In Vitro Fertilization (IVF)
In vitro fertilization (IVF) at a glance
- IVF is a fertility treatment in which a woman’s egg and a man’s sperm are combined in a laboratory in order to achieve fertilization.
- After growing the fertilized egg (embryo) for several days in an incubator, one or several or more embryos can then be placed in a woman’s uterus to achieve a pregnancy.
- Embryos can also be cryopreserved (frozen and stored) to be used at a later time.
- IVF is an effective treatment for a variety of male and female infertility conditions.
- According to the Society for Assisted Reproductive Technology (SART), the average woman of reproductive age has a 20 to 35 percent chance of getting pregnant per IVF cycle, with even better pregnancy rates for younger women.
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What is IVF?
In vitro fertilization (IVF) is an assisted reproductive technology that begins by collecting a woman’s eggs and a man’s sperm and combining them together outside the woman’s body in a laboratory dish for fertilization. In vitro is Latin for “in glass” and refers to the laboratory Petri dish in which the egg and sperm are combined. After the eggs are fertilized and become embryos, the physician determines the best embryo(s) to transfer to the woman’s uterus.
If IVF treatment is successful, the embryo will implant in the uterus and result in a pregnancy. Any remaining embryos can be frozen and stored for future use or donated to other couples. IVF can overcome most causes of male and female infertility.
IVF is a complex technique involving five basic steps:
- Superovulation, the process of stimulating a woman to release multiple healthy eggs, as opposed to the single egg a woman normally ovulates.
- Egg retrieval and sperm collection.
- Insemination and fertilization of the eggs by the sperm.
- Embryo development and genetic testing (if needed).
- Embryo transfer into a woman’s uterus.
IVF has a high rate of success because it allows for a controlled interaction of eggs and sperm. Medications increase the number of mature eggs a woman can produce at a single time. Doctors can evaluate each developed embryo to determine which ones are most likely to result in pregnancy.
While not appropriate for all couples or individuals, IVF offers a high chance of pregnancy in a short period of time.
The first IVF baby was born in 1978. Nearly 40 years later, births from IVF represent more than 1.5 percent of all babies born in the United States, according to SART.
Who should consider IVF?
Overall, IVF can help some patients experience pregnancy and parenthood who would otherwise not be able to. This includes women in their late 30s or early 40s (see age related infertility below), women otherwise struggling to conceive due to ovulatory problems, anatomical issues or male infertility factors, men and women who need donor sperm or eggs, and same sex couples.
IVF is most commonly recommended for women with nonfunctional or missing fallopian tubes and for men with very poor sperm quality. In some instances, a doctor may first recommend alternative infertility treatments, such as intrauterine insemination (IUI), prior to IVF. However, if these are not successful, IVF is often the next step.
IVF treatment is also beneficial when one or both parents carries potential genetic defects because it allows for preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS) on embryos prior to uterus implantation. PGD and PGS can help increase the chances of a live birth because these forms of genetic testing can identify embryos with chromosomal and genetic defects. Such defects are a major cause of both failure of an embryo to implant and miscarriage. Embryos identified through PGD or PGS as carrying these conditions are not chosen for implantation.
Common reasons to undergo IVF:
- Age related infertility: A woman’s egg quality diminishes with age. IVF can give an older woman a better chance to conceive by increasing the number of eggs she produces, enhancing selection of good quality eggs, or by allowing her to use donor eggs to create embryos.
- Recurrent pregnancy loss/miscarriage: Depending upon the underlying issue for recurrent pregnancy loss, IVF may be an effective treatment in helping to begin a successful pregnancy by increasing the number of candidate embryos and possibly using PGD or PGS to enhance successful implantation.
- Unexplained infertility: One fifth of infertile couples are diagnosed with unexplained infertility, and these couples often achieve pregnancy using IVF.
- Anovulation: If a woman is not ovulating (anovulation), ovulation-inducing pills often aid in achieving pregnancy. But if she is unable to achieve pregnancy with these conservative measures, IVF can be used, which has very high success rates.
- Damaged fallopian tubes: If significant tubal damage exists, the only fertility treatment options are surgical repair, which has a low success rate, and bypassing the fallopian tubes using IVF.
- Male infertility factors: Typically, male infertility factors involve low quantity or quality of sperm. In these cases physicians recommend IVF with intracytoplasmic sperm injection (ICSI).
- Endometriosis: Endometriosis can cause infertility but can be successfully treated using a combination of surgery and medication. If the first round of surgical or medical treatment fails, IVF is an appropriate next step.
- Low ovarian reserve: If a woman has a low number of eggs in her ovaries, the IVF process can be used to stimulate healthy eggs to develop, allowing the reproductive endocrinologist to collect mature eggs directly from the ovaries. In particular, younger women with low ovarian reserve who generally have good egg quality would have better success rates with IVF treatment.
What are the risks of IVF?
The most widely reported risk associated with IVF is a multiple birth pregnancy (twins or more). This can result in pregnancy and labor complications, premature delivery, and ongoing medical and developmental problems for the children. Although IVF can be uncomfortable, most women resume normal activities within a day after undergoing treatment.
As with many medical treatments, there is always a risk of negative drug interactions and side effects. Fertility medications can have a number of side effects including headaches, mood swings, abdominal pain, hot flashes and bloating. Considered a surgical procedure, IVF carries the normal risks of surgery including reaction to anesthesia, blood loss, damage to tissue and organs, and infection.
There is also a very small risk that some women will overreact to the hormone drugs used to stimulate the ovaries, but ultrasound and hormone monitoring during this drug treatment phase usually ensures that any overreaction is foreseen and any risk avoided.