Understand IVF procedures, risks, costs, and success rates

IVF stands for in vitro fertilization , which literally means "at the conception of the laboratory." With IVF treatment, the egg is fertilized with sperm in a Petri dish. Typically, many eggs are obtained from the biological mother (who may or may not be the intended father), as not all eggs will be fertilized, and not all fertilized eggs will develop into a viable embryo.

A few days after fertilization, the best embryos or embryos are transferred to the mother or surrogate uterus through a catheter through the cervix.

Any additional embryos can be cryopreserved for future cycles.

When is IVF used?

Because the eggs are obtained directly from the ovaries and the embryo is transferred to the uterus through the cervix, IVF does not require open, clear fallopian tubes . Women with blocked fallopian tubes can use IVF to achieve pregnancy.

IVF is also used for cases of male infertility that cannot be overcome with IUI treatment or other treatments. In some cases, men without sperm in their semen can obtain sperm directly from the testicles or the vas deferens. Men with low sperm counts are more likely to be successful with IVF treatment.

IVF can also be used in conjunction with ICSI , which involves taking a single sperm and injecting it directly into an egg. Even though the sperm are injected directly into the egg, fertilization is not yet guaranteed, but the chance of pregnancy success is much higher with ICSI than without those who need this procedure.

IVF can also be used in cases of unexplained infertility, women in need of an embryo or egg donor, those using a traditional surrogate or gestational carrier, or after multiple unsuccessful fertility treatments .

The procedure

The IVF procedure may be slightly different for different people, depending on what assisted reproductive technologies are being used and whether it involves donated eggs , sperm, or embryos.

There are also some situations that cause a cycle to be canceled in between, either because not enough follicles grow or because of a high risk of severe ovarian hyperstimulation syndrome (OHSS) .

With that said, this is a basic description of the procedure.

Typically, the woman will begin taking birth control pills or an injectable medication that prevents ovulation during the cycle prior to treatment , interrupting the woman's normal ovulation cycle. This is so that the doctor can regulate ovulation and not lose the eggs before recovery. After the initial blood test and an ultrasound, the woman will begin taking ovulation-stimulating medications, usually gonadotropins .

In minimally stimulated IVF , either Clomid is used or ovulation stimulating medications are not used, but this is unusual. The clinic will monitor follicular growth and hormone levels with ultrasound and blood tests every few days.

When the follicles are ready, the woman will receive an injection of hCG to mature the eggs. Egg retrieval will be scheduled for a very specific number of hours after injection, during which time the woman will receive IV sedation and the eggs will be retrieved through an ultrasound-guided needle through the vaginal wall.

While the woman has the egg retrieval, the man will provide the semen sample.

Sometimes this is done once in recovery and also sometime before recovery day (and frozen), in case of problems or anxiety creating the sample.

The semen will undergo a special washing procedure, and the eggs will be placed in a special culture. The sperm will be laid with the eggs, in the hope that fertilization will take place.

A few days later, an embryologist will help select the healthiest embryo from the fertilized embryos, and your fertility doctor will help decide how many embryos to transfer. Leftover embryos can be cryopreserved for a later cycle, donated to another couple, or thrown away.

Success rate

Your chances of IVF success will depend on a variety of factors, including your age, cause (s) of infertility, use or not of donor eggs, previous treatment results, and the clinic's experience with your particular needs.

That said, in general, IVF treatment has excellent success rates. According to 2009 statistics compiled by the Society of Assisted Reproductive Technologies (SART), for women under 35, the percentage of live births per IVF cycle was about 41 percent.

Success rates decline with age, with a 12 percent success rate for women ages 41 to 42.

Safety

IVF is generally safe, but as with any medical procedure, there are risks. Your doctor should sit down with you and explain all the possible side effects and risks of each procedure.

Ovarian hyperstimulation syndrome (OHSS) occurs in 10 percent of women who undergo IVF treatment. For most women, the symptoms will be mild and they will recover easily. By a small percentage, OHSS can be more serious and may require hospitalization. Less than 1 percent of women who undergo egg retrieval will experience blood clots or kidney failure due to OHSS.

Egg retrieval can cause cramping and discomfort during or after the procedure, but most women will feel better in a day or so. Rare complications include accidental puncture of the bladder, bowel, or blood vessels; pelvic infection; or bleeding from the ovary or pelvic vessels.

If a pelvic infection occurs, it will be treated with antibiotics through a vein. In rare cases of severe infection, the uterus, ovaries, or fallopian tubes may need to be surgically removed.

Embryo transfer can cause mild cramping during the procedure. On rare occasions, women will also experience cramping, bleeding, or spotting after the transfer. In very rare cases, infection can occur. The infection is usually treated with antibiotics.

There is a risk of multiples, which includes twins, triplets, or more. Multiple pregnancies can be risky for both the babies and the mother. It is important to talk with your doctor about how many embryos to transfer, as transferring more than necessary will increase the risk of conceiving twins or more.

Some research has found that IVF can increase the risk of very rare birth defects, but the risk is still relatively low. Research has also found that the use of ICSI with IVF, in certain cases of male infertility , can increase the risk of infertility and some sexual birth defects in male children. However, this risk is still low (less than 1 percent conceived with IVF-ICSI).

IVF Pregnancy

IVF has a higher risk of conceiving multiples, and a multiple pregnancy carries risks for both the mother and the babies. Risk of multiple pregnancy include labor and birth prematurity , maternal hemorrhage, cesarean delivery , high blood pressure induced by pregnancy and gestational diabetes .

Research has also found that women who conceive with IVF are more likely to experience preterm labor , even with a single baby.

Women who conceive with IVF are more likely to experience spotting in the early months of pregnancy , although their spots are more likely to resolve without harming the pregnancy.

The risk of miscarriage is roughly the same for women who conceive naturally, with the risk increasing with age. For young women in their 20s, the miscarriage rate is as low as 15 percent, while for women over 40, the miscarriage rate can be more than 50 percent.

There is a 2 to 4 percent risk of ectopic pregnancy with IVF conception .

cost

The average cost of IVF is $ 12,000, but this can vary depending on the technologies used. IVF with egg donation is the most expensive, with a cycle of between $ 25,000 and $ 30,000.