How Does the IVF Process Work?

What is IVF Treatment?

In Vitro Fertilization, commonly referred to as IVF, is the assisted process of fertilization to help in the conception of a child. IVF is a type of assisted reproductive technology (ART) that, in summary, extracts eggs from a female and manually combines them with sperm samples in a laboratory. If the egg becomes fertilized, the embryos are transferred into the uterus. From there, patients wait to see if a pregnancy takes place. The process can be an effective and efficient treatment for infertility.

Since 1985, when the Society for Assisted Reproductive Technology began collecting data, more than 1 million babies have been born from IVF and related treatments — the first IVF baby was born in the United States in 1981. Today, according to the Centers for Disease Control and Prevention (CDC), IVF and other assisted reproductive technology are offered at more than 440 fertility clinics across the country.

According to the CDC, the use of ART has doubled over the past decade, and considering about 10 percent of American women have trouble getting pregnant, it’s no wonder why. Approximately 1.6 percent of all infants born in the United States are conceived using ART cycles, 99 percent of which are IVF treatments. For most couples, IVF is chosen only after other types of fertility treatments have failed — ovulation stimulation, medication, insemination or surgery.

An IVF treatment cycle begins on the first day of a female’s menstrual cycle and ends with the retrieval of the egg. It’s important to note that the success rate increases exponentially as more IVF cycles are completed. In a study done in the United Kingdom, among women undergoing IVF, the live-birth rate for the first cycle was 29.5 percent. After 6 cycles, it increased to 65.3 percent.

Why Should I Start IVF Treatment?

In Vitro Fertilization is typically used when couples have continuously failed in attempts to conceive and after other types of fertility treatments were not successful. IVF can be used to treat infertility caused by a number of reasons, including female ovulation disorders, premature ovarian failure, uterine fibroids, genetic disorders, blocked, damaged or removed fallopian tubes, and male infertility, such as decreased sperm count.

Women who have damaged or removed fallopian tubes can get pregnant through IVF treatment because the eggs are retrieved from the ovaries, and the embryos are transferred through the cervix — no direct need for open fallopian tubes.

For couples who hope to use an egg donor or surrogate, IVF treatment is a viable option.

Understanding IVF and Male Infertility Treatments

Many IVF resources target women who have fertility difficulties, though IVF is common for couples with a range of fertility problems, including male infertility. Because IVF combines both egg and sperm to ensure insemination happens, this process can be used when either gender has a fertility difficulty. During the initial consultation process, a doctor will determine any issues that have made getting pregnant difficult; from here, this specialist can determine if IVF is the best course of action, or if other male infertility treatments are better suited.

In many cases, fertilization success for men with low sperm count is more likely through IVF. And in the cases of male infertility, the IVF process can utilize donor sperm during insemination. These options allow couple to start families regardless of fertility issues impact eggs or sperm.

Common IVF Terms You May Have Heard

Starting IVF treatment isn’t just about what happens at the doctor’s office — you’ve probably already realized that there’s a lot of research involved in the process. To help, here are a few common IVF terms that you may have heard, explained.

  • Blastocyst: Going through the IVF process can seem clinical, especially when it comes to what reproductive tissues and matter are called. After an egg is fertilized by sperm, it develops into blastocyst. Within five to seven days, these cells then turn into an embryo, which can be transferred to the uterus during IVF.
  • Clomid: Clomid is a commonly used fertility medication that a doctor may recommend during IVF. It encourages the body to ovulate and release an egg.
  • HCG levels: Human Chorionic Gonadotropin (HCG) is a hormone created by the body after conception has occurred. HCG can be tested for from blood or urine, and is the hormone that pregnancy tests identify to determine if conception has occurred. After an IVF cycle, your HCG levels will be checked to determine if you are pregnant.
  • IVF with PGS: Some couples choose to undergo IVF after determining they have a family or genetic history of particular diseases, syndromes or other traits. Preimplantation Genetic Screening (PGS) can be used to study each embryo and determine if it has genetic or chromosomal abnormalities before being transferred to the uterus.
  • PCOS: Polycystic Ovarian Syndrome (PCOS) is an ovarian issue that can cause irregular menstrual cycles and make it difficult for women to ovulate — a crucial part to the conception and pregnancy process. Women with PCOS do not release eggs regularly, and their ovaries often have many small cysts within. IVF is a strong option for women with PCOS, since it can help their bodies ovulate to achieve pregnancy.

The IVF Treatment Process Explained

The IVF process, start to finish, is complicated and completed in multiple stages: fertility calendar and pre-treatment cycles, ovarian stimulation with fertility medications, retrieval of the eggs, insemination of the eggs, the transfer of the embryos, and the waiting period. Treatment timelines and medications vary between women, so a fertility treatment consultation with an IVF specialist is vital.

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Stages of IVF Treatment

When researching or starting IVF treatment for the first time, many patients are unclear of how the process works. In the simplest terms, it can be broken down into five main steps. In most cases, an IVF cycle takes between four and six weeks to complete, though the timeline varies from person to person.

 

  1. Initial blood work, cycle tracking and fertility analysis is done. To begin IVF, your doctor or fertility specialist will evaluate your hormone levels and menstrual cycle to determine what medications and plan of action may be needed.
  2. Begin fertility drug injections to help stimulate ovaries. After determining how your body will react to specific medications, your doctor will prescribe fertility medications that help the follicles in your ovaries produce eggs.
  3. Undergo minor surgery to retrieve eggs. Following a round of injections, your doctor will determine the best date to retrieve eggs from the follicles of your ovaries. Sperm will also be collected from a partner or donor.
  4. Fertility clinic specialists begin the fertilization process. After egg retrieval, a fertility lab will combine the eggs and sperm for insemination. Fertilized eggs will become embryos.
  5. Embryos are transferred to the uterus. Embryos that have developed from the fertilization process will be placed in the uterus, normally 3 to 5 days after retrieval, so that they can embed. If this process is successful, pregnancy will occur and IVF is considered a success.

While these are the basics of IVF infertility treatments, every woman who undergoes the process has varying results. The amount of time spent on each step depends on how your body responds to prescribed medications and your specific treatment plan. Additionally, starting IVF treatments at different ages can also impact the process timeline. Overall, this can impact the length of your IVF treatment schedule in comparison to other IVF recipients.

Fertility Calendar and IVF Pre-Treatment

It’s common for a patient to be placed on birth control pills during the cycle before IVF treatment will begin. This is done to induce the start of a menstrual cycle, which commences the first stage in IVF treatment. With the help of birth control or other suppression drugs, doctors can control the cycle and prevent the patient from ovulating on her own. This can also decrease the patient’s risk of ovarian hyper-stimulation syndrome (OHSS), a potential IVF process side effect that dangerously enlarges the ovaries with fluid.

The first day of a menstrual cycle will be the first day of an IVF treatment cycle. This will be used as a baseline. The baseline stage will require ultrasounds and blood work and is very important when evaluating hormone levels, uterine lining and the lack of ovarian cysts. If these parameters are not met, IVF treatment will be less successful and should not be used.

Ovarian Stimulation

The next stage of IVF treatment includes the injection of fertility drugs, which are given to stimulate the ovaries to produce more follicles than would be produced in a normal menstrual cycle. A follicle is a small fluid-filled sac that is capable of releasing a mature egg. The idea is to retrieve as many mature eggs as possible to increase the success rate of fertilization.

IVF medications are complicated, and the exact medication is determined by the fertility clinic’s doctor based on the patient’s body. She will likely self-administer a combination of injections, patches or pills that can last between 8-12 days. This can sometimes mean 1-4 IVF shots per day. The stimulation phase might take longer if follicles are slow to mature.

Once a patient is taking ovarian stimulation medicine, a physician will be monitoring very closely her hormone levels and the growth and development of follicles. This is an IVF requirement. Dosages might be increased or decreased based on the body’s reaction and the growth of follicles.

Then, when multiple egg follicles are mature and anywhere from 18-20 mm in size, the doctor can decide to plan the egg retrieval process. Once that is planned, one final injection of medication is given to trigger the last stage in oocyte, or egg, maturation. Often referred to as a ‘trigger shot,’ human chorionic gonadotropin (hCG) is typically a one-time IVF shot that is vital to the process and encourages the last stage of maturation for the eggs. It also loosens the eggs from the follicle walls. hCG brand names include Ovidrel, Novarel, and Pregnyl.

Timing is everything with the hCG shot, which often times must be administered within a one-hour window. The eggs must be retrieved within 36 hours of the shot.

IVF Egg Retrieval

Good timing is an IVF requirement. The egg retrieval stage of IVF occurs after ovarian stimulation, but before ovulation, so the window is small. About 36 hours after the hCG shot is administered, the egg retrieval process will begin.

This is an out-patient procedure. Ultrasound Directed Follicular Aspiration (UDFA), the official name for the egg retrieval process, is performed under a light anesthesia. Using an ultrasound-guided needle, the doctor will withdraw the fluid from each follicle. There is one oocyte, or egg, in each follicle. Once the fluid is removed from the follicle, it’s passed along to an embryologist, who will examine the fluid to determine if an egg is present.

The doctors will be able to tell the patient the exact number of eggs that were retrieved during the process — most studies place the optimal number of retrieved oocytes between 10-15. It’s important to note that not every follicle has an egg, and not every egg is mature enough. Beyond that, not every mature egg will fertilize and not every fertilized egg will result in a pregnancy.

Where Does Fertilization Occur?

Once the eggs are examined, doctors can determine if they are mature enough for fertilization. If they are, the eggs must be fertilized within hours of retrieval. Doctors will ask that the partner provide a sample of sperm on the day of the retrieval process or prior to, in which case they will freeze the sperm.

Once the sperm sample is available for doctors, the embryologist performs a semen analysis to choose the superior sperm. Once chosen, several thousand sperm will be placed in each culture dish with one egg. This is the process of insemination. A healthy, mature egg will then allow one sperm to attach. During the cortical reaction, a process initiated during fertilization, the egg prevents the fusion of multiple sperm to it.

After 12 to 24 hours in an incubator, the culture dishes are examined to determine whether or not the fertilization of oocytes was successful. Unless the partner suffers from severe male infertility — in which case IVF treatment can be done using donor sperm — on average, 60-70 percent of retrieved oocytes fertilize successfully.

In some cases where the probability of fertilization is low, Intracytoplasmic sperm injection, or ICSI, might be used. During this specialized and manual process, a delicate needle is used to immobilize and pick up a single sperm and insert it into the egg. If the sperm is injected and the needle is removed carefully enough, normal fertilization can take place.

It takes about three days for an embryo to mature and fertilize. If maturation and fertilization is confirmed, it can be tested for genetic viability and even gender. If a viable embryo has been created, doctors will schedule the transfer. Now, the fertilized eggs can be considered embryos.

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Embryo Transfer

The final step in IVF treatment is known as the transfer of embryos, which is done to facilitate conception. Embryos are typically transferred into the woman’s uterus 3-5 days following the retrieval of the eggs.

An embryologist will examine the embryos and select the healthiest. Although embryos can be transferred on day 3 or 4, recently, clinics have suggested the embryo to be transferred on day 5 of embryo growth. This is when it reaches the blastocysts stage, a stage during which an embryo has developed and has two cell components and a fluid cavity. Researchers say this allows the best selection of embryos.

At this point, the fertility doctor will help determine how many embryos will be transferred into the uterus. This subject is of much debate — some medical experts suggest no more than four, while recent studies have shown success with just one. Of course, the more embryos that are transferred, the better the chance of pregnancy. But that also means the higher the chance of a multiples pregnancy — twins, triplets, quadruplets — which can lead to a number of complications, including premature delivery and low birth weight.

During the transfer process, a catheter-like tube holding the predetermined number of embryos will be passed through the cervix to distribute the embryos into the uterus. An anesthesia is not often needed.

High progesterone levels are important on the day of an embryo transfer as they increase implantation rates. This is the main medication that will be given after the egg removal, and the supplements will likely continue until the pregnancy is confirmed and the body is producing enough progesterone on its own. It’s important to sustaining pregnancies as well.

A pregnancy test can be ordered 9-12 days following the embryo transfer and might include blood work as well as progesterone testing. This will determine if the embryo is planted. If the IVF treatment was a success and the pregnancy test is positive, doctors will monitor blood work, ultrasounds and general pregnancy information to watch for miscarriages or ectopic pregnancies. If after 12-14 days, the pregnancy test is still negative, doctors will tell the patient to cease taking progesterone and discuss the possibility of another cycle of IVF.

Frozen Embryo Transfers (FET)

Should additional high-quality, healthy and mature embryos exist, cryopreservation can be used to freeze the embryos and use for a later cycle of IVF treatment, should this round not be successful.

IVF embryo freezing through cryopreservation has become a widely used technology. During IVF cycles, women can choose to freeze the healthy embryos to produce a viable pregnancy in the future. The ‘thaw cycle’ or Frozen Embryo Transfer Cycle (FET) will include hormone preparation for the uterus, estrogen preparation and progesterone preparation. The embryos are thawed and then transferred into the woman’s uterus. The cryopreserved embryos are viable for an infinite amount of time and include success rates comparable to fresh IVF cycles.

Age and IVF Success Rates

Based on CDC’s Fertility Clinic Success Rates Report, more than 231,000 assisted reproductive technology cycles were performed during 2015, more than 99 percent of which were IVF treatments. These resulted in 60,778 live births — note: of the more than 231,000 cycles performed, 20 percent were done with the intent of banking, or freezing, all resulting eggs or embryos for future use.

The success rate of IVF treatment depends on a variety of factors, including the most vital: age. IVF success rates in both pregnancy and live birth decline as women age — in 2015, 42.6 percent of ART cycles resulted in pregnancy and 37.1 percent in live birth for women under the age of 35. Those are excellent numbers. For women 38-40, however, those numbers decrease to 26.9 and 19.5 respectively. Moreover, for females over the age of 44, only 2.7 percent of cycles result in pregnancy.

As women age, the number of oocytes that are produced in ovaries decrease naturally, especially after the age of 37. Age alone has a major effect on fertility, and this makes it hard for fertilization and pregnancy to occur. From there, and across most ages, pregnancy success rates are about 6 percentage points higher than live birth rates — pregnancies can result in miscarriage, induced abortion or stillbirth, and this is a major factor in decreasing rates with age.

The risk of miscarriage is about the same for women who go through IVF treatment and those who conceive naturally; risk simply increases with age. It’s important to note that success rates, both pregnancy and live birth, are also affected by the use of donor eggs, infertility, previous treatment outcomes, clinic expertise and more.

Additionally, research published in the Medical Journal of Australia has shown that women who undergo multiple In Vitro Fertilization cycles of are more likely to have a live birth, with IVF success rates increasing exponentially. Researchers looked at more than 56,000 females, and for those women over the age of 40, the live birth success rate rose from 10 percent at the first cycle of IVF to around 40 percent after the seventh cycle.

Can IVF Cycles Be Canceled?

IVF treatment cycles can be cancelled for a number of reasons before the egg retrieval; the cancellation rate increases with age. For instance, if ovarian stimulation drugs have not worked and follicles have not grown properly, the doctor might adjust medication dosages. If the response is still weak, the IVF treatment cycle can be cancelled. Another cycle can be started at a later date, but if follicles do not grow, an egg donor might be suggested.

If the ovaries have the opposite response — are overstimulated — and doctors determine patients are at risk of OHSS, the IVF treatment cycle will be stopped before egg are removed and the trigger shot will be cancelled. OHSS can become severe, and symptoms can include nausea or vomiting, shortness of breath, faintness, severe stomach pains, quick weight gain in a short period of time or decreased urinary frequency.

How Long Does The IVF Process Take?

The typical IVF timeline from start to finish can take anywhere from four to six weeks — from the first day of IVF treatment to the transfer of embryos and final pregnancy test. Before beginning an IVF cycle, your fertility specialist should discuss a timeline with you, which may need to be updated throughout the process depending on how your body responds to fertility medications and procedures. While fertility clinics and specialists have general guidelines on how quickly or slowly the process should move, don’t be discouraged if your particular case requires additional time. Some common factors that can impact the time IVF takes include:

  • Preparing your body for ovulation through use of birth control pills, or by monitoring your menstrual cycle
  • How your body responds to fertility hormone injections, and if more medications are needed to help stimulate your follicles and help your eggs mature before they can be retrieved
  • How successful your round of IVF is, and if more cycles are needed

How Much Does IVF Cost?

Pursuing fertility treatment is a big step, and research is advised. Across the United States, the average cost for one cycle of In Vitro Fertilization is $12,000 and rarely lower than $10,000. Often times, these numbers will not include medications, so it is important to choose the right fertility clinic and ask questions regarding the cost of IVF treatment. You may want to ask your clinic or fertility specialist if the quoted cost includes:

  • Pre -IVF fertility testing
  • Ultrasounds
  • Fertility drugs
    Cryopreservation of extra embryos
  • Pregnancy testing
  • Bloodwork

While IVF has been around since the late 1970s, this process is known for it’s price tag… and that’s because each individual responds to infertility treatments differently. What can be shocking to many considering IVF is the cost does not guarantee pregnancy — in fact, the cost of IVF treatment can well exceed the average $12,000 if multiple cycles are needed. In many cases, it’s not unusual for couples or individuals to require multiple IVF cycles before having a successful pregnancy.

There are ways to reduce the cost of IVF treatment, dependent upon your preferences and specific fertility clinic. Using donor eggs can drop the cost since egg retrieval is no longer necessary. And, it’s also possible to reduce the price tag by using your own frozen embryos; since multiple eggs are fertilized and develop into embryos at one time, extras can be cryopreserved for a possible second or third cycle.

Other factors can also increase the cost of In Vitro Fertilization. Choosing to use a surrogate for pregnancy can increase the cost depending on your specific surrogate agency and contract. And just like other IVF needs that are not factored into the cost, genetic testing such as Preimplantation Genetic Diagnosis or Screening (PGD or PGS) can also increase your out-of-pocket cost. Choosing to test embryos before they are transferred to the uterus can run from $2,000 to $7,000, and is often not included in the overall IVF cost.

The Center for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology are great resources for further understanding the cost of IVF treatment and associated infertility treatments. These resources can also help you background check specific fertility clinics and their IVF success rates.

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IVF Process Side Effects

IVF treatment generally has positive success rates, especially for women under 35. However, like any medical procedure or medications, infertility treatments can have side effects caused by the process itself, along with medications used. IVF treatment side effects can often include:

  1. Cramping and abdominal pain: Period-like cramps are common during the IVF process, along with minor abdominal pain that feels similar to your menstrual cycle. You can combat general cramps with over-the-counter pain relievers or a heat pad to reduce discomfort.
  2. Bloating: Fertility medications can heavily impact how your body retains water, leading to the dreaded side effect of bloating. This is especially common in your midsection, where fluid can build up near the ovaries (creating abdominal tenderness, too). You can combat bloating by increasing your fluid intake, and participating in light exercise such as walking.
  3. Breast tenderness: Tenderness is often felt throughout your menstrual cycle, and can be amplified by IVF medications. You can help ease this discomfort by using warm or cold compresses on your breasts (whichever feels best) or by taking a warm or cool shower. Wearing a supportive but non-restricting bra can also help.
  4. Constipation: Constipation is an unfortunate side effect that can be remedied by eating more fiber, increasing your water intake, and avoiding dehydrating beverages such as coffee and soda.
  5. Headaches and mood swings: Headaches and mood swings are common IVF treatment side effects. Over-the-counter medications can ease headaches, and while no medication can help with mood swings, knowing that they’re a normal part of IVF treatment helps. If you find mood swings are disrupting your day, be sure to seek out self-care practices such as enjoying alone time, reading a book, taking a nice bath, or sharing feelings with a friend or loved one.
  6. Hot flashes: If you suddenly feel very warm, have a flushed face, or find yourself randomly sweating, you may be experiencing a hot flash. They can appear at random during the IVF treatment process, but you can help prevent them by reducing stress, avoiding spicy foods and warm environments, and cutting back on alcohol or caffeine intake.

While rare, it is possible to experience IVF treatment side effects that are more concerning, such as:

  • Intense pain in the pelvic region or abdomen
  • Heavy vaginal bleeding
  • Fever at or higher than 100.5 degrees
  • Blood or other discoloration in urine
  • Rapid weight gain in a short span of time
  • Shortness of breath
  • Diarrhea

If you experience any of these symptoms, it is important to contact your doctor or fertility specialist immediately, as they could be signs of ovarian hyperstimulation syndrome (OHSS), a rare condition that can affect women who are taking fertility medications. OHSS is a rare and severe side effect that happens when the ovaries react to medications by swelling. While OHSS can go away on its own, it is critical that a doctor evaluate the situation and determine what course of action is best.