In Vitro Fertilization, IVF - the Process and Procedures
What is in vitro fertilization - IVF?
The IVF process involves:
- Stimulating multiple follicles and eggs to develop
- Egg retrieval to get the eggs
- Fertilizing the eggs in the laboratory
- Embryo transfer to the uterus
- Louise Brown was the first IVF baby in the world. She was born in July of 1978 in England.
- Louise was 28 (in 2006) when she had her own baby (not IVF)
- Hundreds of thousands of children are born every year after IVF treatments
- Well over 5 million babies have been born with IVF
Who should be treated with in vitro fertilization?
IVF can be used as an effective treatment for infertility of all causes except for women with infertility caused by an anatomic problem with the uterus, such as severe intrauterine adhesions.
It is generally used in couples who have failed to conceive after at least one year of trying who also have one or more of the following:
- Blocked fallopian tubes or pelvic adhesions with distorted pelvic anatomy. Women that have had tubal ligation and are considering tubal reversal surgery as well as men that are considering vasectomy reversal surgery might also consider IVF.
- Male factor infertility (low sperm count or low motility). ICSI is an IVF procedure that can fertilize eggs even with poor sperm quality.
- Failed 2-4 cycles of ovarian stimulation with intrauterine insemination
- Advanced female age - over about 38 years of age. In vitro fertilization and advanced maternal age is discussed in detail on the female age page.
- Reduced ovarian reserve, which means lower quantity (and sometimes quantity) of eggs. A day 3 FSH and estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Reduced egg quantity and quality is usually treated with either IVF, or with IVF with egg donation.
- Severe endometriosis
- Unexplained infertility when inseminations have failed. Unexplained infertility means standard fertility tests have not found the cause of the fertility issue.
How does IVF improve fertility?
In vitro fertilization increases the efficiency of human reproduction, which is often not very efficient naturally.
- Essentially, it is a numbers game that worsens as the female partner ages
- With IVF we remove multiple eggs - and after careful culture for 3-5 days of the eggs that fertilize, we transfer one or more of the "prettiest" embryos back to the uterus.
- Any remaining embryos (if there are any) can be frozen for future use by the couple
In a sense, we compress many months of "natural" attempts into one menstrual cycle. By transferring the fertilized embryo(s) directly to the uterine cavity, fertility is improved for many couples that have sperm issues (fertilization defects), or issues on the female side related to egg pickup from the ovary, or tubal transport of the embryo to the uterus.
Therefore, with IVF:
- We stimulate with medications to produce multiple follicles and eggs (only one follicle with one egg inside develops in a natural menstrual cycle)
- We retrieve the eggs from the ovaries when they're ready (release and tubal pickup of the egg can be inefficient naturally)
- We coerce fertilization in the lab (sperm or egg issues can cause fertilization problems in a natural situation)
- We culture the embryos for several days and then pick the best one (or more) for transfer to the woman - selection of the best one(s) increases success.
- We transfer the embryos to the best location in the middle of the uterine cavity (tubal transport of the embryo to the uterus is bypassed)
As shown in the graph above, as women age we get less eggs with in vitro fertilization. More importantly, we see lower rates of implantation per embryo transferred (compare "Embryos Transferred" to "Fetal Heartbeats"). The rate of miscarriage increases with the age of the female partner (compare "Fetal Heartbeats" to "Babies Born"). The numbers above the columns show the actual values (averages for each age group).
"Day 5 Blasts" are estimated because we do both day 3 and day 5 transfers. For those couples that had a day 3 embryo transfer procedure we estimated the number of day 5 blastocysts that (probably) would have been available if we had cultured all embryos until day 5.
We freeze excess viable embryos on day 5 and day 6. Not all couples will have embryos available for freezing. The purple arrows on the chart above show that some embryos will possibly be frozen after the embryos for transfer are selected.
From data such as what is shown above, we can calculate a useful statistic called the implantation rate. The implantation rate is usually defined as the percentage of embryos transferred that implant and develop to the stage of ultrasound documented fetal heartbeat.
For example, if we transfer 2 embryos to the uterus and the female becomes pregnant - and if there is one fetal heartbeat seen on early ultrasound (single pregnancy) the implantation rate is 50% (1 of 2 implanted). If there are two fetal heartbeats seen on early ultrasound (twin pregnancy) the implantation rate is 100% (both embryos implanted).
- Implantation rates are considered by fertility doctors when talking with couples about their chances for IVF success rates and multiple births.
- Implantation rates are used by in vitro fertilization labs to measure internal quality control.
- A weakness somewhere in the system (in the lab, or elsewhere) will cause implantation rates to drop as embryos become "weaker" - with a decreased ability to implant and continue to develop.
- By tracking implantation rates clinics can have an early warning system. If the rates drop significantly it should trigger a thorough evaluation of the entire clinical and IVF laboratory system.
- Our implantation rates for 2015 (SART data) were 53% for women under 35 years old, 48% for age 35-37, 31% for 38-40 and 8% for women age 41-42.
- See our SART IVF success rates on the SART site
|How much does IVF cost?|
Single Cycle In Vitro Fertilization Cost
Multiple Cycle In Vitro Fertilization Cost
Starting at $18,000
Multiple Cycle In Vitro Fertilization Cost
Starting at $25,000
- Before you choose an in vitro fertilization clinic for your treatment, make sure you know the IVF success rates of the clinics you are considering.
- Both SART and the CDC (US government agency) make this easy by posting success rates for all reputable IVF clinics on their websites.
- See success rates for any clinic by following links to the SART and CDC websites