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. The fertilized eggs (embryos) are then implanted back into the uterus of the person they came from. Or, they may be implanted into a gestational carrier or surrogate.^1-5

From there, these embryos may 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 after IVF.^1-5

IVF is most often performed by reproductive endocrinologists. This is 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 doctor thinks you may respond to other less expensive or invasive options. Examples include fertility drugs that aim to promote ovulation or intrauterine insemination. This is a procedure where sperm are inserted into the cervix and uterus around the time of ovulation. IVF can be used by people who are having difficulties in becoming pregnant due to a variety of reasons, such as:^1,2

• Endometriosis
• 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 dysfunction

In some cases, IVF may be used as a means of preserving fertility. Eggs and sperm can be harvested from the body. They are then frozen in order to store them for later use. This method may be used by people 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 doctor will perform a variety of tests to look at the number and quality of eggs and sperm between you and your partner. Your doctor will also screen for any underlying conditions or infectious diseases. They will also examine your uterus and cervix using ultrasound imaging or hysteroscopy.

If your doctor thinks IVF could lead to pregnancy, the process may be started. Major steps in the IVF process, or an IVF cycle, include the following:^1,2,6

• Ovulation induction – During this step, you will be given drugs to help stimulate your ovaries to produce multiple, mature eggs. You may also need to take other drugs to 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 2, 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 doctor 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 retrieved from the follicles (the sacs that contain the eggs) using a small needle. If a person is donating their eggs to someone else, they are retrieved in the same manner.
• Retrieval of sperm – Sperm samples can come from a person's partner or from a donor. If your partner is providing the sperm, they 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. In other cases, 1 sperm may be directly matched and injected into 1 egg. This process is called intracytoplasmic sperm injection (ICSI). The method used may depend on the underlying cause of infertility or if previous IVF attempts 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 usually be those that appear healthiest. 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.

Roughly 10 days to 2 weeks after the embryo transfer, you will take a pregnancy test. Based on the results of the pregnancy test, you will either undergo early pregnancy care and follow-up, or another cycle of IVF may be pursued, if desired.^1,2,5

What are the possible side effects of IVF?

The side effects and risks of IVF include:^1-3

• Mild cramping or bloating
• Constipation
• Breast tenderness
• Side effects related to any fertility drugs 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 of becoming pregnant with multiples. This includes complications such as low birth weight and increased risk of premature delivery

These are not all the possible side effects of IVF. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with IVF.

Things to know about IVF

IVF is very expensive. The cost is roughly $10,000 to $15,000 per cycle. It can also be a stressful and emotional experience, especially when a cycle does not lead to pregnancy. These issues can lead to their own mental, emotional, and physical challenges for a person or couple trying to become pregnant.^1,3,6,7