sperm in an attempt to generate embryos. However, not all of the eggs will be fertilized.

Sperm retrieval

If you’re utilizing your partner’s sperm, you’ll need to deliver a semen sample on the morning of egg retrieval at your doctor’s office or clinic. Masturbation is usually used to get a sample of sperm. Testicular aspiration, which involves extracting sperm straight from the testicle using a needle or surgical technique, is sometimes required. Sperm from donors can also be used. In the lab, sperm and semen fluid are separated.


Fertilization can be attempted using two common methods:

  • Insemination done the old-fashioned way. Healthy sperm and mature eggs are combined and incubated overnight during traditional insemination.
  • Sperm injection into the cytoplasm (ICSI). ICSI involves injecting a single healthy sperm straight into each maturing egg. When the quality or quantity of sperm is a concern, or fertilization attempts during previous IVF cycles have failed, ICSI is frequently performed.

In some cases, other procedures may be recommended by your doctor before embryo transfer.

  • Hatching with assistance. An embryo “hatches” from its surrounding membrane (zona pellucida) about five to six days after fertilization, allowing it to implant into the uterine lining. If you’re a mature woman with a history of failed IVF attempts, your doctor may suggest assisted hatching, which is a technique in which a hole is cut in the zona pellucida right before transfer to help the embryo hatch and implant. Because the technique can thicken the zona pellucida, assisted hatching is especially effective for eggs or embryos that have been previously frozen.
  • Genetic testing prior to implantation: After five to six days of development, embryos are allowed to develop in the incubator until a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes. Embryos with no abnormal genes or chromosomes can be implanted in your uterus. Preimplantation genetic testing can lessen the danger of a parent passing on a genetic disease, but it can’t completely remove it. It’s possible that prenatal testing will still be advised.

Embryo transfer

Embryo transfer is normally done two to five days following egg retrieval, either at your doctor’s office or a facility.

  • A light sedative may be administered to you. Although you may suffer mild cramping, the treatment is normally painless.
  • A catheter, a long, thin, flexible tube, will be inserted into your vagina, through your cervix, and into your uterus by your doctor.
  • The catheter’s end is linked to a syringe holding one or more embryos suspended in a small volume of fluid.
  • The doctor injects the embryo or embryos into your uterus with a syringe.

If it is successful, an embryo will implant in the lining of your uterus about six to ten days following egg retrieval.

Fertility Treatments

After the procedure

You can resume your normal daily activities after the embryo transfer. Your ovaries, however, may still be swollen. Avoid strenuous activities if you can, as it may cause discomfort.

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The following are some of the most common negative effects:

  • Passing a tiny amount of clear or red fluid quickly after the surgery is due to the cervix being swabbed prior to the embryo transfer.
  • Breast tenderness due to high estrogen levels
  • Mild bloating
  • Mild cramping
  • Constipation

Contact your doctor if you experience moderate or severe pain following the embryo transfer. He or she will look for problems like infection, ovarian torsion, and severe ovarian hyperstimulation syndrome.


Your doctor will analyze a sample of your blood 12 to two weeks following the egg retrieval to see if you’re pregnant.

  • If you’re pregnant, your doctor will refer you to an obstetrician or other pregnancy expert for prenatal care;
  • If you’re not pregnant, you’ll stop taking progesterone and will most likely start bleeding within a week. Contact your doctor if you don’t get your period or if you have unusual bleeding. If you want to try another round of in vitro fertilization (IVF), your doctor may suggest some steps you can take to increase your chances of becoming pregnant.
Fertility Treatments

The chances of having a healthy baby after IVF are determined by a number of factors, including:

  • The age of the mother: You’re more likely to get pregnant and give birth to a healthy kid using your own eggs via IVF if you’re younger. To boost the chances of success, women over the age of 41 are frequently advised to consider using donor eggs during IVF.
  • The state of the embryo: embryos that are more developed are related to higher pregnancy rates than embryos that are less developed (day two or three). Not all embryos, however, make it through the development process. Discuss your specific situation with your doctor or other health care professional.
  • A history of pregnancy: Women who have previously given birth have a higher chance of conceiving via IVF than women who have never given birth. Women who have tried IVF several times yet failed to conceive have lower success rates.
  • The reason behind infertility: Having a regular supply of eggs improves your chances of becoming pregnant with IVF. Those with severe endometriosis had a lower chance of getting pregnant with IVF than women with unexplained infertility.
  • Aspects of one’s lifestyle: Women who smoke have fewer eggs retrieved during IVF and are more likely to miscarry. Smoking reduces a woman’s chances of success with IVF by 50%. Obesity can make it more difficult to become pregnant and have a child. Alcohol, recreational drugs, too much caffeine, and some prescriptions can all be dangerous.

Discuss any issues that pertain to you with your doctor and how they may affect your chances of a successful pregnancy.

What Are the Success Rates for IVF?

The reason for infertility, where the operation is being performed, whether the eggs are frozen or fresh, whether the eggs are donated or your own, and your age all affect IVF success rates. The Centers for Disease Control and Prevention (CDC) provides national statistics for all assisted reproductive technology operations conducted in the United States, including IVF, GIFT, and ZIFT, albeit IVF is by far the most prevalent, accounting for 99 percent of procedures.

According to the most recent study, 50 percent of IVF operations in women aged 35 and under resulted in a live birth. Only 3.9 percent of egg transplants for women aged 42 and up resulted in a pregnancy.

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Are There Other Issues With IVF to Consider?

Embryos that aren’t used in your initial IVF round can be frozen and used later. If you need IVF a second or third time, this will save you money. If you don’t want your leftover embryos, you and your partner can either donate them to another infertile couple or ask the clinic to destroy them. Before the clinic destroys or donates your embryos, you and your partner must consent.

The age of a woman plays a significant role in the effectiveness of IVF for any couple. In 2018, a woman under the age of 35 who utilized her own eggs had a 37.6% chance of conceiving a singleton (one kid) through IVF, compared to an 11 percent chance for a woman between the ages of 41 and 42. With numerous egg transfers, the success rate rises.

According to the CDC, the success rate of IVF is rising in all age groups as procedures improve and doctors gain more experience.

What is the cost of IVF?

According to the National Conference of State Legislatures, the average cost of an IVF cycle in the United States is between $12,000 and $17,000. This cost will vary based on where you reside, how many medications you’ll need to take, how many IVF cycles you’ll need, and how much your insurance company will pay for the process. You should research your insurance company’s IVF coverage thoroughly and request a written explanation of your benefits. Many states have not implemented laws requiring insurance companies to cover at least some of the cost of infertility treatment, despite the fact that some have.

Also keep in mind that some insurance companies will cover the cost of infertility medicines and monitoring but not IVF or other artificial reproductive techniques. Resolve: The National Infertility Association distributes an “Infertility Insurance Advisor” brochure that offers advice on how to analyze your insurance coverage contract.

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