In Vitro Fertilization Health Article

Definition

In vitro fertilization (IVF) is a procedure in which eggs (ova) from a woman's ovary are removed, they are fertilized with sperm in a laboratory procedure, and then the fertilized egg (embryo) is returned to the woman's uterus.

Purpose

IVF is one of several assisted reproductive techniques (ART) used to help infertile couples to conceive a child. If after one year of having sexual intercourse without the use of birth control a woman is unable to get pregnant, infertility is suspected. Some of the reasons for infertility are damaged or blocked fallopian tubes, hormonal imbalance, or endometriosis in the woman. In the man, low sperm count or poor quality sperm can cause infertility.

IVF is one of several possible methods to increase the chances for an infertile couple to become pregnant. Its use depends on the reason for infertility. IVF may be an option if there is a blockage in the fallopian tube or endometriosis in the woman, or low sperm count or poor quality sperm in the man. There are other possible treatments for these conditions, such as surgery for blocked tubes or endometriosis, which may be attempted before IVF.

IVF will not work for a woman who is incapable of ovulating or with a man who is not able to produce at least a few healthy sperm.

Demographics

IVF has been used successfully since 1978, when the first child to be conceived by this method was born in England. Over the past 20 years, thousands of couples have used this method of ART or similar procedures to conceive.

Description

In vitro fertilization is a procedure in which the joining of egg and sperm takes place outside of a woman's body. A woman may be given fertility drugs before this procedure so that several eggs mature in the ovaries at the same time. The mature eggs (ova) are removed from the woman's ovaries using a long, thin needle. The physician has access to the ovaries using one of two possible procedures. One involves inserting the needle through the vagina (transvaginally); the physician guides the needle to the location in the ovaries with the help of an ultrasound machine. In the other procedure, called laparoscopy, a small thin tube with a viewing lens is inserted through an incision in the navel. This allows the physician to see on a video monitor inside the uterus to locate the ovaries.

Once the eggs are removed, they are mixed with sperm in a laboratory dish or test tube. (This is the origin of the term "test tube baby.") The eggs are monitored for several days. Once there is evidence that fertilization has occurred and the cells have begun to divide, they are then returned to the woman's uterus.

In the procedure to remove eggs, a sufficient number may be gathered to be frozen and saved (either fertilized or unfertilized) for additional IVF attempts.

Diagnosis/Preparation

Once a woman is determined to be a good candidate for in vitro fertilization, she will generally be given fertility drugs to stimulate ovulation and the development of multiple eggs. These drugs may include gonadotropin-releasing hormone agonists (GnRHa), Pergonal, Clomid, or human chorionic gonadotropin (hcg). The maturation of the eggs is then monitored with ultrasound tests and frequent blood tests. If enough eggs mature, a physician will perform the procedure to remove them. The woman may be given a sedative prior to the procedure. A local anesthetic agent may also be used to reduce discomfort during the procedure.

The screening procedures and treatments for infertility can become a long, expensive, and, sometimes, disappointing process. Each IVF attempt takes at least an entire menstrual cycle and can cost $5,000–10,000, which may or may not be covered by health insurance. The anxiety of dealing with infertility can challenge both individuals and their relationship. The added stress and expense of multiple clinic visits, testing, treatments, and surgical procedures can become overwhelming. Couples may want to receive counseling and support through the process.

Aftercare

After the IVF procedure is performed, the woman can resume normal activities. A pregnancy test can be done approximately 12–14 days after the procedure to determine if it was successful.

Risks

The risks associated with in vitro fertilization include the possibility of multiple pregnancy (since several embryos may be implanted) and ectopic pregnancy (an embryo that implants in the fallopian tube or in the abdominal cavity outside the uterus). There is a slight risk of ovarian rupture, bleeding, infections, and complications of anesthesia. If the procedure is successful and pregnancy is achieved, the pregnancy carries the same risks as any pregnancy achieved without assisted technology.