In Vitro Fertilization for Infertility Treatment
In vitro fertilization (IVF) is an assisted reproductive technology used to help promote pregnancy. During IVF, multiple eggs are fertilized by sperm outside of the body in a lab. These eggs and sperm cells can come from the couple trying to conceive, or they can come from donors. Multiple fertilized eggs, also called embryos, are then implanted back into the uterus of the woman in which they came from or into a gestational carrier or a surrogate. From there, these embryos could potentially lead to pregnancy. However, pregnancy does not always occur with IVF. Factors such as age, preexisting conditions, lifestyle choices, number of embryos implanted into the uterus, and more can impact the chance of becoming pregnant post-IVF. IVF is most often performed by reproductive endocrinologists, a type of gynecologist who specializes in infertility. Your reproductive endocrinologist can help determine your chances of getting pregnant using IVF.1-5
When is IVF used?
IVF is a more invasive fertility treatment that can be expensive and time-consuming. IVF may not be a first-line fertility treatment if your provider thinks you may respond to other, less expensive or invasive options, such as fertility medications intended to promote ovulation or intrauterine insemination (where sperm are inserted into the cervix and uterus around the time of ovulation). IVF can be used by individuals who are experiencing difficulties in becoming pregnant due to a variety of reasons, including, but not limited to:
- Uterine fibroids
- Disorders with ovulation
- Damage or blockage of the fallopian tubes
- Loss of ovarian function
- Genetic disorders
- Unexplained infertility
- Male sterility
- Issues with sperm production or sperm abnormalities
- Sexual difficulties, such as erectile dysfunction1,2
In some cases, IVF may be used as a means of preserving fertility. Eggs and sperm can be harvested from the body and frozen in order to store them for later use. This technique may be used for those who might be undergoing treatment that may impact their fertility, eggs, or sperm, such as chemotherapy or radiation therapy for cancer.1,2
What happens during IVF?
Before beginning a cycle of IVF, your provider will perform a variety of tests to look at the number and quality of eggs and sperm between you and your partner, screen for any underlying conditions or infectious diseases, and examine your uterus and cervix using ultrasound imaging or hysteroscopy, both of which provide images of these structures to your provider. If your provider thinks undergoing IVF could lead to pregnancy, the process may be started. Major steps in the IVF process, or an IVF cycle, include the following:
- Ovulation induction: During ovulation induction, you will be given medications to help stimulate your ovaries to produce multiple, mature eggs. You may also be instructed to take additional medications that will help prevent your body from releasing these eggs too soon or to help prepare the lining of your uterus for the upcoming implantation. After a week or two, your provider will take ultrasound images of your eggs to determine if they are ready to be retrieved.
- Retrieval of the eggs: If your eggs are ready to be harvested, your provider will collect and remove them from your body before ovulation. Most often, the eggs will be retrieved through the vagina using ultrasound guidance while you are asleep. The eggs are aspirated from the follicles (the sacs that contain the eggs) using a small needle. Anesthesia is often used in order to make women more comfortable during the procedure. If a woman is donating her eggs for someone else, they are retrieved in the same manner.
- Retrieval of sperm: Sperm samples can come from a woman's partner or from a donor. If your partner is providing the sperm, he will most likely be asked to produce the sample the same day your eggs are retrieved.
- Fertilization: The eggs and sperm are brought together in a lab to promote fertilization. In some cases, they may all be mixed together, while in other cases, it may be necessary to directly match and inject one selected sperm into each egg in a process called intracytoplasmic sperm injection (ICSI). The fertilization method may depend on the underlying cause of infertility or if previous attempts at IVF have not led to pregnancy. Eggs that are fertilized become embryos.
- Embryo transfer: In a typically painless procedure, your doctor will insert a thin, flexible catheter into your vagina and your uterus. One or more of the embryos will be inserted into the uterus through the catheter. The embryos selected for implantation will generally be the healthiest appearing embryos and the number inserted will depend on a variety of factors, including maternal age. Transferring a larger number of embryos can lead to a higher chance of pregnancy, however, it can also lead to a higher chance of becoming pregnant with multiples. Any remaining embryos can be frozen and stored for potential future use.1,2,6
Roughly a week and a half to two weeks after the embryo transfer, the woman will take a pregnancy test. Based on the results of the pregnancy test, either the woman will undergo early pregnancy care and follow-up, or another cycle of IVF may be pursued, if desired.1,2,5
What are the side effects and risks of IVF?
The side effects and risks of IVF include, but are not limited to, the following:
- Mild cramping or bloating
- Breast tenderness
- Side effects related to any fertility medications taken such as mood swings, hot flashes, and abdominal bloating or pain
- Increased risk of infection or bleeding during egg harvesting
- Increased risk of developing an ectopic pregnancy
- Increased risk in developing a multiple gestation pregnancy and its accompanying complications such as low birth weight and increased risk of premature delivery1-3
Please note: This is not an exhaustive list of all the possible side effects. Patients should talk to their doctor about what to expect with treatment.
IVF is also very expensive, costing roughly $10,000 to $15,000, or more, per cycle. It can also be a stressful and emotional experience, especially when a cycle doesn't lead to pregnancy. These issues can lead to their own mental, emotional, and physical challenges for a woman or couple trying to become pregnant.1,3,6,7