Guide to the IVF Treatment Process
In vitro fertilization (IVF) is a form of Assisted Reproductive Technology (ART) that uses a strategic set of procedures to support parents on their fertility journey. Many people choose IVF to assist with conception, whether they have had problems conceiving in the past, or are simply reaching an age where their reproductive potential is diminishing. While IVF is most commonly pursued by people experiencing infertility, IVF is also a viable option for same-sex couples and hopeful single parents.
In IVF, doctors prescribe medication to stimulate the ovaries. Then, they gather mature eggs from the ovaries and fertilize them with sperm in a lab. Finally, they transfer the fertilized egg(s) to the uterus. A full cycle of IVF typically takes around three weeks.
Conception is personal. Though IVF is considered one of the most effective forms of ART, it is not right for everyone, and a successful procedure depends on many factors. Your doctor can help you decide if IVF is right for you.
When to use IVF
In vitro fertilization is often used as a treatment for infertility or to help address genetic problems, but it is not the only form of ART. If you are a same-sex couple or a single mom, you may consider a less invasive treatment like intrauterine insemination (IUI) before deciding on IVF treatment.
As a primary infertility treatment, IVF is a helpful option for couples struggling to get pregnant. It can also be a good approach if you have certain health conditions. You may decide to choose IVF treatment if you or your partner has any of the following:
Fallopian tube damage or blockage
This is a complication that can prevent an egg from being fertilized or an embryo from traveling to the uterus.
An ovulation disorder
Those who experience irregular ovulation may produce fewer eggs for fertilization.
When tissue similar to the lining of the uterus implants and grows outside the uterus, a condition called endometriosis, it often affects the ovaries, uterus, and fallopian tubes. It is important to note that most women with endometriosis will become pregnant without any medical assistance. For women diagnosed with severe endometriosis (stage III/IV) who do want to become pregnant, around 75% will be able to do so, two-thirds naturally and one-third with the help of IVF.
These benign tumors in the uterus can interfere with the implantation of a fertilized egg and often affect women in their 30s and 40s.
Previous tubal sterilization
In this procedure, the fallopian tubes are permanently cut or blocked to prevent pregnancy. IVF may be an alternative to tubal ligation reversal.
Impaired sperm production or function
Those with below-average sperm concentration, weak sperm mobility, or abnormal sperm size and shape may struggle with infertility, but some of these problems may be correctable with methods like intracytoplasmic sperm injection (ICSI).
A genetic disorder
Those at risk of passing on a genetic disorder to their child may be candidates for preimplantation genetic testing, a procedure used to identify genetic abnormalities in embryos created through IVF.
Cancer or another serious health condition
Cancer treatments like radiation or chemotherapy can harm fertility. For cancer patients, IVF for fertility preservation may be an option. Likewise, those with uterine conditions that impede healthy function of the uterus or for whom pregnancy poses a serious health risk might choose IVF and use a gestational carrier.
When no cause of infertility has been found after an evaluation, a person may be diagnosed with unexplained infertility.
Risks of IVF
It’s important to remember that IVF is not successful for everyone. Some patients need to undergo multiple rounds of IVF before they achieve pregnancy, and normal risks like miscarriage and birth defects can still impact these pregnancies. Also, IVF can be expensive, and some insurance companies don’t cover treatment.
Ultimately, IVF is unique to each person and might not be as effective for women over 37 years old. Like all medical procedures, IVF may cause possible adverse side effects like anxiety and depression. Other risks include the following:
If more than one embryo is transferred to the uterus during IVF, the result may be a pregnancy with multiple fetuses.
Premature delivery and low birth weight
According to some research, IVF can increase the risk of early labor and low birth weight.
Ovarian hyperstimulation syndrome
The use of injectable fertility drugs to induce ovulation during IVF can cause ovarian hyperstimulation syndrome. The symptoms include mild abdominal pain, bloating, nausea, vomiting, and diarrhea and can last a week or more.
Egg-retrieval procedure complications
Doctors use an aspirating needle to collect eggs during IVF. This can possibly damage the bowel, bladder, or blood vessels and cause bleeding or infection.
About 2% to 5% of women who use IVF have an ectopic pregnancy. During an ectopic pregnancy, the fertilized egg implants outside the uterus, usually in a fallopian tube, and the fertilized egg can’t survive. The pregnancy must be terminated.
Preparing for your IVF treatment
Before you begin IVF treatment, you will schedule a consultation with a reproductive endocrinologist. In this meeting, your doctor will look at your medical history and talk to you about your fertility goals. They will likely also discuss the kinds of mental preparation you’ll need to help cope with the emotional impact of IVF treatment. Then, they will prescribe fertility testing.
You may be required to complete mandatory pre-treatment tests prior to your consultation. They will prescribe other tests customized to meet your needs. The doctor will use your results to discuss treatment options.
Tests such as a hormone panel, ultrasound, blood work, and semen analysis will help your physician determine your medication protocol and other approaches that may be best for you. Some tests you may need include the following:
Ovarian reserve testing
During the first few days of your menstrual cycle, your doctor will test the concentration of various hormones in your blood to determine the quantity and quality of your eggs. This helps predict how your ovaries will respond to fertility medication.
Infectious disease screening
To help prevent the spread of infectious disease, your doctor will screen you for diseases like HIV, Hepatitis B, and Hepatitis C.
Mock embryo transfer
A mock embryo transfer may be done to help determine the depth of your uterine cavity. Your doctor will use the results to decide which technique to use to successfully transfer the embryos into your uterus.
Before the start of an IVF treatment cycle, your doctor will conduct a semen analysis to measure things such as the quantity of semen, concentration of sperm, sperm motility, and sperm morphology.
During a uterine exam, your doctor examines the inside lining of the uterus They will likely use one of three procedures: an ultrasound, a biopsy, or sonohysterography.
Questions to consider before beginning IVF
Most IVF patients can finish their testing within one to two months. When your testing is complete, you may need to schedule a follow-up visit with your doctor so that they can explain the results, discuss treatment options, and answer any questions you may have.
While you are consulting with your doctor, you may want to consider some of these important questions before beginning IVF treatment:
How many embryos will be transferred?
Your doctor will determine how many embryos to transfer based on your age and the number of eggs retrieved. Typically, more embryos are transferred to older women. Specific guidelines will be followed to prevent a multiple pregnancy, but be sure to discuss this with your doctor before the transfer procedure.
What will you do with any extra embryos?
You can elect to freeze extra embryos for several years to make future cycles of IVF less expensive and invasive. Most embryos will survive the freezing and thawing process. You can also choose to donate unused frozen embryos to another couple or to a research facility.
How will you handle multiple pregnancies?
As medical technology and techniques improve, multiple embryo transfers are done less frequently. But if you happen to have multiple embryos transferred, be prepared for a multiple pregnancy, which can become a health risk. You will also want to consider the added financial risk of having more than baby.
Have you considered the potential complications associated with using donor eggs, sperm, embryos, or a gestational carrier?
Your doctor will evaluate your fertility, prior treatments, health, and age before recommending these services. As working with a donor can be stressful, you may hire a trained counselor to help you understand the various aspects of each service, including the legal rights of the donor.
What you can expect
Undergoing a round of IVF can feel overwhelming. Understanding the ins and outs of the procedure and processes may help alleviate your stress. Once you have finished your screening and consultation, it will take 2–3 weeks to complete the IVF process, which includes five additional steps:
During this stage of the process, you may take oral and injectable fertility medication with synthetic hormones to stimulate the ovaries to produce multiple eggs, which are needed to increase the chances of a successful pregnancy. Some eggs won’t fertilize or develop normally after fertilization. This stage typically lasts one to two weeks.
When you are ready for egg retrieval, you will be given general anesthesia and pain medication. Then, your doctor will use a transvaginal ultrasound aspiration procedure to suction eggs from the growing follicles in your ovaries and collect them. It takes about 20 minutes to remove multiple eggs.
Doctors use one of two common methods to fertilize the eggs in a laboratory: conventional insemination or intracytoplasmic sperm injection (ICSI). In conventional insemination, doctors place mature eggs in a culture medium and incubate them. When semen numbers are low or prior IVF cycles have failed, doctors use ICSI. During this procedure, one healthy sperm is injected directly into each mature egg. In certain situations, your doctor may recommend other methods for fertilization.
Within 24 hours of fertilization, the embryologist should be able to determine how many embryos have formed. They may spend 5–7 days in the laboratory before they can be frozen or transferred back to the uterus. You might choose to test embryos for genetic or chromosome abnormalities at this time.
The embryologist and your physician will decide the number of embryos that should be transferred based on their appearance and rate of development. Typically, embryos are transferred on day three or five using a soft catheter, which your physician will place in the uterine cavity through the cervix under the guidance of an ultrasound.
The procedure feels similar to a pap smear, but side effects include spotting, breast tenderness, mild bloating and cramping, and constipation.
About 10 to 12 days after the transfer, a blood test is performed to determine if you are pregnant. If you’re pregnant, your doctor will refer you to a pregnancy specialist for prenatal care. If you’re not pregnant, you should stop taking progesterone and expect to get your period within a week. At this time, you can consult with your doctor about attempting another round of IVF.
Additional IVF Procedures
IVF success depends on several factors including maternal age, embryo status, reproductive history, causes of infertility, and lifestyle. If your first round of IVF is unsuccessful, you’re not alone. Many people attempt multiple rounds of IVF before achieving a successful pregnancy. You may want to consider these additional IVF procedures to support you as you continue on your fertility journey.
Laser-assisted hatching facilitates implantation by creating a small gap in the outer membrane of the uterine wall before implantation. This technique usually takes place before embryo transfer and helps the embryo break out of the membrane. Assisted hatching is shown to improve IVF success rates in both fresh and frozen embryo transfers.
Pre-Implantation Genetic Testing (PGT)
Patients who have had several miscarriages or failed IVF attempts may benefit from pre-implantation genetic testing (PGT). This procedure happens during an IVF cycle and helps detect genetic abnormalities, inherited genetic diseases, and aneuploidy, a condition in which an embryo has a missing or extra chromosome that may prevent implantation.
A biopsy is performed on an embryo by extracting several cells from its outer layer on the fifth, sixth, or seventh day of development. The extracted cells are sent out for analysis and preserved. The embryo is returned after the results are received.
Endometrial Receptivity Testing
One of the main causes of implantation failure is the lack of synchronization between the embryo and endometrium, the lining of the uterus. Typically, physicians use ultrasound technology to examine the thickness and pattern of the endometrial lining to determine the best window of implantation (WOI), but some people have alterations in their endometrium that may impact their implantation rate and IVF success.
Studies have shown that 30% of infertility patients have a displaced WOI. An endometrial receptivity test like MIRA™ can analyze the endometrial lining at the molecular level to determine the optimal time for embryo transfer.