In Vitro Fertilization (IVF)

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In Vitro Fertilization

IVF (In Vitro Fertilization) is the process when an egg is fertilized with sperm outside the body (in a laboratory dish) and then is followed by an embryo transfer.  The embryo transfer procedure is when the fertilized egg (known as an embryo) is placed into the uterus of the female who then carries the baby on to term.  This is the principle treatment for infertility when other forms of ‘assisted reproduction’ have failed.

Possible Side Effects:

  • Cramping for a day or two.
  • Sometimes done with the concurrent use of fertility drugs which can cause Ovarian Hyperstimulation Syndrome (OHSS) and increases the risk of having multiples.

Costs:

  • In the US it can range from $8,000 to $15,000 (plus the costs of the fertility drugs).

Rate of Success (Conception):

  • 6% to 35%; depends on the age of the woman

The IVF Process (Step-by-Step):

There are five basic steps in the IVF process which include the following:

  • Monitoring of the female and stimulating the ovaries to develop healthy eggs (often with medications).
  • Collection (harvesting) of the eggs.
  • Collection of sperm from the donor.
  • Combining the eggs and sperm (in a laboratory) in an environment that allows for fertilization and early embryo growth.
  • Placement of the embryo(s) into the uterus of the female that will carry the embryo through to birth.


Step 1: Often fertility medications are used to manage the egg production from the female’s ovaries increasing the likelihood of collecting more than one egg during a woman normal cycle via a process often called ovulation induction. Because eggs do not always develop or fertilize after collection, production of multiple eggs is needed. Using ultrasound to monitor the ovaries, and taking urine and blood sample to examine hormone levels, egg development can be tracked closely.

Step 2: Guided by ultrasound imaging, a hollow needle is inserted through the pelvic cavity to retrieve the eggs.  This minor surgical procedure is called follicular aspiration and it uses only minor sedation and local anesthesia to limit pain and discomfort of the patient.  Typical symptoms may include cramping on the day of the procedure as well as some pressure or sensations of fullness in the weeks that follow.

Step 3: Sperm is typically obtained via normal ejaculation from the male donor, which is then prepared and stored for later when it is to be combined with the eggs.

Step 4: The prepared sperm and eggs are placed in laboratory incubators that enable fertilization to occur. This process is called insemination. When there is reason to believe that there is a low probability of fertilization via the normal laboratory insemination process, a single sperm can be injected directly into the egg increasing the chances for fertilization.  This is known as introcytoplasmic sperm injection (ICSI).  The eggs are monitored for successful fertilization through observation that looks for cell divisions to commence.  Once cell division is confirmed, the once fertilized eggs are then knows as embryos.

Step 5: The embryos are nurtured in the lab for a short time confirming their health and are commonly transferred into the recipient women’s uterus two to three days after the eggs were retrieved.  The transfer process involves having a preset number of embryos suspended in fluid passed through a catheter that enters the women through the vagina to her womb.  This process is typically guided by ultrasound imaging and is painless to the women, though some minor cramping is common.

Once the above steps are completed, the women is recommended to rest while she is observed for the typically pregnancy symptoms.  Blood tests and on occasion ultrasounds are used to confirm successful implantation and pregnancy.

Frequently Asked Questions

What are the Success Rates of IVF?

Success rates of IVF procedures depend on numerous factors including, but not limited to patient age and type method used. Though it can vary greatly by clinic, patient age, and procedure used, among many variables, in the US, the approximate live birth rate for each IVF cycle is:

– 30% – 35% for women less than 35 years of age
– 25% for women 35 to 37 years of age
– 15% – 20% for women 38 to 40 years of age
– 6% – 10% for women over 40 years of age

Most clinics publish or will inform potential clients of their facility’s success rates.

It is important to know that when comparing success rates among different clinics, once should look closely as to how success is defined.  While some clinics confirm pregnancy via blood or urine tests, a clinical pregnancy is where a pregnancy has been verified through ultrasound.

What if my husband is sterile or my eggs are not healthy?

IVF procedures can also be done with donor eggs, sperm, or embryos if a couple’s own eggs and sperm are not an option.   In approximately 10% of all IVF cycles, donor eggs are utilized.

What are the risks?

As with most medical procedures, there are risks and IVF is no different. The risks of IVF vary with each step of the process.

Step 1: When preparing the female’s ovaries for egg harvesting, there is the risk of hyperstimulation causing the ovaries to become swollen and painful. This condition is known as Ovarian Hyperstimulation Syndrome is rare and can include symptoms like nausea, vomiting, sensation of bloating and lack of appetite.  More severe symptoms can also occur, but those are even more rare

Step 2: This step carries the typical risks associated with minor surgery and laparoscopic procedures. These include risks of receiving anesthesia, bleeding, infection and damage to bowel, bladder or blood vessels among others.  Again, these risks are very rare and happen very infrequently.

Step 3: As will all assisted reproductive procedures, there is a higher possibility for multiple pregnancies. With this come the typical risks and concerns related to multiples during pregnancy including the increased risk of premature delivery.

Please keep in mind that IVF procedures involve a significant financial, physical, and emotional commitment. It is common for couples to endure psychological stress and emotional problems during the process, especially if IVF is unsuccessful.

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