What is In Vitro Fertilization?

In vitro fertilization (IVF) is a process where eggs and sperm are combined outside the body to create embryos. These embryos are then transferred to the uterus in hopes of achieving pregnancy. IVF has helped millions of people worldwide start families since the first successful IVF birth in 1978.

The IVF process involves several steps, starting with hormone treatments to stimulate the ovaries, followed by egg retrieval and fertilization in a lab. Once the embryos are formed, one or more are transferred to the uterus, and the hopeful waiting begins.

Who Can Benefit from IVF?

IVF is a solution for various fertility challenges. For couples struggling with infertility, IVF can bypass issues like blocked fallopian tubes, low sperm count, or unexplained infertility. If you’ve been trying to conceive for over a year without success (or six months if you’re over 35), IVF might be an option worth discussing with your doctor.

Single women who wish to become mothers can use IVF with donor sperm to achieve pregnancy. This option is also common for same-sex female couples, who may decide to use donor sperm or participate in reciprocal IVF, where one partner provides the egg, and the other carries the pregnancy.

For those facing medical conditions like endometriosis, polycystic ovary syndrome (PCOS), or genetic disorders, IVF may be recommended to improve the chances of a successful pregnancy. It's also an option for preserving fertility before undergoing treatments, like chemotherapy, that could affect your reproductive health.

The IVF Process Step-by-Step

Initial Consultation and Testing

Before starting IVF, you’ll undergo a thorough consultation with a fertility specialist. They will review your medical history, perform fertility tests (such as blood tests and ultrasounds), and assess your likelihood of success. This step helps determine the best approach for your specific needs.

Ovarian Stimulation

The next step involves daily hormone injections to stimulate the ovaries to produce multiple eggs. This process is monitored closely with regular blood tests and ultrasounds to track your body’s response and ensure eggs are maturing properly.

Egg Retrieval

When the eggs are ready, they are retrieved through a minor procedure called “follicular aspiration.” This is done under sedation, where a needle is guided through the vaginal wall to collect the eggs from the ovaries. Many people wonder if IVF really hurts, but in reality, it’s more of a discomfort than pain. Thanks to the sedation, most patients report feeling only mild cramping or pressure during and after the procedure, rather than significant pain.

Sperm Collection and Fertilization

At this stage, your partner or sperm donor provides a sperm sample. The sperm and eggs are combined in the lab, where fertilization occurs. In cases where sperm quality is low, a single sperm may be injected directly into the egg through a process known as intracytoplasmic sperm injection (ICSI). When morphology issues are identified in the sperm, further methods of sperm preselection can be used to ensure only the best sperm cells are chosen for fertilization, improving the chances of success.

Embryo Culture and Selection

Once fertilized, the embryos are monitored in the lab for several days. At this point, your fertility specialist will assess the embryos for quality. Selection in the embryo stage means that not all embryos will continue to develop, and not all of them will make it to day 5, which is the blastocyst stage. In some cases, where the fertility doctor believes an early-stage transfer could increase the chances of conception, they may recommend transferring the embryos on day 3 instead of waiting for day 5. This decision depends on your specific situation and the development of the embryos.

Embryo transfer

The most promising embryo(s) are transferred into the uterus. This is a quick, non-surgical procedure done with a thin catheter. Once the embryo is transferred, you’ll enter what’s often referred to as “the two-week wait.”

The embryo transfer is the last step of an in vitro fertilization cycle. It is usually painless and is done without sedation in most cases.

The procedure requires specific preparation and can be performed either in the same cycle as the egg retrieval or in a later cycle, known as a frozen embryo transfer (FET). The latter is recommended if there are medical concerns or if genetic testing of the embryos is advised before the transfer.

The number of embryos to be transferred is decided by your doctor, together with the embryologist and yourself. One or more embryos can be transferred, but the risks, such as the possibility of a multiple pregnancy, are thoroughly considered before making a decision.

The Two-Week Wait

After the embryo transfer, you’ll wait about two weeks to take a pregnancy test. This period can be emotionally challenging, so having a strong support system in place is essential.

IVF Costs and Financing Options

The cost of IVF varies widely, but in the United States, a single cycle can range from $12,000 to $15,000, not including medications, which can add another $3,000 to $5,000. Some insurance plans may cover parts of the process, such as testing or medication, but full coverage for IVF is less common.

Financing options include loans, payment plans offered by clinics, and grants from fertility organizations. Keep in mind that you may need more than one IVF cycle to achieve pregnancy, so budgeting for multiple attempts may be necessary.

Many couples are also considering medical tourism, which involves traveling to countries where in vitro fertilization treatments are more affordable without compromising on quality. Assisted-reproduction hubs are found throughout Europe and Asia, two popular destinations for couples from North America due to the lower costs and permissive legislation surrounding fertility treatments.

Risks and Side Effects of IVF

In vitro fertilization is generally safe, but like any medical procedure, there are risks. Some people experience short-term side effects from the hormone treatments, such as bloating leading to a perceived weight gain, cramping, or mood swings. More serious risks, though rare, include ovarian hyperstimulation syndrome (OHSS), where the ovaries become swollen and painful due to overstimulation.

There’s also a risk of multiple births, such as twins or triplets, which can lead to complications for both the mother and babies. Fertility specialists carefully monitor the number of embryos transferred to reduce this risk.

IVF can also take an emotional toll. Failed cycles are common, and the process can feel overwhelming. Make sure you have access to emotional support, whether through counseling, support groups, or loved ones.

Preparing for IVF

If you’re moving forward with in vitro fertilization treatments, preparing for IVF both physically and emotionally is key. On the physical side, adopting a healthy lifestyle, including a balanced diet, regular exercise, and quitting smoking, can improve your chances of success.

Emotionally, it’s important to recognize that IVF can be stressful. Consider seeking therapy or joining a support group where you can share your concerns and experiences with others going through the same journey.

Alternatives to IVF

In vitro fertilization isn’t the only option for assisted reproduction. Intrauterine insemination (IUI) is a less invasive and less expensive procedure where sperm is placed directly into the uterus during ovulation. This might be a good alternative if your fertility challenges are milder. The decision to choose IUI over IVF considers your fertility and medical history, your current health status, as well as your partner's.

If egg or sperm quality is an issue, using donor eggs or donor sperm might be recommended. For those unable to carry a pregnancy, surrogacy offers an option where another woman carries the baby to term.

Main Take-Aways

In vitro fertilization is a complex process that has helped millions of people, including couples facing infertility, single women, and same-sex couples, build their families.

The complexity of the process, the emotional toll, and the high cost can make the start of this journey particularly overwhelming. Understanding the steps, risks, and costs can empower you to make informed decisions. Working with an expert fertility buddy can help prepare you for your first IVF consultation, set realistic expectations, and sift through the information to focus on what truly matters to you.