In Vitro Fertilization

About the Procedure

In vitro fertilization (IVF) is a process - a series of procedures - to impregnate a woman by implanting an egg, fertilized outside her body, into her uterus. IVF is used as a method of infertility treatment after all other options have been exhausted. Infertility in a woman can be due to blocked, scarred, or absent fallopian tube(s), endometriosis, hormonal imbalance, or other unknown reasons. Male infertility can be the result of a low sperm count, slow sperm motility, immature or defective sperm. When the sperm cannot penetrate an egg or sperm count is low, one may be injected into the egg in a procedure known as Intracytoplasmic Sperm Injection (ICSI).

Under the guidance of a gynecologist, a woman's ovaries are hormonally prepared to produce numerous eggs through a process called ovarian stimulation. Immediately prior to ovulation, the doctor retrieves the eggs from the ovaries by needle aspiration while the patient is either anesthetized or awake but sedated. The eggs and sperm are put in a laboratory dish where fertilization is expected to occur in about 48 hours. When the fertilized eggs are five days old (referred to as zygotes), they are examined and the doctor selects the "best" ones to implant into the uterus. At this point, a couple may choose to have genetic testing performed on the zygotes to avoid passing on inheritable diseases. When the gynecologist has determined the uterus is ready to accept a fertilized egg, the embryo(s) are transferred with a catheter through the vagina and cervix while the patient is awake. A pregnancy test will be given two weeks later.

What to Know Before the Procedure

When a woman begins the IVF process by taking the hormones which encourage numerous eggs to mature, she is at risk for Ovarian Hyperstimulation Syndrome, an increase in fluid being released from the ovary with serious, sometimes life-threatening consequences. Women who are taking fertility medications may experience bloating, abdominal pain, mood swings, headaches, and depression. During egg retrieval, complications may occur, such as bleeding, infection, damage to bowel or bladder, nerve damage, and anesthesia-related risks. Ectopic pregnancy and miscarriage occur with IVF, and may require hospitalization and/or additional procedures. The likelihood of multiples increases with IVF since more than one fertilized egg is transferred to the uterus. Carrying more than one baby introduces the concern of prematurity and health complications for the mother.

Many couples (or individuals) are unsuccessful in achieving or maintaining a pregnancy with the first IVF procedure and may need to repeat the process. Only a third of first attempts are successful, one-half after three attempts, and near 60% after six attempts. There are studies which suggest a connection between IVF and certain birth defects, although no specific cause has been identified.

What to Know After the Procedure

Following embryo retrieval, the patient leaves the facility when she has recuperated from the administration of anesthesia or drugs and is advised to rest for the remainder of the day. Unless otherwise advised, the patient may return to work and/or normal activities the following day. After the embryo transfer procedure, the woman will stay in the facility for a few hours before being discharged. Having a driver available at discharge is recommended. Progesterone, a hormone which aids implantation, must be taken by the woman for eight to ten weeks following the transfer.

If you Need to Travel Outside of your Local Hospital

It is more likely that couples will use IVF when it is easily available and when there is insurance coverage for it. The cost for the process is prohibitive for many people who would like to participate in it. At $12,500 per attempt, the United States has the highest cost for IVF in the world. It would be understandable for a couple to locate a physician in another country. However, since it is a process which takes weeks with procedures dependent on the woman's response to hormones, and may involve considerable discomfort, consideration must be given to the feasibility of being away from one's normal routine for a lengthy period of time.