• Babies born to IVF are sometimes called test tube babies.
• All high-tech infertility treatments (including IVF) are grouped under the general term Assisted Reproductive Technology (ART).
What Is IVF?
IVF is a high tech infertility treatment which helps women become pregnant. During an IVF cycle (one full treatment), the woman takes fertility drugs to stimulate her ovaries to produce several eggs. The eggs are then extracted by minor surgery and mixed with sperm in a laboratory dish. In vitro means 'in glass', referring to the glass test tube or petri dish where the mixing takes place. The fertilized egg is then placed inside the woman's womb which has been prepared by hormone treatment to be ready to house the embryo. IVF is like bringing out the big guns for treating female infertility. It is highly expensive, involves lots of screenings, blood tests and minor procedures. You will be putting some powerful medications into your body, some have risks and side effects. Expect to be hanging around your chosen fertility clinic for hours on end. Be prepared to be called unexpectedly and drop everything else you are doing. In other words IVF is a financial and emotional roller coaster, it is not something you should rush into without preparing and researching. If you have decided to go ahead, be prepared to have your life turned upside down! Exciting times ahead, with some cliff-hanging moments.
What Is An IVF Protocol?
An IVF protocol is a schedule of what treatment you will receive during your cycle. It includes the drugs you need to take, when and how often to take them and what other instructions you need to follow. Not all women have the same protocol. IVF protocols can vary according to a woman's age, whether or not she has regular menstrual cycles and what her hormone levels are like. The details of protocols can also vary from clinic to clinic, and they may call them by different names. Generally however protocols fall into 2 main categories: Long protocols for women who have normal hormone levels and regular menstrual cycles. And short protocols for women with high follicle stimulating hormone (FSH) levels or for those who have failed to respond to ovarian simulation (another less expensive type of ART). One you have signed off on your protocol, the games begin!
How Is IVF Done?
There are 5 main steps in IVF treatment:
1. Egg Stimulation
Normally a woman only produces one egg a month. However as IVF is an expensive treatment, ideally doctors want to extract as many eggs as possible in one cycle to improve the chance of pregnancy ( because not all eggs will survive). To do this, a procedure called ovarian stimulation is performed. The woman is given fertility drugs to boost her egg production. She will also need regular transvaginal ultrasounds and blood tests to check that the drugs are working.
2. Egg Retrieval
As soon as the woman ovulates, the eggs are retrieved through the vagina in a minor surgery called follicular aspiration. Using ultrasound the surgeon guides a thin needle through the vagina and sucks the eggs out, one at a time. If the woman cannot produce her own eggs, egg donation may be considered.
The eggs are placed in a culture dish and mixed with the sperm (this is called insemination). Usually the sperm enters the egg (fertilizes it) within a few hours. Today however, most couples choose not to take any risks and opt for ICSI procedure. That is, the sperm is injected into the egg - just in case it can't manage the task on its own!
The embryos are then incubated for 3 to 5 days to allow them to divide and grow (read about day 5 embryo transfer). The couple will nervously wait to hear how many of the embryos are 'viable'. The embryos will be graded, as this determines how many should be transferred to ensure a pregnancy. It's not an exact science, hence the risk of twins or multiple births. Any 'extra' embryos can be frozen for future cycles.
4a. Genetic Testing
Couples who are worried about passing on a genetic disorder to their child may consider pre-implantation genetic diagnosis (PGD). This procedure is done 3 to 4 days after the eggs have been fertilized. A single cell is extracted from the growing embryo and tested for signs of the disorder in question. If the embryo contains signs of the disorder the parents may choose to reject it. Not all clinics offer this service because it is still considered controversial. You may also be referred to a genetic counselor for advice.
5. Transfer of Embryo
Embryo transfer: Once the embryos have been graded the doctor will discuss the results with the couple. Together they will agree how many embryos to transfer - as we mentioned, it is not an exact science. Assisted hatching may be offered, particularly if previous IVF cycles have failed. This is where a small hole is made in the shell surrounding the embryo so it can hatch more easily and implant. The embryos are placed in the woman's womb using a thin tube (catheter) inserted through the vagina. If the embryo sticks to the womb, it is said to have implanted, and pregnancy occurs. A pregnancy test will be done 12-14 days later - meantime it's a waiting game. An estimated 10 to 15 percent of women become pregnant, for the rest, the cycle needs to be repeated.
Who Considers Using IVF?
IVF is primarily used in the following situations:
1. For women hoping to experience a pregnancy after 35.
2. Women with damaged or blocked fallopian tubes that cannot be fixed (see causes of infertility).
3. Women with severe endometriosis.
4. Male infertility, if the man has a low sperm count. See other causes of infertility in men.
5. Unexplained infertility that has not responded to more conservative treatment.
What Are The Risks?
1. Babies born via IVF are at greater risk of premature labor as well as birth defects by the age of 1.
2. Recent worrying reports show a significant increase in birth defects if ICSI is used.
3. The risk of preeclampsia doubles if you are expecting more than one baby.
4. Even if you become pregnant, 1 in 4 pregnancies will end in miscarriage.
5. Rarely, fertility drugs can cause ovarian hyperstimulation syndrome (OHSS). This causes rapid fluid-build up, weight gain (10 pounds within 5 days) and nausea. It can be treated with bed rest or fluid extraction by needle.
6. Fertility drugs can cause PMS type symptoms - such as mood swings, bloating and headaches. The meds may need to be injected several times a day, so there may be bruising at the site of injection.
For questions on this and other topics, see womens health questions.
What Are The Success Rates?
IVF Success Rates: Statistics can vary from clinic to clinic, and you need to be careful when looking at the results. Pregnancy rates reflect the number of women who become pregnant after IVF, not the number who go on to give birth to a living child. The Society of Assisted Reproductive Technologies (SART) estimates the chance of giving birth to a live baby after IVF is:
• 42 percent for women under 35.
• 32 percent aged 35 to 37.
• 22 percent aged 38 to 40.
• 13 percent aged 41.
• 4 percent aged over 41.
How Much Does It Cost?
The average cost per cycle is between $12,000 and $17,000. However the cost of a live birth (which may take several cycles) averages about $55,000. Most insurance companies will not cover the costs, although they may cover the cost of the original fertility tests to diagnose the problem. For more detail see our article on IVF costs.