The Basics of IVF, a Not-So-Basic Procedure

IVF. These three letters together have been part of the popular lexicon in the United States since the 1980s and were known to medical researchers long before that.

But what exactly is IVF, or in vitro fertilization? How does it work? What is the success rate? Are there different procedures? Who might want to consider it?

What is IVF?

In vitro fertilization is the process of fertilizing an egg with sperm outside the body, explained Michael Simoni, M.D., a reproductive endocrinologist with Reproductive Medicine Associates of New Jersey. It is the most commonly used form of assisted reproductive technology (ART).

How does in vitro fertilization work?

IVF is accomplished by collecting mature eggs from the ovaries and fertilizing them in an embryology lab with either a partner's sperm or a donor's sperm. The fertilized egg grows for a few days before it is prepared for freezing or put back into the patient's uterus, said Jennifer Makarov, M.D., a board-certified OB-GYN and reproductive endocrinology and infertility specialist at New Hope Fertility in New York City.

While undergoing IVF, the patient's ovaries are stimulated to grow as many eggs as possible for that month or cycle. The eggs are retrieved through a surgical procedure and then brought to a lab where an egg is combined with a sperm to create an embryo. The embryo is then observed for a couple of days as it grows before being implanted back into the uterus, Simoni explained.

IVF success rates

"IVF has the highest success rate of any fertility treatment available," Makarov said.

However, the chances of birth after IVF depend on the age of the patient and the reason they need to do IVF.

"National numbers show around 50 percent of patients less than 35 years old will eventually achieve a live birth with the eggs from one IVF stimulation cycle," Simoni explained. "At 38, that number decreases to 35 percent. After 42, only 4.1 percent of patients will achieve success with one IVF stimulation cycle."

"The success of IVF comes down mostly to the age of the female partner," Makarov added. "As you get older, it can take more egg retrieval cycles in order to get pregnant because age is such an important factor. So we see the success rates go down for women over the age of 35 and more drastically for women ages 40 or over."

Why do people pursue IVF?

Since in vitro fertilization has the highest success rate out of all the available fertility treatments, IVF candidates typically have not been able to get pregnant through other infertility treatments, such as intrauterine insemination (IUI). Other people choose IVF to treat the causes of infertility, such as blocked or damaged fallopian tubes, a very low sperm count or age, Makarov explained.

Patients also choose IVF due to anatomy issues, an inability to carry a pregnancy, a desire to freeze eggs for the future or a need to genetically test an embryo.

One of the most common reasons patients undergo IVF is for "unexplained infertility," which is when modern science cannot find a reason for the person's lack of fertility and all other methods of natural and assisted reproductive technology have been exhausted, Simoni said.

Who is the ideal candidate for IVF?

"The ideal candidate [for IVF] is really anyone who wants to expand their family and understands it may take a little bit of work or maybe a nonconventional route to get there, depending on personal circumstances," Simoni said. "This isn't easy or guaranteed, and if a patient comes into the process with those assumptions, the outcomes can be catastrophic to their well-being."

Patients who have optimized their health—whatever that entails according to their primary care or specialist providers—are good candidates. Many clinics, due to medical and ethical concerns, have cutoffs for different IVF treatments based on age and body mass index (BMI), according to Simoni, who advises patients to look for those parameters.

What should I expect from IVF?

Outside of the initial appointments and consultations, there is a diagnostic component of IVF where you undergo bloodwork, imaging and some "uncomfortable procedures," Simoni warned.

"During the stimulation and transfer cycles, patients should expect transvaginal ultrasounds and bloodwork a few times a week," Simoni added. "The egg retrieval procedure is surgery under general anesthesia with risks, but a minimally invasive surgery nonetheless. The process is very accurately timed, down to hours, so there is almost daily communication with the medical team."

After the egg retrieval process, you may experience discomfort and cramping. Your doctor can likely prescribe pain medication.

How much does IVF cost?

Standard IVF can cost between $15,000 and $30,000, Makarov explained.

The cost of IVF depends on how much medication you use, since IVF medications are expensive and no generic versions of these medications exist. A type of in vitro fertilization called "mini IVF" harnesses natural hormones, which cuts down on the cost of injectable hormones. Mini IVF can range from $10,000 to $15,000, depending on how much embryo testing is done.

"Many employers are choosing to offer fertility benefits for their employees to support family-building, so ask your [human resources] office about it, or at least think about it the next time open enrollment comes around," Simoni said. "I encourage those who may need additional assistance to look into fertility treatment grants. These are usually sponsored by nonprofit organizations to help provide funds to families in which finances are the primary obstacle."

How long does it take to get pregnant with IVF?

Some patients get pregnant within the first month of IVF, while other patients might need to go through multiple months of treatment before getting pregnant, Makarov said.

In terms of the full IVF process, Simoni said you should be aware it takes about two months to complete the diagnostics and come up with a plan. After that, it takes another month to go through treatment and get an embryo. Following that, expect another one to two months to prepare the embryo to transfer back into its uterine environment.

"The fastest would be about four to five months total, from first visit to first pregnancy test. However, there are limited indications to proceed straight to IVF, so do not be surprised if your doctor recommends other interventions or maybe additional diagnostics before proceeding to IVF," Simoni explained.

What are the different types of in vitro fertilization?

Conventional IVF uses a higher dosage of injectable hormones. Mini IVF uses more natural hormones and about 75 percent less of injectable hormones. Natural IVF uses no hormones or injections; rather, this process tracks the body's natural ovulation, Makarov explained.

Traditional and donor IVF are two ways of combining the necessary egg and sperm. Traditional IVF uses the patient's egg and the partner's sperm to be transferred into the patient's own uterus. Donor IVF means a couple uses a donor egg, sperm or embryo because they are unable to use their own.

Co-IVF exists, too. It is a subset of donor IVF when a same-sex couple creates embryos with the egg of one patient and usually fertilizes it with donor sperm. The resulting embryo is then placed into the other partner to carry on the pregnancy, Simoni explained.

In vitro fertilization has come a long way in the 40 years since the first U.S. baby was born using the procedure. Find out more about IVF in future stories that detail the procedure itself, including the risks and benefits, how to discuss the process with a partner and more.