In Vitro Fertilization for Infertility
Treatment Overview
During in vitro fertilization (IVF), eggs and sperm are brought together in a laboratory glass dish to allow the sperm to fertilize an egg. With IVF, you can use any combination of your own eggs and sperm and donor eggs and sperm.
After IVF, one or more fertilized eggs are placed in the uterus .
Ovulation and egg retrieval. To prepare for an assisted reproductive procedure using your own eggs, you will require hormone treatment to control your egg production (ovulation). This is done to prevent unpredictable ovulation, which would make it necessary to cancel that in vitro attempt. This is typically done using one of two similar types of gonadotropin-releasing hormone analogue (GnRH agonist or GnRH antagonist). The following are two examples of how ovulation can be controlled:
- You first receive about 10 days of nasal or injected GnRH agonist that "shuts down" your pituitary . Next, you get daily ovary-stimulating hormone injections and are closely monitored for 2 weeks before egg retrieval. At home, you or your partner injects you with gonadotropin or follicle-stimulating hormone (FSH) to make your ovaries produce multiple eggs ( superovulation ).
- You start treatment with FSH injections and then add the GnRH antagonist injection after about 5 days, which stops the production of luteinizing hormone (LH) within an hour or two.
After the first week, your doctor checks your blood estrogen levels and uses ultrasound to see whether eggs are maturing in the follicles . During the second week, your dosage may change based on test results. And you are monitored frequently with transvaginal ultrasound and blood tests. If follicles fully develop, you are given a human chorionic gonadotropin (hCG) injection to stimulate the follicles to mature. The mature eggs are collected 34 to 36 hours later by needle aspiration guided by ultrasound. You will usually have pain medicine and sedation for this procedure.
Sperm collection. Sperm are collected by means of masturbation or by taking sperm from a testicle through a small incision. This procedure is done when a blockage prevents sperm from being ejaculated or when there is a problem with sperm development. Sperm may have been collected and frozen at an earlier time. Then the sperm are thawed on the day the eggs are collected.
Fertilization and embryo transfer. The eggs and sperm are placed in a glass dish and incubated with careful temperature, atmospheric, and infection control for 48 to 120 hours. About 2 to 5 days after fertilization, the best fertilized eggs are selected. One to three are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. Those remaining may be frozen (cryopreserved) for future attempts.
Pregnancy and birth. Any embryos that implant in the uterus may then result in pregnancy and birth of one or more infants.
What To Expect After Treatment
Overall, in vitro fertilization (IVF)-related injections, monitoring, and procedures are emotionally and physically demanding of the female partner. Superovulation with hormones requires regular blood tests, daily injections (some of which are quite painful), frequent monitoring by your doctor, and harvesting of eggs.
These procedures are done on an outpatient basis and require only a short recovery time. You may have cramping during the procedure. You may be advised to avoid strenuous activities for the remainder of the day or to be on bed rest for a few days, depending on your condition and your doctor's recommendation.
Why It Is Done
In vitro fertilization may be a treatment option if:
- A woman's fallopian tubes are missing or blocked.
- A woman has severe endometriosis.
- A man has low sperm counts.
- Artificial or intrauterine insemination has not been successful.
- Unexplained infertility has continued for a long time. How long a couple chooses to wait is influenced by the female partner's age and other personal factors.
- A couple wants to test for inherited disorders before embryos are transferred.
IVF can be done even if a:
- Woman has had a tubal ligation reversal surgery that was not successful.
- Woman does not have fallopian tubes.
- Woman's fallopian tubes are blocked and can't be repaired.
IVF can be done using donor eggs for women who cannot produce their own eggs due to advanced age or other causes.
How Well It Works
The number of women who have babies after in vitro fertilization varies, depending on many different things. Almost all assisted reproductive technology (ART) procedures are done using IVF.
Age. Birth rates resulting from a single cycle of IVF using women's own eggs are about 30% to 40% for women age 34 and younger, then rates decrease steadily after age 35. footnote 1 The aging of the egg supply has a powerful effect on the chances that an assisted reproductive technology (ART) procedure will result in pregnancy and a healthy baby.
Cause of infertility. Infertility can be caused by problems with the woman's or the man's reproductive system. Some of these causes can include problems with the fallopian tubes, with ovulation , or with the sperm.
Pregnancy history. A woman who has already had a live birth is more likely to have a successful ART procedure than a woman who hasn't given birth before. This "previous birth advantage" gradually narrows as women age from their early 30s to their 40s.
Own eggs versus donor eggs. Birth rates are affected by whether ART procedures use a woman's own eggs or donor eggs. Many women over age 40 choose to use donor eggs, which greatly improves their chances of giving birth to healthy babies. For each cycle of in vitro fertilization: footnote 1
- Using her own eggs, a woman's chances of having a live birth decline from over 40% in her late 20s, to 30% at about age 38, and to 10% by about age 43.
- Live birth rates are about the same among younger and older women using donor eggs. Women in their late 20s through mid-40s average about a 55% birth rate using fresh (not frozen) embryos.
Frozen embryos versus fresh embryos. Donor-frozen IVF embryos from a previous IVF cycle that are thawed and transferred to the uterus are less likely to result in a live birth than are donor-fresh (newly fertilized) IVF embryos. footnote 1 But frozen embryos are less expensive and less invasive for a woman, because superovulation and egg retrieval aren't needed.
Risks
In vitro fertilization (IVF) increases the risks of ovarian hyperstimulation syndrome and multiple pregnancy.
- Superovulation with hormone treatment can cause severe ovarian hyperstimulation syndrome . Your doctor can minimize the risk of ovarian hyperstimulation syndrome by closely monitoring your ovaries and hormone levels during treatment.
- The risk of conceiving a multiple pregnancy is directly related to the number of embryos transferred to a woman's uterus. Multiple pregnancies are high-risk for both the mother and the fetuses.
There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques, such as IVF. Talk with your doctor about these possible risks.
Embryo transfer success versus the risk of multiple pregnancy
For a woman over age 35 to maximize her chances of conceiving with her own eggs and carrying a healthy pregnancy, she may choose to have more embryos transferred than a younger woman would. But this increases her risk of multiple pregnancy.
Because of the risks to the babies of multiple pregnancy, experts recommend limiting the number of embryos transferred. Your doctor will recommend a certain number of embryos to be transferred based on your age and specific situation.
Women over 40 have a high rate of embryo loss when using their own eggs. As an alternative, older women can choose to use more viable donor eggs. When a woman uses donor eggs, experts recommend using the donor's age to help figure out how many embryos to transfer. footnote 2
What To Think About
Smoking has a damaging effect on fertility and pregnancy. Smoking reduces the chance that IVF will work. Smoking can also affect the health of the fetus.
In vitro fertilization provides diagnostic information about fertilization and embryo development (which is not the case with a GIFT or ZIFT procedure).
Using ultrasound to help collect eggs from the woman's ovaries is less expensive, less risky, and less invasive than egg collection by laparoscopy .
In the United States, a cycle of in vitro fertilization costs approximately $10,000 to $15,000.
If you and your doctor are concerned about passing on a genetic disorder to your child, preimplantation genetic diagnosis might be available. Some genetic disorders can be identified with specialized testing before an embryo is transferred, increasing the chances of conceiving a healthy child.
References
Citations
- Centers for Disease Control and Prevention, American Society for Reproductive Medicine, and Society for Assisted Reproductive Technology (2010). 2010 Assisted Reproductive Technology National Summary Report. Available online: http://www.cdc.gov/art/ART2010/PDFs/ART_2010_National_Summary_Report.pdf.
- Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology (2013). Criteria for number of embryos to transfer: A committee opinion. Fertility and Sterility, 99(1): 44–46.
Current as of: May 29, 2019
Author: Healthwise Staff
Medical Review: Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & Femi Olatunbosun MB, FRCSC - Obstetrics and Gynecology
