What Is IVF? Your Complete Guide to Understanding the Process

If you’ve been at it for some time but are still getting negative pregnancy tests, IVF, or in vitro fertilization, may be an option for you. So what is IVF? In short, it’s a fertility treatment that consists of extracting a woman’s eggs, fertilizing them with sperm in a lab, and putting an embryo back in her uterus in the hopes of creating a viable pregnancy.

It’s a complicated process and it’s absolutely normal if just the thought of a fertility treatment like IVF has you feeling overwhelmed. To help break it down, we asked Lucky Sekhon, M.D., a reproductive endocrinologist, infertility specialist and board certified obstetrician and gynecologist in New York, and Enrique Soto, M.D., a fertility specialist and Fellow of the American College of Obstetricians and Gynecologists in Miami to walk us through the process, costs and risks of IVF.

Why consider IVF?

First things first. Infertility is defined as the inability to get pregnant after one year of having regular unprotected sex with your partner, according to Johns Hopkins Medicine. The causes of infertility can vary from what’s called male factor infertility—which includes problems like poor sperm quality and low quantity—to female factor infertility like blocked or missing fallopian tubes, endometriosis, or fibroids. If you’ve been having sex with your partner during your fertile windows but are still not getting pregnant, you may be dealing with one of these underlying issues. IVF may be able to help circumvent them.

But that’s not the only reason IVF may also be something to consider. It’s also used by couples who have genetic conditions that run in the family such as cystic fibrosis because genetic testing can easily be done on embryos created in a lab. “By creating an embryo outside of the body, it gives us the opportunity to genetically test the embryo to ensure we are selecting the best embryo to transfer into a woman’s uterus,” says Sekhon. “This serves to maximize success rates and reduce the risk of miscarriage."

In vitro fertilization is also often an option for older women. Age plays a significant part in developing genetically healthy embryos—the risk of having an abnormal embryo with problematic DNA is 60-70% for women who are 40 years old and 85-90% in women 45 years and older, according to the medical journal Fertility and Sterility—which is why IVF is suggested for women in their mid to late 30s and older.

IVF Process: How does in vitro fertilization work?

In vitro fertilization has several successive steps: preliminary exams, ovarian stimulation, egg retrieval, fertilization, genetic testing, and implantation. The multi-step process is surprisingly efficient and one IVF cycle can take as little as three weeks, according to the Mayo Clinic.

Preliminary exams

Once you decide to start IVF, a fertility specialist will do some routine testing like a pelvic ultrasound, semen analysis, uterine exam, and blood tests to determine if you’re a good candidate for IVF.

Ovarian stimulation

If everything is clear, they’ll start the egg maturation and growing process, which is called “ovarian stimulation.” You’ve probably heard that IVF involves a lot of needles and this is where they come in. Twice a day for a period of eight to 10 days, you’ll receive injections of synthetic hormones like follicle stimulating hormone and luteinizing hormone into your abdomen, in order to kick your natural ovulation cycle into overdrive. (The hormones will likely make you bloat, but this process shouldn’t cause permanent weight gain.)

Soto says that his patients usually come in for five or six short appointments during the stimulation phase for transvaginal ultrasounds—where a specialized ultrasound wand is placed inside the vagina—and blood tests.

After an ultrasound has shown that the ovarian follicles (where the eggs grow) have become the correct size and there are enough eggs to harvest, the fertility specialist will stop the hormone treatments and go in for an egg retrieval about two days later.

Egg retrieval

Egg retrieval is an outpatient procedure during which you’ll be put under light anesthesia. The method is called “transvaginal ultrasound aspiration,” which means the eggs are lightly suctioned with a long, thin needle that goes through the vaginal wall to the ovaries. “The entire process is quite easy,” says Sekhon. “The ovaries actually sit on the other side of the vaginal wall, in the pelvis, so they are very easy to access.” The procedure is quick, taking between five and 20 minutes.

Fertilization

The same day that the eggs are retrieved, they are combined with sperm (a partner’s or donated) in a lab. The fertilized eggs are then put in an incubator, where they will develop for about a week while being monitored under a microscope for proper development.

Genetic testing

This step is optional. If you want to do genetic testing, doctors take a small biopsy from the embryos and then freeze them, which is called cryopreservation. After the biopsy results come back, women can try for an implantation of a preserved embryo during her following menstrual cycle.

If you want to try to get pregnant right away without genetic testing, an embryo is transferred using a catheter that’s inserted into the vagina to the uterus and a syringe that contains an embryo suspended in liquid. With the push of the syringe, you’re one step closer to being pregnant.

Implantation

About two weeks after the embryo transfer, a doctor will administer a blood test to see if you are pregnant. If you test negative, you can try for another implantation about three weeks into your next menstrual cycle using any frozen embryos. If your pregnancy test is positive, your fertility specialist will refer you to a regular OBGYN as your pregnancy will be treated just like any other.

The chance of miscarriage after IVF is the same as with a naturally conceived pregnancy—about 15-25%, according to the Mayo Clinic.

How Much Does IVF Cost?

In vitro fertilization, paid out of pocket, is pricey—around $15,000 to $25,000 for one cycle, according to Fertility IQ. Soto says that prices can vary depending on whether it is a fresh embryo transfer versus a frozen transfer and if you want genetic testing, among other factors. One of the biggest expenses are the synthetic hormone medications used during ovarian stimulation, which cost around $5,000 per cycle.

However, some insurance plans are starting to offer coverage for in vitro fertilization, says Sekhon, at least in part. And some larger companies are even offering fertility benefits for their employees. Make sure you call your insurance company or reach out to your company’s human resources representative to check to see what’s covered before starting the process.

IVF Risks and Safety

"In general, IVF is very safe,” says Sekhon. Long term studies have not shown any link between breast and ovarian cancer and in vitro fertilization, according to the American Society for Reproductive Medicine. In addition, studies have shown that the long term health of babies conceived from IVF is comparable to that of naturally conceived children, according to Fertility and Sterility.

Overall, the risks of IVF are fairly low. Bruising, allergic reaction, and hyperstimulation of the ovaries during the egg growth period, are the most common, says Soto. The most invasive portion of IVF is the egg retrieval. The thin needle used during the procedure poses a very small risk of major bleeding but like any procedure, it does carry the risk of infection.

Genetic testing of the embryos is also low risk. While there is a small chance of a false negative or positive genetic test, Soto cites that the accuracy of the results after a biopsy is about 98-99% in genetic labs. There is also the rare occurrence of an ectopic pregnancy after in vitro fertilization, though the chances are very small.

What about couples who plan for one baby but end up with multiple? Current national guidelines suggest transferring only one embryo during each in vitro fertilization cycle, which makes women less likely to give birth to multiple children. It is still possible to become pregnant with multiples with one embryo transfer. “A single embryo may divide in the uterus after a transfer,” Soto says. “But the risk is very low, approximately 3%.”

IVF Success Rates

So does in vitro fertilization work? Yes, but there are a variety of factors that influence the IVF success rate, says Soto, including “the cause of infertility, age of the patient, number of embryos transferred, transfer of genetically normal versus untested embryos, and the IVF center.” To get some insight into your personal chances of IVF success, the Society for Assisted Reproductive Technology offers a helpful tool.

Age is a significant factor. As women get older, they produce less eggs, which are also more likely to have genetic abnormalities. So the chances of finding a normal embryo become especially slim in women 40 years old and older, Sekhon says. In cases where you can get a genetically normal embryo, the transfer rate of success is about a 60-65%, regardless of age and diagnosis, according to internal data from the Reproductive Medicine Association of New York.

And where you receive fertility treatment really does matter. Finding a fertility doctor who makes you feel comfortable and empowered throughout the in vitro fertilization process can make your journey to parenthood smoother. SART also offers resources to compare IVF clinic success rates.

“You are not alone. It is extremely common to hit a bump in the road and face challenges on the journey to building your family,” says Sekhon. “While the path may not be straight forward, with the right support and guidance, you will get there.”

Minhae Shim Roth is a writer and reporter in the San Francisco Bay Area. Follow her on Instagram @momphdblog.

Experiences of infertility always have one thing in common: uncertainty. The countless visits to doctors, the months (or years) of planning, the tens of thousands of dollars, never add up to a guarantee. Even under the best of circumstances, there's only so much about a pregnancy you can plan and in the midst of a global pandemic, the idea of planning anything seems foolish. For National Infertility Awareness Week, we're exploring the uncertainty—and the hope.

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