In Vitro Fertilization (IVF)

Couples and doctors have been successfully using in vitro fertilization (IVF) to overcome infertility at an ever-increasing rate since 1985. Accounting for 99 percent of all assisted reproductive technology (ART) procedures performed in the U.S., IVF is the most popular form of ART by far.

IVF 101: A simplified overview

In natural conception, the microscopic sperm travel all the way through the cervix, through the uterus and up through the fallopian tube, where it may meet an egg (if the female partner is ovulating). Along the way, some sperm meander, get lost and die; it is the hope that one will reach the egg and then break through its outer shell. Once fertilized, the egg continues traveling down the fallopian tube to the uterus, where it implants into the uterus wall and grows into an embryo.

A number of conditions can prevent this from happening, both due to the man's biology (if the sperm don't swim fast enough and die before reaching the egg, for instance), and also the woman's biology (such as a damaged fallopian tube, for one.) In fact, approximately 6 million couples in the US struggle with infertility.

In an IVF conception, you bypass all of this traveling; instead, your doctor retrieves eggs from your ovary (through a technique called aspiration), mixes them with your partner's sperm in a laboratory dish, where the sperm fertilize the eggs and they begin to grow into an embryo. Your doctor then transfers the embryo(s) (in fact, the strongest ones with the best chances of developing) through a catheter directly to your uterus, where at least one will (hopefully) implant and grow.

What are the steps in an IVF cycle?

The total time to complete one IVF cycle can range from four to 10 weeks. Most couples who undergo IVF usually undergo three to five cycles before becoming pregnant.

The basic steps of IVF, also called an IVF Treatment Cycle (IVF Cycle for short), are:

Ovarian stimulation

During ovarian stimulation (also called ovulation induction) you will take multiple medications (fertility drugs) to stimulate your ovaries so they produce multiple, healthy eggs. During ovarian stimulation, your doctor:

  • Uses a combination of oral and injectable medications to stimulate your ovaries and ovarian follicles. (This takes eight to 14 days.)
  • Closely monitors your ovaries and follicles using blood tests and ultrasound. Normally, estrogen increases as the follicles grow, and progesterone stays low until after ovulation.
  • Injects a shot of hCG hormones to trigger your eggs to grow into their final stage of maturation. This will prepare your ovaries to release the eggs to the fallopian tubes. Before ovulation occurs, which is within 34 to 36 hours, your doctor will retrieve the eggs.

Timing is critical. If you ovulate prematurely, or before the doctor can retrieve the eggs, you will have to start this step over.

Egg Retrieval

Once you have enough healthy mature eggs, you move to egg retrieval. This is a minor surgical procedure that usually takes about 30 minutes and is performed on an outpatient basis. During egg retrieval your doctor will:

  • Give you either local anesthesia or mild sedatives to help you relax and to reduce any pain or discomfort during the process.
  • Insert and thread a very thin, fine needle through your vagina and cervix into your ovaries using an ultrasound for guidance.
  • Harvest the eggs, using the ultrasound and a gentle suction pump.

After retrieving the eggs, your doctor carefully examines them for maturity and quality, then puts the healthiest eggs in an IVF dish in an incubator.

Fertilization & Embryo Culture

Your doctor can go about fertilizing the eggs in multiple ways, including mixing the egg and sperm together, or injecting sperm directly into the egg, in a procedure called intracytoplasmic sperm injection (ICSI).

Fertilization usually takes place within a few hours of the sperm and eggs being mixed, just like in unassisted reproduction. Once the egg is fertilized, your doctor puts it back into the incubator, in an embryo culture, so it can grow.

The lab will closely monitor your embryo, examining it through a microscope for any abnormalities.

Embryo transfer

On day three or five, your doctor will transfer multiple embryos (or a single embryo, in the case of elected single embryo transfer--eSET) to your uterus using a thin catheter.

Once there, the embryos are left to implant in the uterus. When an embryo successfully implants, pregnancy results. If any unused embryos remain, you may chose to freeze them for later use, or even donate them to another couple or to science.

After Transfer

After your embryo transfer, you will take daily shots or pills of the hormone progesterone for eight to 10 weeks, to help the embryo implant successfully. The added progesterone helps thicken the lining of your ovaries and uterus, which makes it easier for the embryo stay implanted.

Finally, about 12 -14 days after the transfer, you will take a pregnancy test.

Who does IVF help and what are the success rates?

Doctors use IVF to treat many causes of infertility including:

  • Blocked, damaged, or absent fallopian tubes
  • Hormonal conditions such as polycystic ovarian or primary ovarian syndromes
  • Irregular or absent menstrual cycles
  • Physical issues in the uterus or cervix such as endometriosis or fibroids
  • Male factor (issues with sperm quality/quantity, health and motility, or physical problems producing sperm)
  • Unexplained infertility

According to some reports, pregnancy is achieved in about 30 percent of all cycles (live birth rates are lower at roughly 22.4 percent). These figures can fluctuate depending on the cause of infertility, the skill of your doctor and clinic and finally your age:

  • women under the age of 35 years have a 30 to 35 percent chance of having a baby
  • women 35 to 37 years have a 25 percent chance
  • women 38 to 40 years have a 15 to 20 percent chance
  • women over the age of 40 years have a 6 to 10 percent chance

What is the cost of IVF?

One IVF cycle (minus the associated costs of medications, counseling, emergency health treatments and time off from work) costs about $12,400 in the United States. You may need more than one cycle to successfully conceive, and your insurance may not cover all or any of these treatments.

Couples struggling with infertility often experience stress, financial strain and depression.

IVF and all ART procedures, carry certain risks.

Updated July, 2014

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