In vitro fertilization (IVF) is a type of assistive reproductive technology (ART). It involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm. This fertilized egg is known as an embryo. The embryo can then be frozen for storage or transferred to a woman’s uterus.
Depending on your situation, IVF can use:
- your eggs and your partner’s sperm
- your eggs and donor sperm
- donor eggs and your partner’s sperm
- donor eggs and donor sperm
- donated embryos
Your doctor can also implant embryos in a surrogate, or gestational carrier. This is a woman who carries your baby for you.
The success rate of IVF varies. According to the American Pregnancy Association, the live birth rate for women under age 35 undergoing IVF is 41 to 43 percent. This rate falls to 13 to 18 percent for women over the age of 40.
IVF helps people with infertility who want to have a baby. IVF is expensive and invasive, so couples often try other fertility treatments first. These may include taking fertility drugs or having intrauterine insemination. During that procedure, a doctor transfers sperm directly into a woman’s uterus.
Infertility issues for which IVF may be necessary include:
- reduced fertility in women over the age of 40
- blocked or damaged fallopian tubes
- reduced ovarian function
- uterine fibroids
- male infertility, such as low sperm count or abnormalities in sperm shape
- unexplained infertility
Parents may also choose IVF if they run the risk of passing a genetic disorder on to their offspring. A medical lab can test the embryos for genetic abnormalities. Then, a doctor only implants embryos without genetic defects.
Before beginning IVF, women will first undergo ovarian reserve testing. This involves taking a blood sample and testing it for the level of follicle stimulating hormone (FSH). The results of this test will give your doctor information about the size and quality of your eggs.
Your doctor will also examine your uterus. This may involve doing an ultrasound, which uses high-frequency sound waves to create an image of your uterus. Your doctor may also insert a scope through your vagina and into your uterus. These tests can reveal the health of your uterus and help the doctor determine the best way to implant the embryos.
Men will need to have sperm testing. This involves giving a semen sample, which a lab will analyze for the number, size, and shape of the sperm. If the sperm are weak or damaged, a procedure called intracytoplasmic sperm injection (ICSI) may be necessary. During ICSI, a technician injects sperm directly into the egg. ICSI can be part of the IVF process.
Choosing to have IVF is a very personal decision. There are a number of factors to consider.
- What will you do with any unused embryos?
- How many embryos do you wish to transfer? The more embryos transferred, the higher the risk of a multiple pregnancy. Most doctors won’t transfer more than two embryos.
- How do you feel about the possibility of having twins, triplets, or a higher order multiple pregnancy?
- What about the legal and emotional issues associated with using donated eggs, sperm, and embryos or a surrogate?
- What are the financial, physical, and emotional stresses associated with IVF?
There are five steps involved in IVF:
- egg retrieval
- embryo culture
A woman normally produces one egg during each menstrual cycle. However, IVF requires multiple eggs. Using multiple eggs increases the chances of developing a viable embryo. You’ll receive fertility drugs to increase the number of eggs your body produces. During this time, your doctor will perform regular blood tests and ultrasounds to monitor the production of eggs and to let your doctor know when to retrieve them.
Egg retrieval is known as follicular aspiration. It’s a surgical procedure performed with anesthesia. Your doctor will use an ultrasound wand to guide a needle through your vagina, into your ovary, and into an egg-containing follicle. The needle will suction eggs and fluid out of each follicle.
The male partner will now need to give a semen sample. A technician will mix the sperm with the eggs in a petri dish. If that doesn’t produce embryos, your doctor may decide to use ICSI.
Your doctor will monitor the fertilized eggs to ensure that they’re dividing and developing. The embryos may undergo testing for genetic conditions at this time.
When the embryos are big enough, they can be implanted. This normally occurs three to five days after fertilization. Implantation involves inserting a thin tube called a catheter inserted into your vagina, past your cervix, and into your uterus. Your doctor then releases the embryo into your uterus.
Pregnancy occurs when the embryo implants itself in the uterine wall. This can take 6 to 10 days. A blood test will determine if you’re pregnant.
As with any medical procedure, there are risks associated with IVF. Complications include:
- multiple pregnancies, which increases the risk of low birth weight and premature birth
- miscarriage (pregnancy loss)
- ectopic pregnancy (when the eggs implant outside the uterus)
- ovarian hyperstimulation syndrome (OHSS), a rare condition involving an excess of fluid in the abdomen and chest
- bleeding, infection, or damage to the bowels or bladder (rare)
Deciding whether to undergo in vitro fertilization, and how to try if the first attempt is unsuccessful, is an incredibly complicated decision. The financial, physical, and emotional toll of this process can be difficult. Speak with your doctor extensively to determine what your best options are and if in vitro fertilization is the right path for you and your family. Seek a support group or counselor to help you and your partner through this process.