In Vitro Fertilization (IVF)
IVF at a glance
- In vitro fertilization (IVF) is a laboratory procedure that retrieves a woman’s eggs, fertilizes them with a man’s sperm, and places the resulting embryo into the woman’s uterus to achieve pregnancy.
- IVF is the most successful fertility treatment currently available and can be effective against a variety of infertility conditions that affect men and women.
- Single embryo transfer is considered the optimal approach to IVF, since it reduces the risk of conceiving twins, triplets or more, which can have serious health risks for mother and child.
What is IVF?
The term in vitro is Latin for “in glass,” which refers to the method of combining eggs and sperm in a Petri dish in a fertility clinic laboratory. When the sperm fertilizes an egg, an embryo is created that will be transferred directly into the woman’s uterus.
In preparation for IVF, the woman takes medication that stimulates her ovaries to produce mature eggs, which are retrieved surgically. The man provides a sperm sample, either naturally or via surgical procedure.
If male factor infertility is present, the couple may opt to use intracytoplasmic sperm injection (ICSI), a form of artificial insemination, or use the sperm of a donor.
A fertility specialist carefully monitors the fertilization process in the laboratory and evaluates the quality of each embryo prior to transfer into the woman’s uterus. If indicated, genetic screening tests, such as preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS), can be performed. Because approximately 40 percent of IVF embryos have chromosomal abnormalities that result in a failed pregnancy, genetic testing to screen out those flawed embryos increases the chances for successful implantation and pregnancy. It also minimizes the risk of implanting an embryo with heritable conditions or serious health problems.
During transfer, an embryo is placed into the woman’s uterus, where it will hopefully implant itself in the uterine lining and continue to develop during a full-term pregnancy into a healthy baby.
A fresh IVF cycle is when the complete IVF process from egg retrieval through embryo transfer occurs within the same cycle.
Embryos created with the IVF process can also be frozen for use in another cycle if the first cycle doesn’t succeed, for a future pregnancy. Since the embryos are already created, patients can do a frozen IVF cycle, in which the woman’s uterus is prepped for implantation and the frozen embryos is thawed and transferred to the woman’s uterus.
Studies show that both fresh and frozen IVF cycle techniques are equally viable methods of embryo transfer. Recent data shows improved pregnancy outcomes with frozen embryos transfers. If the woman is at risk for ovarian hysperstimulation syndrome or her progesterone levels become elevated prematurely during an IVF cycle the embryos are frozen and transferred later instead of putting them back into the uterus during a fresh cycle. Doing so improves the chances of a successful pregnancy and live birth.
Who should consider IVF?
IVF is an effective assisted reproductive technology for both men and women with a range of infertility conditions. It is the primary treatment option for women with damaged, non-existent or abnormal fallopian tubes, or for men with very poor sperm quality.
For patients with other conditions, fertility specialists may recommend trying a different treatment first, and considering IVF as a second-line approach. This approach is often taken because IVF is a complex process and it is also the most expensive assisted reproductive technology. As a second-line treatment, IVF can be beneficial for patients with:
- Low ovarian reserve
- Age-related infertility
- Male factor infertility
- Unexplained infertility.
In addition, patients may choose to undergo IVF treatment who would not otherwise be able to experience pregnancy or biological parenthood, including those who must use donated sperm or eggs, single mothers by choice, or same-sex couples.
What are the risks of IVF?
According to the American Society for Reproductive Medicine, serious complications from the medications or procedures used during IVF treatment are rare. As with any medical procedure, there are potential health risks involved. Following are the types of risks associated with the different aspects of IVF treatment.
Fertility medication risks
The drugs prescribed for ovarian stimulation may cause side effects that include:
- Allergic reactions
- Gastrointestinal discomfort
- Changes in mood
- Soreness or bruising at the site of medication injections.
IVF medications can also cause ovarian hyperstimulation syndrome (OHSS), which affects 10 percent of women undergoing IVF. OHSS is an over stimulation of the ovaries that causes enlargement of the ovaries, abdominal fluid retention and weight gain. Generally, OHSS causes mild to moderate pain, bloating and decreased appetite. About one percent of patients who experience OHSS will develop more serious symptoms, including:
- Intense nausea or vomiting
- Dark-colored urine and decreased urinary frequency
- Severe abdominal pain
- Sudden, significant weight gain (10 pounds or more over a 3-5 day period)
- Blood clots in the legs
- Shortness of breath.
If severe OHSS occurs, the fertility doctor may recommend delaying or rescheduling the embryo transfer until the woman recovers. In some cases, OHSS can occur after embryo transfer, and may last until the tenth week of pregnancy before resolving.
Egg retrieval risks
Egg retrieval is a transvaginal surgical procedure in which a long needle is guided through the vagina into the ovary where it retrieves eggs from follicles. Aside from risks associated with the use of anesthesia during the procedure, egg retrieval carries a slight chance of pelvic and abdominal pain, internal bleeding, infection, or damage to the blood vessels, bladder or bowel.
Embryo transfer risks
During the embryo transfer, a catheter is inserted into the uterus that can cause cramps, spotting or bleeding.
Risk of multiple pregnancy
Some patients will have more than one embryo transferred at a time, which increases the chance of becoming pregnant. However, it also increases the chance of being pregnant with twins, triplets or other multiples. Physicians should strive to transfer the minimum number of embryos that will result in the highest chance of pregnancy while keeping the risk of a multiple pregnancy low.
A multiple pregnancy presents risks during pregnancy and delivery for the mother. For the babies in a multiple pregnancy, there is an increased risk of premature delivery and lifelong health or developmental problems.
Often, fertility treatments like IVF can be emotionally and physically stressful for patients and their families. Fertility clinics routinely offer and recommend psychological counseling for IVF patients.
FIRM’s infertility counseling and support group is led by a Licensed Professional Counselor and provides a safe non-judgmental environment for those to share experiences and feelings due to infertility.