In Vitro Fertilization (IVF)
IVF is the joining of a woman's egg and a man's sperm in a laboratory dish. In vitro means outside the body. Fertilization means the sperm has attached to and entered the egg.
What is IVF?
Normally, an egg and sperm are fertilized inside a woman's body. If the fertilized egg attaches to the lining of the womb and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception.
IVF is a form of assisted reproductive technology (ART). This means special medical techniques are used to help a woman become pregnant. It is most often tried when other, less expensive fertility techniques have failed.
IVF Success Rate by Age
*Live birth rates per egg retrieval using own eggs (2019 data)
The IVF Process
IVF is a complex process with many steps. On average, you can expect the process to last four to six weeks from start to finish.
Step 1: Preparation
Before starting IVF treatment, your healthcare provider may prescribe birth control pills or estrogen to:
- Stop the development of ovarian cysts
- Control the timing of your menstrual cycle
- Maximize the number of mature eggs during retrieval
Step 2: Ovarian Stimulation
During your IVF cycle, you'll take injectable hormone medications to encourage multiple eggs to mature simultaneously:
- Medicines, called fertility medicines, are given to boost egg production
- Normally, a woman produces one egg per month. Fertility medicines tell the ovaries to produce several eggs
- You'll inject fertility medicine for around 8-14 days
- Your progress will be monitored with regular transvaginal ultrasounds and blood tests
- When your follicles reach the right size, you'll receive a "trigger shot" to finalize egg maturation
Step 3: Egg Retrieval
A minor surgery, called follicular aspiration, is done to remove the eggs from the woman's body:
- The procedure takes place about 36 hours after your trigger shot
- You'll receive sedation or anesthesia for comfort
- Using ultrasound guidance, a thin needle is passed through the vagina into each ovarian follicle
- The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle
- The procedure is repeated for the other ovary
- The procedure typically takes less than 30 minutes
- You'll need someone to drive you home afterward
Step 4: Fertilization
The afternoon after your egg retrieval:
- The man's sperm is placed together with the best quality eggs. The mixing of the sperm and egg is called insemination
- Eggs and sperm are stored in an environmentally controlled chamber
- The sperm most often enters (fertilizes) an egg a few hours after insemination
- If the provider thinks the chance of fertilization is low, the sperm may be directly injected into the egg using intracytoplasmic sperm injection (ICSI)
- On average, 70% of mature eggs will fertilize
- The fertilized eggs become embryos and are monitored for 5-6 days
Step 5: Embryo Culture
When the fertilized egg divides, it becomes an embryo:
- Laboratory staff will regularly check the embryo to make sure it is growing properly
- Within about 5 days, a normal embryo has several cells that are actively dividing
- About 50% of fertilized embryos progress to the blastocyst stage, which is most suitable for transfer
- Couples who have a high risk of passing a genetic disorder to a child may consider pre-implantation genetic diagnosis (PGD)
Step 6: Embryo Transfer
There are two types of embryo transfers:
Fresh Embryo Transfer
Your embryo is inserted into your uterus between 3-7 days after the egg retrieval procedure, without being frozen.
Frozen Embryo Transfer
Frozen embryos from a previous IVF cycle or donor eggs are thawed and inserted into your uterus. This is more common and may result in higher live birth rates.
The embryo transfer is a simple procedure that doesn't require anesthesia. It feels similar to a pelvic exam, takes less than 10 minutes, and involves placing the embryos into your uterus using a thin catheter.
Step 7: Pregnancy Test
Your healthcare provider will use a blood test to determine if you're pregnant approximately 9-14 days after embryo transfer. This test measures hCG (human chorionic gonadotropin), the hormone produced by the placenta during pregnancy.
Why IVF is Performed
People choose IVF for many reasons, including infertility issues or when one partner has an existing health condition. It's often tried after other fertility methods have failed.
Common Fertility Issues
- Advanced maternal age - Fertility declines with age, particularly after 35
- Damaged or blocked fallopian tubes - Can be caused by pelvic inflammatory disease or prior reproductive surgery
- Endometriosis - Can affect the function of the ovaries, uterus and fallopian tubes
- Male factor infertility - Including decreased sperm count, blockage, or abnormalities in sperm size and shape
- Unexplained infertility - When no cause can be found despite evaluation
- Ovulation disorders - Fewer eggs available for fertilization
Other Reasons for IVF
- Same-sex couples - Who wish to have biological children
- Single parents by choice - People who wish to have a baby without a partner
- Fertility preservation - Before cancer treatment or other conditions that might affect fertility
- Previous tubal sterilization - If you've had your fallopian tubes removed or blocked
- Genetic disorders - If you or your partner is at risk of passing on a genetic disorder
- Recurrent pregnancy loss - Multiple miscarriages may benefit from IVF with genetic testing
When to Consider IVF
IVF is typically not the first step in treating infertility except in cases of:
- Complete fallopian tube blockage
- Severe male factor infertility
- Advanced reproductive age requiring immediate aggressive treatment
- When other methods have failed
Approximately 5% of couples with infertility will try IVF. More than 8 million babies have been born from IVF since 1978.
Risks and Considerations
While IVF is generally safe, there are several risks and considerations to be aware of before starting treatment.
Medication Side Effects
Some experience side effects from the fertility medications used during the ovulation stimulation phase:
- Bloating
- Abdominal pain
- Mood swings
- Headaches
- Hot flashes
- Nausea
- Breast tenderness
Ovarian Hyperstimulation Syndrome (OHSS)
OHSS occurs when your ovaries swell and leak fluid into your body. Symptoms include:
- Mild to moderate abdominal pain
- Bloating
- Nausea
- Diarrhea
- Weight gain
Severe cases (rare) may involve:
- Severe abdominal pain
- Persistent nausea/vomiting
- Rapid weight gain
- Decreased urination
- Shortness of breath
- Blood clots
Procedural Risks
- Egg retrieval complications - Bleeding, infection, or damage to the bowel, bladder, or blood vessels
- Anesthesia risks - Reactions to medications used during egg retrieval
- Infection - Rarely, egg retrieval may cause infection in the pelvis
Multiple Pregnancy
IVF increases the risk of multiple pregnancies if more than one embryo is transferred. Multiple pregnancies carry risks including:
- Premature delivery
- Low birth weight
- Maternal complications (gestational diabetes, high blood pressure)
- Increased chance of cesarean section
After the Procedure
Proper aftercare following egg retrieval and embryo transfer is important for your comfort and to maximize your chances of success.
After Egg Retrieval
- You may experience mild cramping, bloating, and spotting
- Don't drive for 24 hours after having anesthesia
- Most people return to normal activities the next day
- Take pain relievers as recommended by your doctor
- Stay hydrated and eat protein-rich foods
- Avoid strenuous exercise, alcohol, and hot baths
After Embryo Transfer
Common symptoms after embryo transfer include:
- Mild cramping
- Bloating
- Constipation
- Breast tenderness
- Passing a small amount of clear or bloody fluid
You should be able to resume normal activities after the transfer. Your ovaries will be enlarged, and some discomfort may occur.
Medication After Transfer
Women who undergo IVF must take daily shots or pills of the hormone progesterone for 8 to 10 weeks after the embryo transfer. Progesterone is a hormone produced naturally by the ovaries that prepares the lining of the uterus (womb) so that an embryo can attach.
When to Contact Your Provider
Contact your provider right away if you had IVF and have:
- A fever over 100.5°F (38°C)
- Pelvic pain
- Heavy bleeding from the vagina
- Blood in the urine
- Severe bloating or rapid weight gain
- Difficulty urinating
- Shortness of breath
Outcomes and Success Rates
Statistics vary from one clinic to another and must be looked at carefully. However, patient populations are different in each clinic, so reported pregnancy rates cannot be used as an accurate indication of one clinic being preferable to another.
Understanding Success Rates
- Pregnancy rates reflect the number of women who became pregnant after IVF. But not all pregnancies result in a live birth.
- Live birth rates reflect the number of women who give birth to a living child.
- Success rates decline as a woman's age increases.
- The likelihood of a live birth is approximately 55-60% for women under age 35.
- By age 42, the live birth rate drops to around 5-7%.
Factors Affecting Success
Several factors can influence IVF success rates:
- Age of the woman (younger women generally have higher success rates)
- Previous pregnancy history
- Cause of infertility
- Lifestyle factors (smoking, weight, etc.)
- Quality of the eggs, sperm, and resulting embryos
- The clinic's experience and laboratory protocols
IVF clinics have encouraged single embryo transfers to reduce the risk of twin pregnancies, which have higher risk for complications than singleton pregnancies. Embryos not transferred may be frozen and saved for future use.
Ready to Start Your IVF Journey?
Our team of specialists at UDAAN Fertility Clinic is here to guide you through every step of the IVF process with compassionate care.