In Vitro Fertilization (IVF)
A quick look at IVF
IVF is a high-tech fertility therapy bypassing many infertility problems by combining a man’s sperm with a woman’s egg in a controlled lab environment in order to achieve fertilization. If embryos successfully develop, one or more will be placed in the woman’s womb for a pregnancy.
Benefits of IVF include it being the most effective treatment in assisting couples who may not be able to conceive naturally or with other infertility treatments get pregnant.
Risks of IVF include multiple pregnancy (twins or more), bloating, bleeding, hyperstimulation, infection and psychological stress.
What is in vitro fertilization (IVF)?
In vitro is Latin for “in glass” and refers to the laboratory Petri dish where the man’s sperm fertilizes the woman’s egg to form an embryo. The embryo(s) is then transferred into the woman’s womb (uterus) to hopefully implant successfully and result in a pregnancy.
An IVF procedure occurs in a number of steps: ovarian stimulation (getting eggs to grow), sperm and egg retrieval, fertilization in the lab and embryo implantation (see more details below). These steps happen over the course of several days to months. For instance, an embryo is allowed to grow in the lab for about five days before implanting it into the mother’s uterus. If frozen eggs, sperm or embryos are involved, the IVF process can span months if desired or needed.
IVF is successful in overcoming most causes of female and male infertility. It is the most effective fertility treatment, with cumulative pregnancy rates often above 70 percent if accounting for more than one embryo transfer per IVF cycle, according to the Society of Assisted Reproductive Technology (SART). When preimplantation genetic testing is performed along with IVF, miscarriage rates are lower, as the testing identifies genetically healthy embryos, which helps avoid transferring unhealthy embryos that would be likely to break down in the first trimester.
Often more than one embryo is created through IVF. The patients and physician will decide whether to transplant one or more embryos into the uterus. Any remaining embryos can be frozen and stored for use in the future, donated to other couples or thawed without transfer.
Four steps to standard IVF
The IVF journey requires patience, as there are a few steps that must occur to reach the ultimate goal of pregnancy.
In IVF a woman takes injectable medications in order to stimulate her ovaries to produce multiple eggs for the egg retrieval. This process is called controlled ovarian hyperstimulation (COH). During normal monthly menstruation, the ovaries typically produce one egg; during COH, a woman’s ovaries will produce multiple eggs.
Healthy eggs can be selected for the next phase, and extras can be frozen (cryopreserved) for future use so that the simulation process will likely only need to happen once. However, because embryos often survive better than frozen eggs, patients typically fertilize all eggs retrieved and freeze the resulting embryos, improving chances of future pregnancy.
While a woman is in the stimulation phase, the ovaries are carefully monitored via ultrasound to determine the optimal time to perform the retrieval.
There are also forms of IVF treatment that use less medications known as mini IVF or natural cycle IVF. Though these are options patients can talk to Dr. Parry about, he tends to deemphasize these types of IVF as they are usually less cost-effective.
Egg and sperm retrieval
During an egg retrieval, Dr. Parry will introduce a long, thin needle into each ovary to retrieve the eggs from the follicles. This allows IVF to be done without incisions. The typical egg retrieval yields between 10-20 eggs. The collected eggs will then be placed into lab dishes where they will be counted and evaluated.
A sperm retrieval is generally a less invasive procedure. Most often a man masturbates, ejaculating his semen into a cup and delivers it to the laboratory. Sperm retrievals may be done in the fertility center or in one’s own home, as long as the sperm are delivered within 30 minutes after collection.
In some male infertility cases involving structural problems or erectile dysfunction, a procedure called sperm aspiration may be necessary, in which a urologist retrieves sperm directly from the testicle or epididymis.
Fertilization in the lab
Once the eggs and sperm have been retrieved, the embryologist will attempt to fertilize each egg with sperm to create an embryo. Typically, the egg is placed in a lab dish with more than 50,000 sperm in the hopes that one sperm will fertilize the egg.
To reduce issues with sperm that may prevent it from penetrating the egg, a technique called intracytoplasmic sperm injection (ICSI) can be performed. During ICSI, a Positive Steps Fertility embryologist will use high-powered magnification and a micropipette (very small needle) to inject one sperm through the egg’s tough outer shell and into the cytoplasm where fertilization takes place.
Once the embryos are created, they will grow in the laboratory usually for five to six days to be monitored for proper growth. Transferring the healthiest embryo(s) ensures the highest chance for implantation and pregnancy.
If indicated, at this stage the embryologist will perform preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS). PGS can show which embryos have 23 sets of healthy chromosomes, the necessary number for healthy development. PGD can determine if a specific genetic condition known to be present in one of the parents or their families, such as cystic fibrosis or sickle cell disease, which may be in the genetic makeup of the embryo.
Genetic flaws are a common reason for embryos to fail to implant or cause birth defects and health problems for a child.
The embryo transfer is the last step in the IVF process. Once Dr. Parry has determined which embryo(s) has the highest chance for success, the embryo(s) will be drawn into a catheter for the transfer. Dr. Parry will then advance the catheter past the mother’s cervix, using ultrasound imaging to help determine optimal embryo placement within the uterus. The embryo transfer has a very low level of discomfort, similar to a Pap smear.
Dr. Parry will schedule a follow-up appointment about 12-14 days after the embryo transfer to perform a blood test to confirm pregnancy.
Who should consider IVF?
IVF can help patients get pregnant who would not be able to do so on their own or who may not be as successful with other infertility treatments. This includes:
- Women of advanced maternal age
- Women who experience infertility due to tubal factors, such as from pelvic adhesions or previous pelvic infections
- Women with ovulation problems
- Women with endometriosis
- Men who experience infertility factors
- Same sex couples and individuals that may need to use donor eggs or sperms or a gestational carrier to achieve pregnancy.
Dr. Parry may recommend other infertility treatments prior to trying IVF, such as ovulation induction or intrauterine insemination (IUI). If less invasive treatments are not successful, Dr. Parry may recommend IVF as the next step to save precious time and money.
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Common reasons to undergo IVF
- Age related infertility. A woman’s egg quality decreases with age. IVF can give a woman in her late 30s or early 40s a greater chance of success by increasing the number of eggs produced, controlling the selection of high quality eggs, or by allowing her to use donor eggs.
- Low ovarian reserve. Some women naturally have fewer eggs in their ovaries than others, called low ovarian reserve. Low ovarian reserve also occurs as women age. In these cases, IVF can be used to stimulate many healthy eggs to develop, allowing the collection of multiple mature eggs from the follicles. Younger women with low ovarian reserve but high egg quality may have better success rates with IVF than older women with low ovarian reserve.
- Recurrent pregnancy loss/miscarriage. IVF can be a helpful treatment to achieve a successful pregnancy by increasing the number of viable embryos and using PGD or PGS to enhance successful embryo selection and implantation.
- Unexplained infertility. One-fifth of couples struggling with infertility are diagnosed with unexplained infertility. This diagnosis simply means that the physician can find no obvious cause for the inability to conceive, even though this can relate to tubal disease or egg quality factors that are hard to pick up with standard testing. Couples diagnosed with unexplained infertility often get pregnant using IVF.
- Anovulation. If a woman is not ovulating (anovulation) or is ovulating infrequently, ovulation-inducing medication can help to achieve pregnancy through intercourse. But if a couple is unable to get pregnant with these lower-tech measures, IVF can be used to overcome anovulation.
- Damaged fallopian tubes. If significant damage exists due to injury or previous tubal ligation, the only fertility treatment options are surgical repair, in which success rates are sometimes less than ideal, or IVF. IVF bypasses the fallopian tubes entirely and has a high success rate.
- Male infertility factors. Typically, male infertility factors involve low quantity or quality of sperm. In these cases Dr. Parry recommends IVF with ICSI.
Risks of IVF
The most common risk associated with IVF is a multiple pregnancy, which means twins or more. While some patients may desire twins, a multiple pregnancy can result in many complications for both mother and children during pregnancy, labor and beyond. This includes premature delivery, low birth weight and ongoing medical and developmental problems for the children.
For this reason, the doctor will typically recommend transferring the fewest number of embryos (usually a single embryo) to achieve a pregnancy with just one baby. Frozen embryos can be used later if pregnancy does not occur during the first round of IVF, if a miscarriage happens, or if a baby is born and the parents want to have another child.
During the ovulation stimulation phase there is a risk of side effects that can include headaches, mood swings, abdominal pain, hot flashes and bloating. There is also a very small risk that some women will overreact to the hormone drugs used to stimulate the ovaries, resulting in a condition called ovarian hyperstimulation syndrome (OHSS). Ultrasound and hormone monitoring during this phase help find a balance that lowers the risk for OHSS while still maximizing the chances of pregnancy.
IVF is considered a surgical procedure, so it carries normal surgical risks. These include reaction to anesthesia, blood loss, infection, and injury to tissue and organs. However, many of these risks are low and can be compared with accepted risks such as driving a car or pregnancy itself.
Next steps: Schedule an IVF consultation
Positive Steps Fertility welcomes new patients and has short wait times for an initial consultation appointment. Many patients will be candidates for our proprietary Parryscope™ fertility testing technique, a gentle, affordable, fast and accurate female infertility test. From there, we can help you decide the best course of treatment, whether it’s IVF or another fertility treatment option.