In vitro fertilization is an assisted reproduction technique that some couples may use to help them conceive. There are a number of fertility issues why a couple may choose in vitro, which is also known as IVF. First, the couple may have difficult conceiving. This could be due to low number of sperm or low-quality sperm or due to problems with the quality of a woman’s eggs. Improper balance of hormone levels, endometriosis, or poor egg quality can also impact a woman’s ability to conceive. Second, a couple may have a history of genetic defects that could potentially be passed on to their offspring. In vitro is an option because a laboratory can screen for some common genetic defects to determine if the embryos are at-risk for the conditions. Sometimes, prospective parents may choose to have eggs and sperm turned into embryos for the purposes of fertility preservation. This may be a choice before parents undergo cancer treatments, such as radiation or chemotherapy.
While in vitro offers hope for those having difficulty conceiving, the process can be extensive, time-consuming, and expensive. According to WebMD, a cycle of in vitro will typically cost between $10,000 and $15,000. In some states, a portion of fertility treatments are covered under insurance. However, not all states do mandate coverage and hopeful parents-to-be may have to pay all the costs associated with IVF.
It’s important that a person understand all of these factors when considering IVF. However, babies born from in vitro now represent an estimated 1.5 percent of all babies born in the United States each year, according to Baby Center. While there are other options available for assisted reproductive technology, in vitro is by far the most common, with an estimated 99 percent of all technologies being in vitro treatments. If a fertility doctor thinks a couple can move forward with the in vitro fertilization process, there are multiple steps they must complete with the ultimate goal in getting pregnant.
Testing Prior to the In Vitro Fertilization Process
Before a fertility doctor will begin an in vitro cycle, they will often recommend performing extensive testing to determine the health of a man’s sperm and woman’s eggs. They will also perform exams that can determine if a woman has a favorable uterus for growing a baby. While these tests may seem extensive, they can save parents thousands of dollars should conditions be unfavorable for pregnancy. Examples of these tests include:
- Semen analysis: This testing can determine if a man’s semen contain enough sperm to fertilize an embryo.
- Ovarian reserve testing: A doctor may conduct blood testing to determine if a woman has enough hormones, such as follicle-stimulating hormone, estradiol, and antimullerian hormone. These tests can determine how a woman’s ovaries would respond to fertility medications designed to stimulate their fertility. In addition to these tests, an ultrasound to determine if the ovaries are healthy enough to respond to fertility medications.
- Infectious disease screening: The presence of conditions such as HIV and sexually transmitted diseases can result in pelvic inflammatory disease. This can make having a successful pregnancy more difficult. Understanding these challenges before beginning an IVF cycle can help a doctor evaluate a person’s chances for success.
- Uterine cavity exam: An exam such as a sonohysterography can determine if a woman’s cervix and uterus are favorable enough to support a pregnancy. Sometimes, if a woman has a cervix that is too short, this can result in miscarriage. Another option for uterine cavity testing is a hysteroscopy. This is a thin, lighted scope that allows a doctor to view inside the uterus.
Step 1: Ovary Stimulation
A doctor will prescribe medications that are intended to stimulate the ovaries to release not one, but many eggs for possible fertilization. One medication commonly prescribed is gonadotropin. Because timing for when the eggs are released is important, a doctor will also prescribe the medication leuprolide or cetrorelix. These medications are designed to keep the body from releasing an egg too prematurely, when it cannot be harvested.
A woman will usually take these medications for 8 to 14 days. About every two to three days, she will go to her doctor’s office for blood testing. The testing will be for the amount of hormones in the body to determine how the body is responding to the medications. A doctor will also perform regular ultrasounds of the ovaries to determine if the follicles where the eggs develop are responding appropriately. In addition to testing this response, a doctor can determine if medication dosages should be altered in any way to support better follicle growth. In some instances, a woman may not be able to produce enough viable eggs for IVF. In this instance, she may wish to use donor eggs for the IVF process.
Step 2: Administering a Trigger Shot
When a doctor determines that the follicles are mature enough, they will administer something known as a “trigger shot.” This injection is intended to be the final hormone stimulation that will cause the follicles to release mature eggs. The shot usually contains gonadotropin or follicle-stimulating hormone. About a day and a half after the trigger shot is administered, it is time for egg retrieval.
Step 3: Egg Retrieval
For this procedure, a doctor will give a woman medications to help her relax as well as pain-relieving medicines. A doctor will use a special ultrasound probe inserted into the vagina and use a special, thin needle to retrieve the eggs. Ideally, a doctor will remove somewhere between 8 and 15 eggs. Usually, a doctor can remove the eggs in about 30 minutes or less, This process is not associated with a significant amount of side effects. However, some women may experience some uterine cramping and slight bleeding afterward.
A doctor will put the collected eggs into a liquid known as a culture. These eggs are then “incubated” or kept in a warm environment, to foster their health.
Step 4: Sperm Retrieval
The male partner will be asked to make a sperm donation. A fertility specialist will often recommend a man will refrain from habits that may affect a man’s sperm quality and count. This can include refraining from wearing underwear that is too tight as well as avoiding hot baths. Taking the medication cimetidine (Tagamet) is also associated with causing low sperm counts. If a man is unable to donate sperm via masturbation, a doctor may recommend testicular aspiration. This process involves extracting sperm from the testicle directly. One the semen is in the laboratory, the sperm will be separated from the fluid.
Step 5: Fertilizing the Eggs
An embryologist is a medical expert that’s responsible for using the eggs and sperm extracted from a man and woman to create an embryo. The embryologist will examine a woman’s extracted eggs to determine if their quality is enough to have a high success rate for fertilization. Sometimes they will recommend a process called intracytoplasmic sperm injection (ICSI). This process involves using a single sperm injected into the egg for fertilization. This is an alternative to simply combining the sperm with the extracted eggs to see which will become fertilized.
Step 6: Watching the Embryos
The fertilized eggs will turn into embryos, developing over the course of a few days. Usually a couple of days after the embryos are fertilized, they will become what is known as a blastocyte. These are a multi-cell cavity that will ultimately become a placenta and baby. The embryologist will examine the embryos and select the ones that appear to be the most viable. If a family has a history of genetic-related defects, the embryologist may perform screening tests for the most common genetic disorders to ensure the embryo does not have genes present for these defects. However, testing is not available for all types of genetic abnormalities. Doctors will often recommend prenatal testing for genetic abnormalities should a woman become pregnant as a result of IVF.
If there are “extra” embryos that also appear viable, it’s possible to freeze them and save them should a woman require a future round of IVF. This is known as cryopreservation. Using frozen embryos is associated with slightly lower success rates compared with using “fresh” embryos, according to the Mayo Clinic. However, the costs associated with using fresh embryos is much higher. Sometimes couples will choose to donate any remaining embryos to other couples or to research facilities. Others may choose to have them be disposed of.
Step 7: Implanting the Embryos
Several days after the eggs were harvested, the woman will return to the doctor’s office for implantation of the embyros. This process involves inserting a small, thin catheter through the cervix and into the uterus. A doctor will discuss with the couple how many embryos should be implanted. This decision often depends upon a woman’s medical history, age, and previous IVF attempts. Most commonly, anywhere from one to five embryos are inserted. Ideally, the implantation of the embryos will have a positive effect and the embryos will continue to grow and develop. It’s important for a couple to be aware that with more embryos comes a greater chance that they will conceive multiples. According to Baby Center, an estimated 20 percent of women who have babies born through IVF give birth to multiples, which can include triplets.
A woman may experience some side effects associated with the implantation process. Examples of these side effects include:
- Passing a small amount of clear and/or bloody fluid, often occurring immediately after the embryos were transferred due to cervical irritation associated with implanting the embryo(s).
- Breast tenderness, usually due to excess estrogen levels from the IVF cycles
However, if a woman experiences severe pain or symptoms after an IVF cycle, she should contact her doctor immediately.
Usually a woman can take a pregnancy test about two weeks after she has the embryos implanted to see if she may be pregnant. However, sometimes the pregnancy test takes longer to be positive.
Conclusions on the In Vitro Fertilization Process
From start to finish, the IVF process takes about four to six weeks to complete. The success rates for the in vitro fertilization process vary, usually based on a woman’s age at conception. According to Baby Center, the success rates for IVF are as follows:
- Ages 34 and under: 40 percent
- Ages 35 to 37: 31 percent
- Ages 38 to 40: 21 percent
- Ages 41 to 42: 11 percent
- Ages 43 and older: 5 percent
However, an estimated one-fifth of all IVF cycles are cancelled before the parents get to the implantation stage because the medications administered to produce viable eggs may not be effectives. Other times, the medications may cause a woman to develop a condition known as ovarian hyperstimulation syndrome.
Those who are considering IVF should talk to the prospective clinic’s physicians about the clinic’s success rates and costs associated with each step of treatment. Participants should also ask about the likelihood a person will conceive and what potential drawbacks could impact their success rate. If a woman does not become pregnant as a result of the first IVF cycle, there is hope for future cycles. A doctor can evaluate what potentially could be improved in terms of medication administration and embryo transfer. While the decision to proceed can be a difficult one, there are often other lifestyle factors as well as treatment methods that may be able to increase a woman’s likelihood of success in getting pregnant moving forward, such as losing weight or stopping smoking. Each year, the in vitro fertilization process helps women around the world conceive when they didn’t find it possible without medical intervention.
American Pregnancy Association: In Vitro Fertilization
Baby Center: Fertility Treatment: In Vitro Fertilization (IVF)
Mayo Clinic: In Vitro Fertilization
MedlinePlus: In Vitro Fertilization (IVF)