Author: Dana Drake Sieden
More than 71,000 babies are born using In Vitro Fertilization (IVF) in the United States each year. If you’re one of many people struggling with infertility, having IVF as an option could offer much needed hope. Below we are going to help walk you through the basics of how the IVF process works and what actually happens during IVF treatment. Then we’ll tell you what you need to know before you start interviewing fertility doctors. Let’s start with finding out who is a good candidate for the treatment.
Who is a candidate for IVF?
IVF is an option for people who are diagnosed with unexplained infertility – which means there’s no definitive explanation or cause for why they can’t get pregnant. It’s a diagnosis that affects about 20-30% of fertility patients. If a woman’s fallopian tubes are irreversibly blocked, or damaged – IVF may be one of only a few options available to get pregnant. If you have tried other treatments like intrauterine insemination (IUI), without any success, IVF is often the next step. Carriers of genetic diseases or disorders like cystic fibrosis, Tay-Sachs and muscular dystrophy can test the health of the embryo by doing a preimplantation genetic diagnosis (PGD) during the IVF process.
How IVF works
IVF is the process of removing and then fertilizing a woman’s eggs in a laboratory, then transferring an embryo, or possibly multiple embryos, back into her uterus – where it will hopefully implant and continue to develop into a healthy fetus.
The treatment is done through a fertility clinic, and the process is carefully monitored over several months by a fertility doctor, also known as a reproductive endocrinologist. IVF isn’t a one-size-fits-all treatment for infertility. What and how many medications you take during treatment depends on several factors including – your age, and whether you have low ovarian reserve or PCOS. You should discuss all of your options with your fertility doctor. If you decide to move forward, your doctor should then design an IVF protocol for your unique medical history.
The IVF Process
The IVF cycle starts with weeks of hormone therapy, typically administered through daily injections. First, the hormones will be used to suppress your natural menstrual cycle.
There are thousands of follicles inside a woman’s ovaries. Most of them contain an immature egg cell, or oocyte. During a woman’s normal menstrual cycle, one of the follicles will grow and mature until it’s about 15-24 millimeters in diameter. When you’re doing IVF, additional fertility drugs are used to increase egg production – so not just one, but many oocytes will mature.
Author: Dana Drake Sieden
Your doctor will continuously measure the size and growth of the follicles inside the ovaries through vaginal ultrasounds. You can expect daily or weekly visits to the fertility clinic throughout this stage.
When you’re using injectable hormones during IVF to stimulate development of the follicles, there is a risk of over stimulating them. Symptoms of ovarian hyperstimulation syndrome (OHSS) typically occur about 10 days after taking the injectable drugs. A mild to moderate case might cause abdominal bloating, soreness in the area of your ovaries, sudden weight gain, nausea, vomiting and diarrhea. In a severe case, which is rare, symptoms include major rapid weight gain of more than 10-15 pounds in five to ten days, and severe abdominal pain. It’s important to be aware of any of these symptoms and report them to your doctor right away.
Once the follicles reach their optimal size, it’s time to take an injection known as the “trigger shot” that signals the ovaries to release the eggs. But within 24 hours, before the ovaries release the eggs, your doctor will do minor surgical procedure to retrieve them. Most people are put under light sedation when the doctor inserts a long, thin needle through the vagina into each ovary to remove the eggs.
The quality of the eggs are inspected, and then there are two potential next steps. Viable eggs can be combined with the sperm, so that the sperm has a chance to enter an egg on its own, as it would in a woman’s fallopian tubes. Another option is for one sperm to be selected and then injected directly into the egg- which is called an intracytoplasmic sperm injection (ICSI). ICSI is usually the preferred method when there are sperm quality, quantity or mobility issues. ICSI is also often utilized when frozen or donor sperm is being used.
The fertilized eggs are observed in the lab anywhere from two to five days, as the cells divide and become embryos. Sometimes, people will choose to do genetic testing (PGD) on the embryos during this time, to rule out any genetic disorders.
The big question of how many embryos to transfer into a woman’s uterus is up for debate. It really depends on several factors including the mother’s age and quality of the embryos. Medical research and many experts recommend transferring only one embryo, if you are under the age of 38. While it might seem like the more you put in, the better your odds – that’s often not the case, see How Many Embryos to Transfer?, for more info.
Once a decision is made, the healthiest embryo, or embryos, are placed into the uterus through a thin tube, called a catheter. Once the embryo implants to the wall of the uterus, the hope is that it will continue to grow and develop into a healthy fetus.
IVF Success Rates
IVF has been around since the late 1970’s. Today assisted reproductive technology (ART) is advancing quickly and fertility doctors are learning more about what works and how to improve IVF success rates each year.
Author: Dana Drake Sieden
The chances of success through IVF depends on many different factors including: your medical condition, how long you’ve been trying, and the IVF protocol being used. Age can also be a major factor. See, IVF Success Rates for more information.
Success rates will also vary from clinic to clinic. When selecting your fertility doctor and clinic, you’ll want to ask a lot of questions. For example, you should know the success rates and experience of the clinic’s embryologist. Don’t base your decision solely on the clinics success rates, because statistics they publish for pregnancy rates may not include live births. The clinic may also only disclose success rates for patients who are 35 and under. If you are over 35, you should ask for success rates for that particular age group, that resulted in a live birth.
Most health insurance companies do not cover IVF in the United States. It’s very common for people to have to do several cycles of IVF treatment before achieving a full-term pregnancy. Keep in mind, there are no guarantees that even multiple attempts of IVF will result in a pregnancy.
There’s a lot to think about when you’re considering IVF – especially when it comes to the financial, emotional and physical impact of the treatment. Sometimes women might feel pressure to rush into IVF for various reasons. But it’s really important to take the time to get all of your questions answered, and to line up the support you’ll need before starting the process.