In Vitro Fertilization (IVF)

You've probably heard of in vitro fertilization (IVF) and could explain it simply as the process of fertilizing egg cells in a lab rather than inside a woman's body. What you may not know, however, is that this process, which so often results in happy, healthy "test-tube babies," involves several steps, can last for months, and may take a significant physical and/or emotional toll on your life.

Accounting for 70 percent of all assisted reproductive technologies (ART), IVF is the most common advanced fertility treatment. Since its introduction in the U.S. in 1981, the procedure has resulted in more than 200,000 babies! IVF may be able to help you conceive, even if you are facing a variety of fertility issues.

Good candidates for IVF

A reproductive endocrinologist is the best person to seek advice from if you are considering IVF. He or she can help determine if you are a good candidate, as there are many criteria for determining who might be suitable for the procedure.

IVF was first used to help women who could not conceive naturally because of tubal disease. Today, many others benefit from IVF, namely people with ovarian dysfunction, blocked, diseased or absent fallopian tubes, endometriosis or fibroid tumors unresponsive to treatment, male factor infertility (low sperm count), uterine factors or cervical mucus problems, immunological disorders and infertility that simply can't be explained.

Two issues are considered by doctors in advising patients about IVF: Have simpler and less costly treatments been tried, and is there a reasonable chance of achieving pregnancy with these procedures? Based on these considerations, your doctor will evaluate you based on your age and your physical and emotional health. Your doctor wants the procedure to end in a successful pregnancy as much as you do!

What to expect during IVF treatment

If IVF is appropriate for you and you decide to proceed with your treatment, your doctor may prescribe birth control pills a few months prior to the procedure for two reasons. The hormones in oral contraceptives can help your ovaries produce quality eggs when they're needed later, and the Pill can help regulate your cycle so the doctor can determine the best time to begin IVF.

Near the beginning of your menstrual cycle, you will be given injections of fertility drugs to stimulate your ovaries in hopes of producing as many mature eggs as possible during one cycle. Your body normally releases only one. After five days, you will receive another injection to trigger ovulation.

Expect to make several trips to your doctor's office!

By monitoring your blood hormone levels, your doctor will be able to tell when your eggs have matured. Once they have, you will be placed under light anesthesia for 10 to 30 minutes so the doctor may retrieve your eggs. Using a suction needle through a tube inserted into the fallopian tubes through the vagina, your eggs will gently be removed. Your doctor will then combine your eggs with your partner's sperm specimen in a culture dish in a laboratory.

The next day, your doctor will check to see how many eggs have been fertilized. Depending on their quality, extra embryos may be frozen for use at another time, in case your first cycle doesn't succeed. Two to five days later, your doctor will carefully transfer two to four of the embryos to your uterus using a thin catheter. If the treatment works, an embryo will implant itself to the wall of your uterus and continue to grow.

After the transfer, your doctor will order two to three days of bed rest. You'll be asked to continue taking your hormone medication for about two weeks until a pregnancy test can determine whether the cycle was a success.

Success rate of IVF

IVF success rates vary depending on the cause of your infertility, the facility at which you're having the procedure done, and your age. As with natural conception, success rates are higher in women under 40 because younger women tend to have healthier eggs. On average, you have a 35 percent chance of getting pregnant with each IVF cycle and a 29 percent possibility of delivering a baby.

Blastocyst transfer and assisted hatching

If you've already gone through one IVF cycle and did not become pregnant, one option is to try again. There is no limit to how many times you may attempt to get pregnant through IVF, but that can be very costly and the ongoing cycle of treatment and failure may do a number on your emotions.

There are two types of transfers that may occur in the IVF procedure. The standard is a 3-day transfer, when the fertilized eggs are between six and eight cells. In the past few years, however, doctors have moved toward transferring embryos during the blastocyst state when they consist of more than 130 cells. A blastocyst is an embryo that has developed for five days after fertilization and has divided into two different cell types. The embryos that survive this long are usually strong and healthy, and typically offer a greater chance of implantation into the uterine wall.

Another technique that may increase your chances of a successful IVF procedure is known as assisted hatching. It has been speculated that fertility medications and the egg's normal aging process can cause changes in the protective outer membrane that surrounds the embryo, known as the zona pellucida, and harden it, which may interfere with the normal hatching process. Assisted hatching is a procedure in which a hole is made in the outer membrane to help improve the chances of implantation. It helps to thin the thicker-than-normal shell of the embryo to the point where it can hatch on it's own, offering it a better chance of implantation. According to the Center for Reproductive Health & Gynecology, assisted hatching is indicated in the following conditions:

• Your embryos show evidence of having a thick or hardened zona pellucida
• You are over the age of 35 and using your own eggs
• You are using frozen embryos
Assisted hatching can significantly improve the chances of conception for women who have had repeated failure of embryo implantation with IVF.
• Risks of IVF

Just one cycle of IVF takes anywhere from four to six weeks to complete, and, as with any high-tech fertility treatment, it has its risks. While there haven't been medical problems linked to the procedure, there was previous concern that fertility drugs may increase a woman's risk of developing ovarian cancer. Recent examinations of those reports conducted between 1989 and 1999 have found this theory to be untrue, which is good news for couples considering IVF.

One risk associated with IVF, however, is the possibility of multiple births. It is likely after transfer that more than one embryo will implant itself in your uterine lining, which increases your chance of having a pregnancy with two or more babies to 20 to 40 percent. You might consider this a blessing, but multiple fetuses increase your risk of miscarriage and other complications during pregnancy.

IVF, as with all ART treatments, also increases your risk of having an ectopic pregnancy. Ectopic pregnancies occur when a fertilized egg is unable to travel down to the uterus. Instead, it may implant in another location such as the fallopian tubes, the ovaries, in the abdomen, or on the cervix.

The most serious risk associated with IVF is excessive stimulation of the ovaries. As a result of taking fertility drugs, some women develop a condition known as ovarian hyperstimulation syndrome (OHSS). OHSS only occurs in 3 to 5 percent of IVF cycles and is caused when the body has an "over response" to fertility drugs. Too many eggs are produced, causing the ovaries to swell. In rare cases, OHSS can be life-threatening and requires hospitalization, but most cases resolve themselves on their own with careful monitoring by a doctor.

Cost of IVF

Only about 5 percent of couples with infertility seek out IVF, possibly because it's so expensive. According to the American Society of Reproductive Medicine, the average cost of one cycle is $12,400, but the price varies depending on where you live, your medications, and the number of cycles you undergo. Oftentimes your insurance company will pay a portion of the cost of the procedure. Because IVF is so complex and costly, it is generally reserved for cases in which other methods, such as fertility drugs, surgery, and artificial insemination, have failed.