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The Facts About In Vitro Fertilization

IVF is a complex process that makes conception possible for millions of people worldwide.

A microscope is lit from behind by a pink and purple light

In vitro fertilization (IVF) is a series of medical procedures used to boost fertility and assist in conception. Hundreds of thousands of couples in the United States undergo this multistage process each year.

During IVF, mature eggs are retrieved from the ovaries and then sent to a lab to be fertilized by sperm. Once the egg has been fertilized and becomes an embryo, it is transferred from the lab and implanted into the uterus.

People pursue IVF for a number of reasons, and what the process looks like can vary depending on the case.

Looking back at the history of IVF

Fertility treatments like IVF have helped countless patients overcome problems with conception to expand their families. In fact, according to the latest data from the Centers for Disease Control and Prevention, in 2018 there were 306,197 fertility treatment cycles administered in the U.S., with 99 percent of those cycles involving IVF.

The journey to making IVF a reality for humans started in the 1920s, when medical researchers first discovered the female fertility hormones estrogen and progesterone. Later, in the 1940s, medical researchers began to develop supplements that could be used to help with fertility.

Eventually, IVF was developed enough to be tested on living things, starting with mice and rabbits in the 1950s. As animal IVF testing and observation helped to refine and develop the fertility treatment process, researchers eventually moved on to humans. The first human eggs were fertilized in the late 1960s.

Even after those first human IVF developments in the '60s, it took almost another decade to achieve success. The first baby conceived by IVF was born in 1978. More than 40 years later, IVF has become a popular and effective way to address fertility issues across the world.

Who gets IVF?

People turn to IVF for a number of reasons, including infertility, genetic problems or other health issues.

While there are other, less-invasive fertility treatment options available, IVF is typically used as the primary infertility treatment when the patient trying to become pregnant is over 40 years old, according to the Mayo Clinic.

In 2018 there were 306,197 fertility treatment cycles administered in the U.S., with 99 percent of those cycles involving IVF.

IVF may also be the primary option if the patient or their partner is dealing with health conditions like endometriosis, fallopian tube damage or blockage, or an ovulation disorder. Other conditions, such as uterine fibroids, can also make it difficult for a fertilized egg to become implanted in the uterus, making IVF a potential solution.

Oftentimes, IVF is useful for people who have previously had tubal sterilization, which is a procedure in which the fallopian tubes are cut or blocked to permanently prevent pregnancy. IVF can help women who have had their tubes tied conceive without requiring a procedure to reverse the tubal sterilization, which is rarely done anymore due to its low success rate.

Sometimes IVF might be necessary because a patient's partner is experiencing low sperm production or function, either because they've had fertility damaging treatments like cancer therapy or naturally. If semen abnormalities are found, the partner can see a specialist to discuss ways to correct the issue and make sure that there aren't any serious underlying health problems. If sperm quality can't be improved, the couple can decide if they would like to move forward using sperm from a donor.

Couples who are at risk of passing a genetic disorder on to their offspring often turn to IVF. In these cases, the patient's eggs are collected and fertilized, but before they are implanted into the uterus, they are tested for any detectable genetic problems.

It's important to note that not all people who use IVF do so with the intention of getting pregnant immediately. It's not uncommon for patients who are about to begin cancer treatment that can potentially harm fertility, such as radiation or chemotherapy, to use IVF to harvest their eggs to preserve their fertility for future use.

Things you should consider before IVF

While IVF has been successful for many people in recent decades, there are also plenty of cases in which the treatments do not succeed. A number of factors affect success rates, including your overall health, age, personal history with fertility treatments and the reasons behind your fertility struggles.

There's no one-size-fits-all statistic that will tell you if IVF would work for you, but there are resources available to help you predict your chances. The first place to start is your doctor's office. Your doctor will be able to look at your overall health and give you a personalized plan for IVF.

You can also visit the CDC's website, which has an IVF success estimator that works by comparing your demographic information and your reasons for pursuing IVF with the success rates of patients with characteristics similar to yours, data that has been compiled from annual statistics reported by every fertility clinic in the nation.

Another major thing you'll want to consider before committing to IVF is the cost. A single IVF treatment is estimated to cost about $12,000, while the medications you have to take during treatment can cost an additional $3,000 or more. Most clinics offer financing for IVF treatment, and a call to your job's human resources department to find out what fertility benefits you may have is critical. Before you decide to move forward with IVF, be sure that you are prepared to shoulder the expense, which often includes multiple rounds of IVF before achieving success.

And, of course, you should keep in mind that as is the case with any medical procedure, IVF comes with risks. Potential complications include miscarriage, infection, premature delivery and birth defects, among others. Be sure to talk to your doctor about all of the potential risks and benefits of IVF before starting treatment.

How IVF works

A single cycle of IVF includes several steps, including ovarian stimulation, egg retrieval, sperm retrieval, fertilization and embryo transfer. According to medical experts, one cycle can take anywhere from two to three weeks to complete, and multiple cycles may be needed.

If you plan to use your own eggs during IVF, you'll start your cycle by taking synthetic hormones that are designed to stimulate your ovaries so that your body produces multiple eggs, rather than the single egg that is usually released during your monthly ovulation. These hormones are often administered through self-injections at home. You'll also get a medication called human chorionic gonadotropin (hCG), or something similar, which will help the eggs to mature.

Ovulation induction is one of the most important steps in IVF because when more eggs are produced, there are more chances for fertilization, and not all eggs will achieve fertilization.

Other medications included in IVF treatments are intended to prevent premature ovulation and to prepare the lining of your uterus so that it is more receptive to implantation. Once an egg has been fertilized and the embryo is ready to be transferred to the uterus, your uterus will need to be ready to nurture it.

There's no one-size-fits-all statistic that will tell you if IVF would work for you, but there are resources available to help you predict your chances.

To determine whether your eggs are ready for collection, your doctor will likely perform a vaginal ultrasound to take a closer look at your ovaries and administer blood tests to find out how your body is responding to the hormone treatments.

If your doctor finds that there aren't enough follicles developing or that you've ovulated prematurely with an undeveloped egg, your IVF cycle may need to be canceled. Your IVF cycle may also need to be canceled if the vaginal ultrasound finds that too many follicles are developing, as moving forward could put you at risk of ovarian hyperstimulation syndrome, which can cause injury or death.

When a cycle is canceled, your doctor may adjust the doses of your medications with the intention of promoting better success in future IVF cycles. If a patient's response to an IVF cycle is particularly unsuccessful, their doctor may suggest that they seek an egg donor.

When eggs are ready to be collected, the retrieval procedure will be conducted in a doctor’s office 34 to 36 hours after the patient has received their final hormone injection and before they ovulate.

Before the procedure, the patient is sedated and given pain medication. The retrieval is typically performed with an ultrasound probe inserted vaginally to identify follicles (transvaginal ultrasound aspiration). After the probe is inserted, a thin needle connected to a suction device is used to collect the eggs from the follicles over the course of about 20 minutes. Patients can expect pain and cramping after the procedure, which your doctor can treat with pain medication.

Mature and healthy eggs are then sent to a lab where they are mixed with sperm collected from the patient's partner or a sperm donor. The hope is that multiple eggs are successfully fertilized, creating embryos that can be implanted into the patient's uterus. Then the embryos are either frozen for later use or scheduled to be transferred to a patient.

If an embryo is successfully created, a transfer procedure is typically performed in a doctor's office a few days after the eggs were first collected. The doctor inserts a catheter into the vagina, through the cervix and into the uterus. From there, a syringe containing one or more embryos is attached to the catheter and sent through the tube into the uterus. Patients are mildly sedated during embryo transfers, which are typically painless, though the procedure can cause cramping.

After a follow-up appointment, the patient will find out whether the embryo successfully implanted into the lining of the uterus about six to 10 days after the initial egg retrieval. A blood test will also be performed 12 to 14 days after egg retrieval to determine whether the patient is officially pregnant.

Dealing with challenges

IVF is an extensive process that can take a significant toll on a patient both physically and psychologically. Between painful hormone injections, countless doctors appointments, tests and procedures, as well as the stress and anxiety of hoping for success, it's no wonder it can be such a struggle for patients.

If you decide to undergo IVF, it's important that you lean on your support system and communicate how you're feeling with those around you. Be kind to yourself throughout the process, and be sure to talk to your doctor if you have any concerns.