What is IVF?

Couples thinking about IVF as a treatment option, couples getting ready for IVF or couples undergoing IVF treatment need to understand what is IVF. This article gives detailed answers to questions below:

IVF is the acronym of In Vitro Fertilization which is one of the most effective assisted reproductive technologies (ART). In IVF, fertilization of multiple eggs by sperm take place in a laboratory setting, and one or more embryos formed are then transplanted into mother’s uterus.

When is IVF used?

IVF can be used to treat infertility in a couple caused by male factors, female factors or both male and female factors. Women suffering from damaged or blocked fallopian tubes, cervical mucus defect, endometriosis, ovulatory disorders or sperm allergy and men suffering from sperm disorders, blocks in vas deferens or ejaculatory duct, retrograde ejaculation, premature ejaculation or erectile dysfunction can be treated with IVF. IVF is also used to treatun explained infertility.

What is IVF procedure?

In IVF, fertility drugs are used to stimulate production of multiple ovaries (eggs) in women. Once these eggs mature, the fertility specialist retrieves them from ovary through a minor surgical procedure. In a laboratory setting, each egg is then mixed with sperm collected from normal ejaculate of male partner or sperm retrieved from the reproductive tract of male partner. This would result in fertilization of multiple eggs and formation of multiple embryos. One or more healthy embryos are then transplanted into woman’s womb (uterus). A successful pregnancy is achieved when one or more of these transferred embryos gets implanted to the uterus lining and starts growing there. There is a possibility of having a multiple pregnancy (pregnancy with two or more foetuses); if more than one embryo is transferred to a woman’s womb by IVF. This has a few risks associated with it. It is advisable to discuss with the fertility specialist about it. Embryos that are left over from an IVF cycle can be freezed for future use, donated to other infertile couples or destroyed.

IVF can also be performed using donated eggs and/or donated sperm.

The video below shows a 3D animation of IVF procedure.

How long does IVF treatment take?

One IVF cycle, that starts with use of fertility drugs to stimulate production of multiple ovaries and ends with transfer of embryos to mother’s uterus can take approximately four to six weeks. Pregnancy tests can be performed in between day 9 and day 14 after embryo transfer. IVF treatment does not usually require the individual under treatment to get admitted to the clinic or hospital (all procedures are performed on outpatient basis). However, regular visits to the clinic would be necessary till embryo transfer.

What is the success rate of an IVF cycle and what factors influence success rate?

Success rates of IVF can be defined either in terms of pregnancy rates (achieving a successful pregnancy that may or may not result in a live birth) or in terms of live birth rates. The success rate depends on a number of factors such as age of woman under treatment, underlying causes of infertility (could be male factors, female factors or both male and female factors), expertise of treatment facility and whether donor eggs or mother’s own eggs are used for IVF.

Success rates are usually higher for women below 35 years of age and lower for women above 42 years of age. However, if donor eggs (that can be retrieved from a younger woman) are used for IVF, success rates do not depend as much on age. On an average, success rate of a single IVF cycle in terms of achieving a successful pregnancy is 29.4% and success rate of a single IVF cycle in terms of live birth is 22.4%.

Failure of an IVF cycle can be challenging to go through. Be aware that repeated IVF cycles or another treatment method prescribed by the fertility specialist might help in achieving a successful pregnancy and giving birth to a healthy baby.

Please click IVF success rates of clinics in the United States for more information.

How much does IVF cost? How to finance IVF costs?

Cost of IVF can vary with location of clinic, success rates of clinic, expertise of treatment facility etc. In US, one IVF cycle costs between 10,000 to 15,000 dollars. An IVF cycle can have additional costs, if donor eggs (can be very expensive) or donor sperm are needed or procedures such as intracytoplasmic sperm injection (ICSI), assisted hatching or blastocyst transfer are performed in conjunction with IVF. Discuss in advance with the fertility clinic about total costs involved for an IVF cycle and budget for hidden costs such as taking time off work and travel expenses.

Insurance plans may either partially cover IVF or may not cover IVF at all. It is advisable to read the insurance plan carefully and get the help of an independent insurance advisor to find out whether the insurance plan covers the treatment. Click infertility insurance laws for more information on 15 states in the United States that require insurance coverage for infertility treatments.

Some other options for financing IVF are:

Some fertility clinics offer financing options in partnership with local banks
If there is a flexible spending account offered by the employer, use it
Take out money from retirement fund
Take out a loan
Shared risk or refund IVF programs: Couple pays up front for multiple IVF cycles. If the treatment does not succeed within the number of cycles for which the payment is made up front, the clinic or program refunds all or part of the money. Please pay attention to the terms and conditions which define “success” of the treatment. Some clinics define success of treatment as achieving a successful pregnancy, while others define it as live birth, that is, having a take-home baby.

What are the risks of IVF?

Major risks of IVF are: ovarian hyper stimulation syndrome or over stimulation of ovaries (by fertility drugs), multiple pregnancy (pregnancy with two or more foetuses) that can cause high blood pressure and diabetes in mother, premature labor and babies having low birth weight, ectopic pregnancy(a condition in which a fertilized egg gets implanted to fallopian tube instead of uterus and starts growing there), infections or damage to reproductive tract, birth defects in babies (chances are very low) and allergic reactions to drugs.

What are the things to take care of after IVF?

Once embryos are transferred to mother’s uterus, the couple has to wait for two weeks to see symptoms of pregnancy (in case of a successful IVF). Pregnancy tests can be performed between days 9 and 14 after embryo transfer.

It is important to stay relaxed. Following activities are usually forbidden after embryo transfer:

heavy lifting
strenuous physical activity
smoking, use of alcohol or recreational drugs

Couple are advised not to indulge in sexual intercourse and orgasms either till a foetal heartbeat is detected or till a negative pregnancy test.

In some cases, spotting and abdominal cramps result from IVF procedures or implantation of embryo to uterus lining. Though this is not some thing to worry about, in case of doubt, consult the fertility specialist as a precautionary measure.

The fertility specialist may give additional instructions depending on an individual’s medical and treatment history. Usually, there are no issues with going to work, travelling and engaging in light activities during the two week wait period after IVF.

What is blastocyst transfer in IVF?

A blastocyst is an embryo that has developed in the laboratory for at least five days after fertilization. A healthy blastocyst hatches from its shell (zona pellucida) six days or earlier after fertilization. It is then ready to get implanted to the uterus lining.

In a normal IVF procedure, embryos are transferred to mother’s uterus usually on the third day after fertilization. But in blastocyst transfer, embryos are transferred after they have developed to blastocyst stage on day 5 or day 6 after fertilization.

Blastocyst transfer has following advantages:

Embryos that survive till day 5 or day 6 are usually the healthiest ones (approximately 50 % of embryos die soon after third day in the laboratory). Hence, waiting till the fifth or sixth day helps to select best embryos from the lot. This increases chances of a successful pregnancy.

In blastocyst transfer, embryos are transferred to mother’s uterus at almost the same time as it would have happened in a natural pregnancy. This makes it more likely to achieve a successful pregnancy.

Since success rates are higher for blastocyst transfer, fewer embryos (usually one or two) need to be transferred to the uterus. This reduces the risk of multiple pregnancy (in comparison with normal IVF procedure).

However, IVF procedure involving blastocyst transfer requires more complex laboratory settings that have additional costs associated and approximately 50 % of embryos which could have been freezed for future use or donated to other infertile couples are lost during the process. In addition, blastocyst transfer has an increased risk of identical twins.

What is assisted hatching in IVF?

An outer layer called zona pellucida protects an embryo till it reaches the blastocyst stage of development (on day 5 or day 6 after fertilization). Then the embryo has to hatch out of this outer layer, so that it can implant to the uterus lining of mother. In some cases, the outer protective layer of embryos might be thicker than usual. This makes it difficult for the embryo to hatch out and get implanted to the uterus. Assisted hatching uses micro manipulation techniques to weaken the outer layer of an embryo by making a small opening. This process helps embryos to hatch out and successfully implant to uterus lining. Assisted hatching is performed while the embryo is in laboratory, usually on the third day after fertilization.

Assisted hatching is recommended for couples who had two or more failed IVF cycles, women over 38 years of age, women with high levels of follicle stimulating hormone (FSH) on day 3 of menstrual cycle, and for couples whose embryos have thick zona pellucida.

Though chances are very low, assisted hatching can cause damage to embryo and can increase risk of monozygotic (identical) twins.

What is intracytoplasmic sperm injection (ICSI) in IVF?

Intracytoplasmic sperm injection (ICSI) can be performed in conjunction with in vitro fertilization (IVF). ICSI may be recommended for men who suffer from sperm disorders such as low sperm count, complete absence of sperm cells in semen, poor sperm motility or abnormal sperm morphology. These disorders prevent sperm from successfully penetrating and fertilizing an egg. ICSI can also be used to treat infertility in men caused by premature ejaculation, erectile dysfunction or if previous attempts of IVF failed to achieve a successful pregnancy.

Treatment starts with collection of sperm either from normal ejaculate of male partner or from the reproductive tract of male partner and retrieval of ovaries (eggs) from female partner. Donated sperm and/or ovaries can also be used for ICSI. In a laboratory setting, a selected single sperm is then injected into the cytoplasm of an egg. This makes it easier for the sperm to penetrate the egg and fertilize it. Then another single sperm and egg are picked from the sample and same process is repeated (it is repeated a few times to increase chances of formation of multiple embryos). One or more healthy embryos are then transplanted into woman’s womb (uterus).