In vitro fertilization (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Overview
In vitro fertilization (IVF) is one of the treatments for infertility. A woman’s egg and a man’s sperm are fertilized in a laboratory dish. In vitro means outside the body. Fertilization means the sperm has attached to and entered the egg.
How is the in vitro fertilization done?
IVF is a form of assisted reproductive technology (ART). This means special medical techniques are used to help a woman become pregnant. IVF has been successfully used since 1978.
Procedure
Step 1: Stimulation
- Fertility medicines are given to the woman to increase her egg production. Normally, a woman produces one egg per month. Several eggs are produced under the influence of fertility drugs. During this step, the woman will have regular transvaginal ultrasounds to examine the ovaries and blood tests to check hormone levels.
Step 2: Egg Retrieval
- Follicular aspiration (a minor surgical procedure) is done to remove the eggs from the woman’s body. The surgery is normally done as an outpatient procedure in the doctor’s office. The woman will be given medicines so that she does not feel pain during the procedure. Using ultrasound images as a guide, the health care provider inserts a thin needle through the vagina and into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time. The procedure is repeated for the other ovary. The woman may have some cramping after the surgery, but it usually goes away within a day. In rare cases, a pelvic laparoscopy may be needed to remove the eggs.
- If a woman does not or cannot produce any eggs, donated eggs may be used.
Step 3: Insemination and Fertilization
- The man’s sperm is placed together with the best quality eggs and stored in an environmentally controlled chamber. The mixing of the sperm and egg is called insemination. The sperm usually enters (fertilizes) an egg a few hours after insemination. If the doctor thinks the chance of fertilization is low, the laboratory staff may directly inject the sperm into the egg. This is called intracytoplasmic sperm injection (ICSI). Many fertility programs routinely do ICSI on some of the eggs even if everything is normal.
Step 4: Embryo Culture
- When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly check the embryo to make sure it is growing properly. Within about 5 days, a normal embryo has several cells that are actively dividing.
- Couples who have a high risk of passing a genetic (hereditary) disorder to a child may consider pre-implantation genetic diagnosis (PGD). The procedure is done about 3-4 days after the fertilization. Laboratory scientists remove a single cell from each embryo and screen the material for specific genetic disorders. According to the American Society for Reproductive Medicine, PGD can help parents decide which embryos to implant, which decreases the chance of passing a disorder onto the child. The technique is controversial and is not offered at all the centers.
Step 5: Embryo Transfer
- Embryos are placed into the woman’s womb 3-5 days after egg retrieval and fertilization. The procedure is done in the doctor’s office while the woman is awake. The doctor inserts a thin tube (catheter) containing the embryos into the woman’s vagina, through the cervix, and up into the womb. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results.
- More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman’s age. Unused embryos may be frozen and implanted or donated at a later date.
Who needs in vitro fertilization?
IVF is done to help a woman become pregnant. It should be considered as a treatment option for infertility in patients with following risk factors:
- Advanced age of the woman (advanced maternal age)
- Damaged or blocked fallopian tubes (can be caused by pelvic inflammatory disease or prior reproductive surgery)
- Endometriosis
- Male factor infertility, including decreased sperm count and blockage
- Unexplained infertility
Where to find centers that perform in vitro fertilization?
Directions to Hospitals Performing In vitro fertilization
Possible Complications
IVF requires a significant physical, emotional, financial, and time commitment. Couples opting for IVF may experience stress and depression.
Fertility Drugs
Fertility medicines may cause the following side effects in woman:
- Bloating
- Abdominal pain
- Headaches
- Mood swings
- In rare cases, fertility drugs may cause ovarian hyperstimulation syndrome (OHSS). This condition causes a build up of fluid in the abdomen and chest. Symptoms include abdominal pain, bloating, rapid weight gain (10 pounds within 3-5 days), decreased urination despite drinking plenty of fluids, nausea, vomiting, and shortness of breath. Mild cases can be treated with bed rest. More severe cases require draining of the fluid with a needle.
Egg Retrieval
- Risks of egg retrieval include reactions to anesthesia, bleeding, infection, and damage to the structures surrounding the ovaries, including the bowel and bladder.
Risk of Mulitple Pregnancies
- There is a risk of multiple pregnancies when more than one embryo is placed into the womb. Carrying more than one baby at a time increases the risk of premature birth and low birth weight. However, even a single baby born after IVF is at higher risk for prematurity and low birth weight. It is unclear whether IVF increases the risk of birth defects.
Cost Effectiveness
- IVF is very costly. Some, but not all, states have laws that say health insurance companies must offer some type of coverage. However, any insurance plans do not cover infertility treatment. Costs for medicines, surgery, anesthesia, ultrasounds, blood tests, processing the eggs and sperm, embryo storage, and embryo transfer can quickly add up. The exact total of a single IVF cycle varies with each individual, but may cost more than $12,000 - $17,000.
What to expect (outcome and prognosis)?
- According to the Society of Assisted Reproductive Technologies (SART), the approximate chance of giving birth to a live baby after IVF is as follows:
- 41-43% for women under age 35
- 33-36% for women age 35 - 37
- 23-27% for women ages 38 - 40
- 13-18% for women over age 41
- After embryo transfer, the woman may be told to rest for the remainder of the day. Complete bed rest is not necessary, unless there is an increased risk of OHSS. Most women return to normal activities the next day.
- Women who undergo IVF must take daily shots or pills of the hormone progesterone for 8-10 weeks after the embryo transfer. Progesterone is a hormone produced naturally by the ovaries that helps to thicken the lining of the womb (uterus). This makes it easier for the embryo to implant. Too little progesterone during the early weeks of pregnancy may result in a miscarriage.
- About 12-14 days after the embryo transfer, the woman will return to the clinic so that a pregnancy test can be done.
- Call your health care provider right away if you had IVF and have:
- A fever over 100.5 F (38 C)
- Pelvic pain
- Heavy bleeding from the vagina
- Blood in the urine