A guide about the IVF process

 

what is IVF?

Thinking about overcoming infertility with in vitro fertilization (IVF)? Here’s how it works, plus everything you need to know about the IFV timeline, injections, side effects, and more.

About one in eight American couples struggle with infertility, or the inability to conceive despite having regular unprotected sex. As a solution, increasing numbers of people are turning to in vitro fertilization (IVF), a procedure in which surgically removed eggs are fertilized with sperm in a laboratory, then inserted directly into the uterus.

About 5% of all children born in the United States were conceived through IVF, says Amy Schutt, M.D., a reproductive endocrinologist at the Family Fertility Center at Texas Children’s Pavilion for Women. That equates to more than one million total babies. If you’re seeking to get pregnant through IVF, it’s important to understand the success rates, method, and possible side effects. Here’s all you need to know about IVF before signing up for the procedure.

• Who Gets IVF Procedure?

Infertility has a wide range of causes in both women and men. Treatment usually involves correcting the underlying problem with medication or surgery. But sometimes conventional treatment proves difficult, and couples turn to assisted contraception methods like IVF instead. For example, women with fallopian tube blockage often opt for IVF; since the fertilized egg is inserted directly into the uterus during the procedure, the tubes aren’t necessary for conception. Similarly, IVF procedure is common if the man has a low sperm count (oligospermia) or a lack of sperm in the ejaculate (azoospermia).

• Not every woman suffering from infertility is a candidate for IVF. According to Dr. Schutt, patients should think twice about IVF if they have a premature ovarian failure or a serious medical problem that precludes pregnancy. Religious beliefs and financial constraints may also deter women from undergoing the procedure (the average cost of IVF is $12,000, plus an additional $3,000-5,000 for necessary medications). What’s more, women who don’t produce eggs – whether because of menopause or another condition – can’t undergo IVF unless they use a donor or frozen eggs, according to Dr. Timothy Hickman, the medical director of CCRM Houston and director of the Division of Reproductive Endocrinology and Infertility at Houston Methodist Hospital.

IVF Process: How is IVF done?

“IVF involves handling of both eggs and sperm within the laboratory to allow for the fertilization of eggs and early development of embryos,” says Dr. Schutt. To prepare for IVF, a woman takes injectable fertility medications for approximately 10 days, during which the growth of her eggs is closely monitored. “When the eggs are ready to be collected (about 14 days later), the woman takes one final HCG injection that assists in the maturation of the eggs – and 36 hours afterward, the eggs are collected from the ovary,” says Dr. Schutt. Doctors use a narrow needle, suction device, and ultrasound imaging to retrieve the eggs. This IVF process usually involves anesthesia or sedation to relieve pain.

Next, the embryologist places the collected eggs on a Petri dish. She combines the eggs with sperm taken from the male in a process called insemination. If the sperm has low motility (impaired movement) the embryologist may insert sperm directly into the eggs (ICSI). The fertilized eggs, or embryos, are stored for three to seven days. "If genetic testing (chromosomal defect screening that lets you see the sex of the embryo) is to be performed, then the embryo is biopsied between the fifth and seventh day of development," adds Dr. Schutt. Note that some clinics allow you to choose the sex during genetic testing, while others do not. 

Finally, doctors transplant one or more embryos into the uterus with a catheter. Implantation – and subsequent pregnancy – usually takes place one or two weeks later.

IVF Success Rate

According to Dr. Schutt, the success rate of IVF depends largely on egg quality and quantity. “Egg quality is primarily a reflection of the age of the woman from which the eggs are obtained. The younger a woman is when she goes through IVF, the greater chance her eggs will potentially result in a healthy pregnancy,” she says. “Egg quantity is more variable, and it’s measured via ultrasound (to count the number of antral follicles) and lab work,” including blood tests. Other factors that affect IVF success include weight, alcohol intake, and tobacco use. 

IVF Side Effects

Most women who undergo IVF don’t have any symptoms, but possible IVF side effects include:

• Cramping
• Bloating
• Breast tenderness
• Clear or bloody fluid, which comes from the vagina in small amounts
• Mood swings
• Constipation

Some women also experience side effects from the hormonal injections they take before IVF. These include headaches, abdominal pain, mood swings, bloating, hot flashes, and ovarian hyperstimulation syndrome (OHSS) – a rare condition that occurs from excess egg production. Symptoms are weight gain, abdominal pain and swelling, nausea, shortness of breath, and dizziness. Consult your doctor if you think you developed OHSS – or if you experience other worrisome side effects of IVF like heavy vaginal bleeding or excessive pain.

A Guide to the IVF Process

what is IVF treatment

 IVF is a common treatment for people who are unable to conceive naturally

Usually, in IVF, the woman has medicines (fertility hormones) to stimulate the ovaries to produce several eggs. The eggs are then collected and mixed with sperm in a laboratory.

IVF is carried out when the sperm quality is considered to be ‘normal’ If there are issues with the sperm quality such as low motility or numbers, a procedure called intracytoplasmic sperm injection (ICSI) may instead be used – this is where a single sperm is injected into the egg by an embryologist

If fertilization is successful, the embryos are allowed to develop for between two and six days. This helps the embryologist to select the strongest embryo, which is then transferred back to the woman’s womb to hopefully continue to a successful birth.

Often several good-quality embryos will be created. In these cases, it's normally best practice to freeze the remaining embryos because putting two embryos back in the womb increases your chance of having twins or triplets, which carries health risks. You can use your frozen embryos later on if your first cycle is unsuccessful or you want to try for another baby.

What does IVF involve?

This process outlines a single cycle of IVF following the most commonly used procedure. You may find that your treatment is slightly different depending on your history and what your clinic thinks is best for you.

• Usually, the first step is to use medication to stimulate the ovaries to produce eggs. There are different ways this can be done. One way is to suppress natural hormones before taking hormone medication to stimulate the ovaries. This treatment often called a long protocol, involves taking a daily injection or nasal spray to suppress hormone production. A scan checks the woman’s natural cycle is fully suppressed. If it is, hormone treatment (usually gonadotrophin) is started to boost the number of eggs the body produces.
• Some clinics may use the ‘antagonist protocol’. This involves taking medication (an antagonist) to suppress your hormones for a few days after you have taken the hormone medication (usually gonadotrophin) to boost the number of eggs the body produces.
• Whichever way the ovaries are stimulated to produce eggs, you will be closely monitored for a few days by the clinic. This may involve having blood tests or ultrasound scans.
• The eggs will be collected whilst under sedation or general anesthetic. The procedure takes around half an hour and you may feel a little sore or bruised.
• Whilst the eggs are being collected, the man will be asked to come to the clinic to produce a sperm sample, or your donor sperm will be taken from the freezer, for mixing with your eggs.
• Medication will help to prepare the lining of the womb. This is usually taken as a pessary or gel which you can insert yourself into the vagina/rectum.
• The eggs will be mixed with the sperm in a laboratory. The aim is for the eggs and sperm to fertilize to create an embryo.
• If fertilization happens, the resulting embryo(s), will be monitored to check how it’s/they’re developing.
• Two to five days after fertilization, the embryo(s) will be transferred to the womb. You won’t need any kind of anesthetic for this unless you have a condition that would make the procedure painful. You’ll be given a date to do a pregnancy test. Although you’ll understandably be excited at this stage, try not to do this early as you may get a false result.

The IVF success Factors

 Considering IVF Then it’s important to learn about IVF success factors that can help or hinder you're getting pregnant.

IVF Success Factor 1 – Age

Your age and using your own eggs are important IVF success factors to consider. While younger women have higher chances of IVF success, factors that reduce the chances of IVF success include being an older woman with fewer eggs and the lower quality of an older woman’s eggs.

In fact, the live birth IVF success rate for women under 35 who start an IVF cycle is 40 percent. However, women over the age of 42 have a 4 percent success rate.

IVF Success Factor 2 – Previous pregnancy

More IVF success factors to think about include whether or not you were pregnant previously and if it was with the same partner.

If you were pregnant previously with the same partner that’s currently undergoing IVF treatment, there is a greater probability of IVF success. Factors such as a history of recurrent miscarriage or a different partner may reduce the chances of IVF success.

IVF Success Factor 3 – Type of fertility problems

While some male infertility problems do impact IVF success, factors like uterine abnormalities, exposure to DES, or fibroid tumors also decrease the likelihood of success with IVF.

Very important to know: IVF success factors are dependent on ovulation. Ovarian dysfunction, like high FSH levels which indicate a low ovarian reserve, may reduce the chances of IVF success.  Factors that may lower pregnancy rates and reduce success with IVF include needing large amounts of ovulation stimulation drugs.

When both partners are infertile with lower chances for IVF success, factors such as the length of time you have been infertile are important to consider. The chances of IVF success decrease with the amount of time a couple has been infertile.

IVF Success Factor 4 – Use of donor eggs

Donor eggs are a significant consideration, especially if you are over 35-40, as there may be a higher rate of IVF success. Factors such as egg quality and age of donors are important. Using donor eggs from younger women may increase the chances of pregnancy for women over 40. 2011 findings show a 55 percent live birth success rate with a fresh donor egg/embryo transfer.

IVF Success Factor 5 – Lifestyle habits

Stop smoking if you want to improve your chance of having a baby. In fact, many times the woman is required to stop smoking at least 3 months before starting IVF treatment.

• Smokers require higher dosages of fertility drugs to stimulate their ovaries
• Smokers have lower implantation rates than nonsmokers
• Women who smoke require almost twice as many IVF attempts
• Women who smoke experience more failed fertilization cycles

More IVF success factors to mull over include losing weight if you are overweight or obese. Women who are overweight have an increased risk of infertility as well as miscarriage. Overweight women also have less IVF success with fertility treatments than women of normal weight. Underweight women are also at greater risk of having success with IVF. Bottom line: aim to stay within a healthy weight range.

IVF Success Factor 6 – Fertility clinic

The center you choose to perform the IVF treatment can greatly affect your IVF success. Factors to think about when reviewing the success rate of fertility centers include:

• The training and experience of the IVF clinic and staff
• The live birth rate per IVF cycles started
• The rate of patients pregnant with multiples (twins, triplets, or more)
• The laboratory used by the clinic and the qualifications of their staff
• The types of patients accepted at the clinic, more specifically their age and fertility problem

Keep in mind that some clinics are more willing to accept patients with a lower chance of IVF success or they may specialize in particular treatments.

Know  your IVF success factors as you plan to get pregnant

Remember, just as with any chronic illness, knowledge is power with infertility. The more you learn about specific IVF success factors, the more control you will feel about high-tech treatments that help you get pregnant and start a family.

IVF Success factors

common indications for IVF treatment

Although its original intention was to treat women with tubal disease, in-vitro fertilization (IVF) can help couples overcome various types of infertility. For some diagnoses or conditions, such as tubal factor, IVF may be the first-line treatment. In other cases, IVF may be recommended only if simpler treatment fails. Below is a list of common indications for IVF treatment:

Tubal Factor (Damage to Fallopian Tubes) / Pelvic Adhesions

There are two options to treat patients with significant tubal damage and/or pelvic adhesive disease. The first option is to surgically repair the tubes and either get pregnant naturally or use Artificial Insemination or IUI to get pregnant. In many cases, however, surgery is not a good option as it may be very difficult to surgically fix the damaged tube(s) and/or the surgery may cause a high risk of an ectopic pregnancy. In these instances where the surgical option does not pose a high chance for success, the second option is to by-pass the tubes completely by using IVF as the treatment plan. Advanced Fertility Care Physicians will individualize the treatment plan for each patient or couple at our Mesa, Scottsdale, and Glendale AZ offices, and if you have tubal damage, they will provide you detailed information on each option so that you can make an informed decision.

Endometriosis

Current scientific data about endometriosis show that mild to moderate forms of endometriosis may be effectively treated with a combination of surgical and medical therapy. For more stages of endometriosis, including the presence of endometriomas, IVF is the optimal first-line treatment and offers the highest pregnancy success rates.

Male Factor Infertility

One of the most significant advances in the treatment of infertility has been the ability of men with severe sperm abnormalities to achieve fertilization of the egg and successful pregnancy. IVF with the addition of ICSI (Intracytoplasmic Sperm Injection) has enabled couples suffering from abnormal sperm, who would not otherwise be able to conceive, to be able to start a family. ICSI is often recommended if there is any suggestion of a sperm problem, if sperm are obtained surgically, or if there has been a prior failure of fertilization.

Diminished Ovarian Function & Age-Related Infertility

During the course of a woman’s normal reproductive life, her ovarian function decreases with age. In many cases, this reduced function can be overcome through the use of IVF alone, or in conjunction with techniques such as Assisted Hatching and ICSI. For some women, this decrease in ovarian function may start at earlier ages and requires aggressive treatment with IVF sooner rather than later.

Anovulation & Polycystic Ovarian Syndrome (PCOS)

The majority of patients with an ovulation and/or PCOS often conceive using less aggressive treatments such as ovulation induction with IUI. For some patients who are “high responders” to gonadotropin therapy, IVF offers an excellent prognosis and reduces some of the risks of higher-order multiples.

Unexplained Infertility

Approximately 20% of couples will have no identifiable cause of infertility after completing a comprehensive evaluation. IVF is often successful even if more conservative treatments have failed, especially since some of these couples may have yet unidentifiable causes of infertility or sub-fertility.

Family Balancing (also known as Gender or Sex Selection)

For families that wish to have additional children of a particular gender after already having a previous child, PGD allows for the selection of embryos to transfer based on gender. While not perfect, embryo biopsy with genetic chromosome determination prior to the transfer of embryos can allow families to choice in how they expand the family. Read more about PGD.

Genetic Diseases / Preimplantation Genetic Screening or Diagnosis (PGS or PGD)

One additional indication for IVF is to provide genetic testing on embryos prior to implantation. PGD or PGS is used for patients who are at risk for passing on genetic disorders to their offspring as a result of one or both of the partners being carriers for the disease. Diseases such as Cystic fibrosis and Thalassemia are 2 examples of the hundreds of diseases that can be tested for prior to embryo implantation. In addition, IVF with PGS is indicated for women with recurrent pregnancy loss related to chromosomal abnormalities or repeated failed IVF attempts. Learn more about PGD.

What is IVF?

 In Vitro Fertilization (IVF) is a form of assisted reproductive technology (ART) that helps couples dealing with infertility conceive. The process involves extracting a woman’s eggs, collecting a sperm sample, and combining the egg and sperm manually. After the egg and sperm have been combined in the laboratory, the embryo or embryos are transferred to the uterus. Although more costly, time-consuming, and invasive than artificial insemination, IVF has excellent success rates for overcoming various types of infertility. Some of these include tubal factor, endometriosis, male factor infertility, age-related infertility, diminished ovarian function, polycystic ovarian syndrome, and unexplained infertility. Other implications for IVF are gender selection and preimplantation genetic screening for parents at risk of passing down genetic disorders.

There are additional options for IVF, like ICSI, PGD, assisted hatching, donor sperm, and a gestational carrier. Our goal is to help you have a healthy baby, the least invasive, most cost-effective way. The Advanced Fertility Clinic physicians will go over every possible option with you to guide you in making a more informed decision about the process that is right for you.

What is IVF?