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In vitro fertilization (IVF) - Mayo Clinic

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In vitro fertilization (IVF) - Learn about the IVF process and what to expect from this assisted reproductive technology to treat infertility.

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In-Vitro Fertilization. Taking mature eggs from the ovaries and sperm, then mixing it in a lab until it is fertilized. Then the fertilized eggs will be implanted back into the mother.

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1855- Artificial insemination occurs.
1934-Gregory Pincus experiments with IVF in rabbits
1944- 1st successful fertilized egg outside of the body.
1961- Fertilized egg grows for 29 day outside of the body(forms a heart).
1975- 1st IVF pregnancy, but resulted in a Fallopian tube pregnancy.
1978- 1st test tube baby. Louise Brown in Oldham
1979- 2nd baby, Alistair MacDonald
1980- 1st U.S. IVF clinic opens
1981- 1st U.S. test tube baby, Elizabeth Jordan Carr
2004- 1/2 million test tube babies, 450 IVF clinics. IVF as become a mainstream medical technology.

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Controversy Around In-Vitro Fertilization - BM

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Controversy Around In-Vitro Fertilization - BM

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The Roman Catholic Church opposes it because it takes reproduction out of martial context. Another issue is how many embryos are transferred. Having multiple embryos has a higher success rate in having pregnancy, but also increases the chance of having twins.

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in vitro fertilization (IVF), also called test-tube conception, medical procedure in which mature egg cells are removed from a woman, fertilized with male sperm outside the body, and inserted into the uterus of the same or another woman for normal gestation. Although IVF with reimplantation of fertilized eggs (ova) has long been widely used in animal breeding, the first successful birth of a human child from IVF, carried out by British gynecologist Patrick Steptoe and British medical researcher Robert Edwards, did not take place until 1978.

Evaluation and technique

In vitro fertilization is generally undertaken only after an exhaustive evaluation of infertility has been made. A number of the candidates for IVF are women who suffer from blocked or absent fallopian tubes; others are couples in which the male partner has a low sperm count or couples whose infertility is unexplained. The IVF procedure includes the recovery (by needle aspiration) of mature eggs and the incubation of the eggs in a culture medium, as well as the collection and preparation of sperm and its addition to the medium. In certain cases (e.g., low sperm count) intracytoplasmic sperm injection (ICSI) may be necessary. In this technique deoxyribonucleic acid ( DNA) from sperm is injected via a needle into an egg. Fertilization generally occurs within 12 to 48 hours. The potential embryo is then placed in a growth medium, where it is observed periodically for division into two-cell, four-cell, and eight-cell stages. During this period the mother receives progesterone to prepare her uterine lining for implantation of the embryo. The embryo, which at this point is known as a blastocyst, is introduced through the cervix into the uterus, in which the blastocyst seems to float free for about three-and-a-half days. If the procedure is successful, the embryo implants itself in the uterine wall, and pregnancy begins.

Failure of IVF is typically the result of unsuccessful implantation or miscarriage. Possible explanations for failed implantation are immune rejection by the woman; an embryo with an abnormally thick outer membrane (zona pellucida) that prevents embryo hatching once inside the uterine cavity; lack of synchronization between embryonic stage and endometrial development at the time of embryo introduction into the uterus; and embryonic aneuploidy (abnormal chromosome number). Aneuploidy is a central cause of miscarriage in IVF.

In women who have had repeated IVF failures or who are over 38 years old, the success of IVF may be improved by preimplantation genetic diagnosis (PGD). PGD is used to detect the presence of embryonic genetic abnormalities that have a high likelihood of causing implantation failure or miscarriage. In PGD a single cell is extracted from the embryo once the embryo has divided to produce more than five cells (this step-the extraction of a cell-is an inherent risk of PGD because it sometimes damages the embryo). The cell is then analyzed by fluorescence in situ hybridization (FISH), a technique capable of detecting structural abnormalities in chromosomes that standard tests such as karyotyping cannot detect. In some cases DNA is isolated from the cell and analyzed by polymerase chain reaction (PCR) for the detection of gene mutations that can give rise to certain disorders such as Tay-Sachs disease or cystic fibrosis. Another technique, known as comparative genomic hybridization (CGH), may be used in conjunction with PGD to identify chromosomal abnormalities. CGH is more sensitive than FISH and is capable of detecting a variety of small chromosomal rearrangements, deletions, and duplications. It may also be useful in reducing the chance of multiple births (multiple embryos implanted and carried to term simultaneously) by identifying a single healthy embryo with the best chance for successful implantation. The success of IVF can also be improved through assisted hatching, a technique used to thin the outer membrane of an embryo in order to facilitate implantation.

Ethical issues

In vitro fertilization has been a source of moral, ethical, and religious controversy since its development. Although members of all religious groups can be found on both sides of the issues, the major opposition has come from the Roman Catholic church, which in 1987 issued a doctrinal statement opposing IVF on three grounds: the destruction of human embryos not used for implantation; the possibility of in vitro fertilization by a donor other than the husband, thus removing reproduction from the marital context; and the severing of an essential connection between the conjugal act and procreation.

Other ethical questions raised have involved the unusually high rate of multiple births ( twins, triplets, etc.) associated with IVF. This issue is being addressed primarily through the development of better techniques aimed at using fewer fertilized embryos to achieve pregnancy. For example, in the 1980s and 1990s an average of four fertilized embryos were transferred into a woman's uterus to increase the chance of implantation and pregnancy. However, in the early 2000s, following the implementation of improved methods, just two embryos were transferred, while the same rate of success as with four embryos was maintained. The technique of single embryo transfer (SET) is available, though less than 10 percent of women opt for SET because it has a lower rate of success relative to multiple embryo transfer-in many cases at least two cycles of SET are necessary for success. Furthermore, many women are unable to afford additional cycles of IVF using SET and therefore are more likely to choose multiple embryo transfer, even though a multiple birth may be less desirous than a single birth. Thus, the incidence of twins has continued to rise, especially in the United States, where the rate of twin births has increased 70 percent since the 1980s.

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IVF has also raised a number of unresolved moral issues concerning the freezing ( cryopreservation) of ovaries, eggs, sperm, or embryos for future pregnancies.

Kara Rogers.

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in vitro fertilization | medical technology

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in vitro fertilization (IVF), also called test-tube conception, medical procedure in which mature egg cells are removed from a woman, fertilized with male sperm outside the body, and inserted into the uterus of the same or another woman for normal gestation.

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There is a risk having bleeding or infection to the bladder or bowel. The mother might also experience abdominal pain and bloating. There is an increased chance of premature birth, low birth weight, and having multiple pregnancies.

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Normally, an egg and sperm are fertilized inside a woman's body. If the fertilized egg attaches to the lining of the womb and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception.

IVF is a form of assisted reproductive technology (ART). This means special medical techniques are used to help a woman become pregnant. It is most often tried when other, less expensive fertility techniques have failed.

There are five basic steps to IVF:

Step 1: Stimulation, also called super ovulation

Medicines, called fertility drugs, are given to the woman to boost egg production.

Normally, a woman produces one egg per month. Fertility drugs tell the ovaries to produce several eggs.

During this step, the woman will have regular transvaginal ultrasounds to examine the ovaries and blood tests to check hormone levels.

Step 2: Egg retrieval

A minor surgery, called follicular aspiration, is done to remove the eggs from the woman's body.

The surgery is done in the doctor's office most of the time. The woman will be given medicines so she does not feel pain during the procedure. Using ultrasound images as a guide, the health care provider inserts a thin needle through the vagina into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time.

The procedure is repeated for the other ovary. There may be some cramping after the procedure, but it will go away within a day.

In rare cases, a pelvic laparoscopy may be needed to remove the eggs. If a woman does not or cannot produce any eggs, donated eggs may be used.

Step 3: Insemination and fertilization

The man's sperm is placed together with the best quality eggs. The mixing of the sperm and egg is called insemination.

Eggs and sperm are then stored in an environmentally controlled chamber. The sperm most often enters (fertilizes) an egg a few hours after insemination.

If the doctor thinks the chance of fertilization is low, the sperm may be directly injected into the egg. This is called intracytoplasmic sperm injection (ICSI).

Many fertility programs routinely do ICSI on some of the eggs, even if things appear normal.

Step 4: Embryo culture

When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly check the embryo to make sure it is growing properly. Within about 5 days, a normal embryo has several cells that are actively dividing.

Couples who have a high risk of passing a genetic (hereditary) disorder to a child may consider pre-implantation genetic diagnosis (PGD). The procedure is most often done 3 to 5 days after fertilization. Laboratory scientists remove a single cell or cells from each embryo and screen the material for specific genetic disorders.

According to the American Society for Reproductive Medicine, PGD can help parents decide which embryos to implant. This decreases the chance of passing a disorder onto a child. The technique is controversial and not offered at all centers.

Step 5: Embryo transfer

Embryos are placed into the woman's womb 3 to 5 days after egg retrieval and fertilization.

The procedure is done in the doctor's office while the woman is awake. The doctor inserts a thin tube (catheter) containing the embryos into the woman's vagina, through the cervix, and up into the womb. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results.

More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman's age.

Unused embryos may be frozen and implanted or donated at a later date.

IVF is done to help a woman become pregnant. It is used to treat many causes of infertility, including:

Advanced age of the woman (advanced maternal age)

Damaged or blocked fallopian tubes (can be caused by pelvic inflammatory disease or prior reproductive surgery)

Endometriosis

Male factor infertility, including decreased sperm count and blockage

Unexplained infertility

IVF involves large amounts of physical and emotional energy, time, and money. Many couples dealing with infertility suffer stress and depression.

A woman taking fertility medicines may have bloating, abdominal pain, mood swings, headaches, and other side effects. Repeated IVF injections can cause bruising.

In rare cases, fertility drugs may cause ovarian hyperstimulation syndrome (OHSS). This condition causes a buildup of fluid in the abdomen and chest. Symptoms include abdominal pain, bloating, rapid weight gain (10 pounds or 4.5 kilograms within 3 to 5 days), decreased urination despite drinking plenty of fluids, nausea, vomiting, and shortness of breath. Mild cases can be treated with bed rest. More severe cases require draining of the fluid with a needle and possibly hospitalization.

Medical studies have shown so far that fertility drugs are not linked to ovarian cancer.

Risks of egg retrieval include reactions to anesthesia, bleeding, infection, and damage to structures surrounding the ovaries, such as bowel and bladder.

There is a risk for multiple pregnancies when more than one embryo is placed into the womb. Carrying more than one baby at a time increases the risk for premature birth and low birth weight. (However, even a single baby born after IVF is at higher risk for prematurity and low birth weight.)

It is unclear whether IVF increases the risk for birth defects.

IVF is very costly. Some, but not all, states have laws that say health insurance companies must offer some type of coverage. But, many insurance plans do not cover infertility treatment. Fees for a single IVF cycle include costs for medicines, surgery, anesthesia, ultrasounds, blood tests, processing the eggs and sperm, embryo storage, and embryo transfer. The exact total of a single IVF cycle varies, but may cost from approximately $12,000 to $17,000.

After embryo transfer, the woman may be told to rest for the remainder of the day. Complete bed rest is not necessary, unless there is an increased risk for OHSS. Most women return to normal activities the next day.

Women who undergo IVF must take daily shots or pills of the hormone progesterone for 8 to 10 weeks after the embryo transfer. Progesterone is a hormone produced naturally by the ovaries that prepares the lining of the uterus (womb) so that an embryo can attach. Progesterone also helps an implanted embryo grow and become established in the uterus. A woman may continue to take progesterone for 8 to 12 weeks after becoming pregnant. Too little progesterone during the early weeks of pregnancy may lead to miscarriage.

About 12 to 14 days after the embryo transfer, the woman will return to the clinic so that a pregnancy test can be done.

Contact your provider right away if you had IVF and have:

A fever over 100.5°F (38°C)

Pelvic pain

Heavy bleeding from the vagina

Blood in the urine

Statistics vary from one clinic to another and must be looked at carefully. However, patient populations are different in each clinic, so reported pregnancy rates cannot be used as an accurate indication of one clinic being preferable to another.

Pregnancy rates reflect the number of women who became pregnant after IVF. But not all pregnancies result in a live birth.

Live birth rates reflect the number of women who give birth to a living child.

Outlook of live birth rates depend on certain factors such as mother age, prior live birth, and single embryo transfer during IVF. Success rates have changed over the years in part due to the increasing use of single embryo transfers. IVF clinics have encouraged single embryo transfers to reduce the risk of twin pregnancies, which have higher risk for complications than singleton pregnancies. Embryos not transferred may be frozen and saved. The cycles in which those frozen embryos are thawed and transferred are called frozen embryo transfer cycles (FET).

IVF; Assisted reproductive technology; ART; Test-tube baby procedure; Infertility - in vitro

Catherino WH. Reproductive endocrinology and infertility. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 223.

Forman EJ, Lobo RA. In vitro fertilization. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 41.

Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2021;116(3):651-654. PMID: 34330423 pubmed.ncbi.nlm.nih.gov/34330423/.

Tsen LC. In vitro fertilization and other assisted reproductive technology. In: Chestnut DH, Wong CA, Tsen LC, et al, eds. Chestnut's Obstetrics Anesthesia. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 15.

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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In vitro fertilization (IVF): MedlinePlus Medical Encyclopedia

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In vitro fertilization (IVF) is the joining of a woman's egg and a man's sperm in a laboratory dish. In vitro means outside the body. Fertilization means the sperm has attached to and entered the egg.

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In-Virto Fertilization, also known as IVF, is a treatment used for women who have infertility or genetic problems. IVF could be an option for women whose Fallopian tube is damaged, ovulation disorders, premature ovarian failure, endometriosis or any other health related issues.

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Overview

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using a couple's own eggs and sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier - someone who has an embryo implanted in the uterus - might be used.

Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. In addition, IVF can be time-consuming, expensive and invasive. If more than one embryo is transferred to the uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy).

Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

Why it's done

In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less-invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination - a procedure in which sperm are placed directly in the uterus near the time of ovulation.

Sometimes, IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.

Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.

Endometriosis. Endometriosis occurs when tissue similar to the lining of the uterus implants and grows outside of the uterus - often affecting the function of the ovaries, uterus and fallopian tubes.

Uterine fibroids. Fibroids are benign tumors in the uterus. They are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.

Previous tubal sterilization or removal. Tubal ligation is a type of sterilization in which the fallopian tubes are cut or blocked to permanently prevent pregnancy. If you wish to conceive after tubal ligation, IVF may be an alternative to tubal ligation reversal surgery.

Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, a visit to an infertility specialist might be needed to see if there are correctable problems or underlying health concerns.

Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.

A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing - a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.

Fertility preservation for cancer or other health conditions. If you're about to start cancer treatment - such as radiation or chemotherapy - that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.

Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman's eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier's uterus.

Risks

Risks of IVF include:

Multiple births. IVF increases the risk of multiple births if more than one embryo is transferred to your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does.

Premature delivery and low birth weight. Research suggests that IVF slightly increases the risk that the baby will be born early or with a low birth weight.

Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful.

Symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.

Miscarriage. The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally - about 15% to 25% - but the rate increases with maternal age.

Egg-retrieval procedure complications. Use of an aspirating needle to collect eggs could possibly cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also associated with sedation and general anesthesia, if used.

Ectopic pregnancy. About 2% to 5% of women who use IVF will have an ectopic pregnancy - when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can't survive outside the uterus, and there's no way to continue the pregnancy.

Birth defects. The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived. More research is needed to determine whether babies conceived using IVF might be at increased risk of certain birth defects.

Cancer. Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumor, more-recent studies do not support these findings. There does not appear to be a significantly increased risk of breast, endometrial, cervical or ovarian cancer after IVF.

Stress. Use of IVF can be financially, physically and emotionally draining. Support from counselors, family and friends can help you and your partner through the ups and downs of infertility treatment.

How you prepare

The Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology provide information online about U.S. clinics' individual pregnancy and live birth rates.

A clinic's success rate depends on many factors. These include patients' ages and medical issues, as well as the clinic's treatment population and treatment approaches. Ask for detailed information about the costs associated with each step of the procedure.

Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screenings, including:

Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone in your blood during the first few days of your menstrual cycle. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.

Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.

Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV.

Practice (mock) embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.

Uterine exam. Your doctor will examine the inside lining of the uterus before you start IVF. This might involve a sonohysterography - in which fluid is injected through the cervix into your uterus - and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy - in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.

Before beginning a cycle of IVF, consider important questions, including:

How many embryos will be transferred? The number of embryos transferred is typically based on age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred - except for women using donor eggs or genetically tested embryos.

Most doctors follow specific guidelines to prevent a higher order multiple pregnancy, such as triplets or more. In some countries, legislation limits the number of embryos that can be transferred. Make sure you and your doctor agree on the number of embryos that will be transferred before the transfer procedure.

What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will.

Having frozen embryos can make future cycles of IVF less expensive and less invasive. Or, you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.

How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy - which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.

Have you considered the potential complications associated with using donor eggs, sperm or embryos, or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You may also need an attorney to file court papers to help you become legal parents of an implanted embryo.

What you can expect

IVF involves several steps - ovarian stimulation, egg retrieval, sperm retrieval, fertilization and embryo transfer. One cycle of IVF can take about two to three weeks. More than one cycle may be needed.

Ovulation induction

The start of an IVF cycle begins by using synthetic hormones to stimulate the ovaries to produce multiple eggs - rather than the single egg that typically develops each month. Multiple eggs are needed because some eggs won't fertilize or develop normally after fertilization.

Several different medications may be used, such as:

Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.

Medications for oocyte maturation. When the follicles are ready for egg retrieval - generally after eight to 14 days - you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.

Medications to prevent premature ovulation. These medications prevent your body from releasing the developing eggs too soon.

Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.

Your doctor will work with you to determine which medications to use and when to use them.

Typically, you'll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, you may have:

Vaginal ultrasound, an imaging exam of your ovaries to monitor the development of follicles - fluid-filled ovarian sacs where eggs mature

Blood tests, to measure your response to ovarian stimulation medications - estrogen levels typically increase as follicles develop, and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled before egg retrieval for one of these reasons:

Inadequate number of follicles developing

Premature ovulation

Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome

Other medical issues

If your cycle is canceled, your doctor might recommend changing medications or their doses to promote a better response during future IVF cycles. Or you may be advised that you need an egg donor.

Egg retrieval

Egg retrieval can be done in your doctor's office or a clinic 34 to 36 hours after the final injection and before ovulation.

During egg retrieval, you'll be sedated and given pain medication.

Transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs.

If your ovaries aren't accessible through transvaginal ultrasound, an abdominal ultrasound may be used to guide the needle.

The eggs are removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 20 minutes.

After egg retrieval, you may experience cramping and feelings of fullness or pressure.

Mature eggs are placed in a nutritive liquid (culture medium) and incubated. Eggs that appear healthy and mature will be mixed with sperm to attempt to create embryos. However, not all eggs may be successfully fertilized.

Sperm retrieval

If you're using your partner's sperm, a semen sample needs to be provided at your doctor's office or clinic the morning of egg retrieval. Typically, the semen sample is collected through masturbation. Other methods, such as testicular aspiration - the use of a needle or surgical procedure to extract sperm directly from the testicle - are sometimes required. Donor sperm also can be used. Sperm are separated from the semen fluid in the lab.

Fertilization

Fertilization can be attempted using two common methods:

Conventional insemination. During conventional insemination, healthy sperm and mature eggs are mixed and incubated overnight.

Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.

In certain situations, your doctor may recommend other procedures before embryo transfer.

Assisted hatching. About five to six days after fertilization, an embryo "hatches" from its surrounding membrane (zona pellucida), allowing it to implant into the lining of the uterus. If you're an older woman, or if you have had multiple failed IVF attempts, your doctor might recommend assisted hatching - a technique in which a hole is made in the zona pellucida just before transfer to help the embryo hatch and implant. Assisted hatching is also useful for eggs or embryos that have been previously frozen as the process can harden the zona pellucida.

Preimplantation genetic testing. Embryos are allowed to develop in the incubator until they reach a stage where a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes, typically after five to six days of development. Embryos that don't contain affected genes or chromosomes can be transferred to your uterus. While preimplantation genetic testing can reduce the likelihood that a parent will pass on a genetic problem, it can't eliminate the risk. Prenatal testing may still be recommended.

Embryo transfer

Embryo transfer is done at your doctor's office or a clinic and usually takes place two to five days after egg retrieval.

You might be given a mild sedative. The procedure is usually painless, although you might experience mild cramping.

The doctor will insert a long, thin, flexible tube called a catheter into your vagina, through your cervix and into your uterus.

A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter.

Using the syringe, the doctor places the embryo or embryos into your uterus.

If successful, an embryo will implant in the lining of your uterus about six to 10 days after egg retrieval.

After the procedure

After the embryo transfer, you can resume your usual daily activities. However, your ovaries may still be enlarged. Consider avoiding vigorous activity, which could cause discomfort.

Typical side effects include:

Passing a small amount of clear or bloody fluid shortly after the procedure - due to the swabbing of the cervix before the embryo transfer

Breast tenderness due to high estrogen levels

Mild bloating

Mild cramping

Constipation

If you develop moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection, twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulation syndrome.

Results

About 12 days to two weeks after egg retrieval, your doctor will test a sample of your blood to detect whether you're pregnant.

If you're pregnant, your doctor will refer you to an obstetrician or other pregnancy specialist for prenatal care.

If you're not pregnant, you'll stop taking progesterone and likely get your period within a week. If you don't get your period or you have unusual bleeding, contact your doctor. If you're interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.

Embryo status. Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less-developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or other care provider about your specific situation.

Reproductive history. Women who've previously given birth are more likely to be able to get pregnant using IVF than are women who've never given birth. Success rates are lower for women who've previously used IVF multiple times but didn't get pregnant.

Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility.

Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman's chance of success using IVF by 50%. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful.

Talk with your doctor about any factors that apply to you and how they may affect your chances of a successful pregnancy.

Clinical trials

Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions.

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In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child. During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus.

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Rates of In-Vitro Fertilization procedures and births per year- MD

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Rates of In-Vitro Fertilization procedures and births per year- MD

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In 2012 there was 165,175 In-Vitro Fertilization procedures. Only 61, 740 out of 165,175 procedures we successful. In-Vitro Fertilization successful rate are higher for woman under 35 years old compared to woman who are older.

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More American women have had medical help to have their babies than ever, according to the latest annual report from the Society for Assisted Reproductive Technology.

The group represents the greater majority of in vitro fertilization clinics in the United States.

Their report showed that doctors at these clinics performed 165,172 procedures, including IVF, with 61,740 babies born as a result of those efforts in 2012.

That's about 2,000 more babies born using treatments from IVF clinics than in 2011. That also makes 2012 the year with the highest percentage of babies born through IVF than ever reported previously, according to the society.

That upward trend is the opposite of American birth rates overall. Since 2007, the American birth rate has been declining steadily. In 2012, more than 3.95 million babies were born, the Centers for Disease Control reports (PDF). That's below what demographers call the "replacement level," the level at which the generation can replace itself. Of those births, IVF treatments account for about 1.5% of all babies born in the United States that year.

This growing trend doesn't necessarily mean Americans are having more trouble having children. It may point to the fact that couples are having babies later. American women are having babies a lot later in life than they used to: In 1980, the average age of a new mom was about 22. Now, the average age of a new mom is closer to 26, according to the CDC (PDF).

Although women today are generally healthier, fertility does decline as people age. A woman's body produces fewer viable eggs when she gets older, and men's sperm doesn't swim as well as they age.

Women can't wait too long to seek out treatment, though. That is also clear from the annual report.

The IVF success rate was significantly higher for women under the age of 35 compared with those who were older.

Looking only at the IVF treatments that used fresh embryos from non-donor eggs, the number of women under the age of 35 who gave birth using IVF was about 40%, compared with only 31% for women between the ages of 35 and 37. Only 3.9% of 42-year-olds got pregnant as a result of IVF treatment.

IVF treatment has become more medically successful over the years and is gaining acceptance.

It is still, however, cost-prohibitive for a lot of couples. Most assisted reproductive technologies are not covered by insurance, or the reimbursements are capped, according the National Infertility Association.

The average cost of one IVF treatment in the United States is $12,400, and that's without the extra medicines the couple may need, according to the American Society of Reproductive Medicine. Often, couples will need more than one treatment to conceive.

The number of multiple embryos being transferred in IVF treatments has also declined, according to the report.

Doctors prefer that women give birth to a single baby or "singleton," as they are called in medical lingo. That's because even with medical advances, multiple births are still considered risky for mothers and babies.

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more women using ivf than ever before  - cnn

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More women using IVF than ever before - CNN

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More American women have had medical help to have their babies than ever, according to the latest annual report from the Society for Assisted Reproductive Technology. The group represents the greater majority of in vitro fertilization clinics in the United States.

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It takes 30 minutes to one hour to remove the eggs from the mother. It will take about a week for the embryo to be ready. The process of transferring them back into the mother is a quicker process than removing them. The mother is then instructed to stay in bed for four to six hours before going home. The doctor will do a pregnancy test about two weeks later.

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Today, in vitro fertilization (IVF) is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as "test-tube babies." Louise Brown, born in England in 1978, was the first such baby to be conceived outside her mother's womb.

Unlike the simpler process of artificial insemination -- in which sperm is placed in the uterus and conception happens otherwise normally -- IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.

What Causes of Infertility Can IVF Treat?

When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:

Endometriosis

Low sperm counts

Problems with the uterus or fallopian tubes

Problems with ovulation

Antibody problems that harm sperm or eggs

The inability of sperm to penetrate or survive in the cervical mucus

An unexplained fertility problem

IVF is never the first step in the treatment of infertility except in cases of complete tubal blockage. Instead, it's reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven't worked.

If you think that IVF might make sense for you, carefully assess any treatment center before undergoing the procedure. Here are some questions to ask the staff at the fertility clinic:

What is your pregnancy ratio per embryo transfer?

What is your pregnancy rate for couples in our age group and with our fertility problem?

What is the live birth rate for all couples who undergo this procedure each year at your facility?

How many of those deliveries are twins or other multiple births?

How much will the procedure cost, including the cost of the hormone treatments?

How much does it cost to store embryos and how long can we store them?

Do you participate in an egg donation program?

Continued

What Can I Expect From IVF?

The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one.You will then be tested to determine whether you're ready for egg retrieval.

Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won't develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.

During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour.

Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner's sperm, which he will have donated on the same day.

While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage.

Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring up to three embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.

Continued

Following the procedure, you would typically stay in bed for several hours and be discharged four to six hours later. Your doctor will probably perform a pregnancy test on you about two weeks after the embryo transfer.

In cases where the man's sperm count is extremely low, doctors may combine IVF with a procedure called intracytoplasmic sperm injection. In this procedure, a sperm is taken from semen -- or in some cases right from the testicles -- and inserted directly into the egg. Once a viable embryo is produced, it is transferred to the uterus using the usual IVF procedure.

What Are the Success Rates for IVF?

Success rates for IVF depend on a number of factors, including the reason for infertility, where you're having the procedure done, and your age. The CDC compiles national statistics for all assisted reproductive technology (ART) procedures performed in the U.S., including IVF, GIFT, and ZIFT, although IVF is by far the most common; it accounts for 99% of the procedures. The most recent report from 2009 found:

Pregnancy was achieved in an average of 29.4% of all cycles (higher or lower depending on the age of the woman).

The percentage of cycles that resulted in live births was 22.4% on average (higher or lower depending on the age of the woman).

Are There Other Issues With IVF to Consider?

Any embryos that you do not use in your first IVF attempt can be frozen for later use. This will save you money if you undergo IVF a second or third time. If you do not want your leftover embryos, you may donate them to another infertile couple, or you and your partner can ask the clinic to destroy the embryos. Both you and your partner must agree before the clinic will destroy or donate your embryos.

A woman's age is a major factor in the success of IVF for any couple. For instance, a woman who is under age 35 and undergoes IVF has a 39.6% chance of having a baby, while a woman over age 40 has an 11.5% chance. However, the CDC recently found that the success rate is increasing in every age group as the techniques are refined and doctors become more experienced.

Continued

What Are The Costs of IVF?

The average cost of an IVF cycle in the U.S. is $12,400, according to the American Society of Reproductive Medicine. This price will vary depending on where you live, the amount of medications you're required to take, the number of IVF cycles you undergo, and the amount your insurance company will pay toward the procedure. You should thoroughly investigate your insurance company's coverage of IVF and ask for a written statement of your benefits. Although some states have enacted laws requiring insurance companies to cover at least some of the costs of infertility treatment, many states haven't.

Also be aware that some carriers will pay for infertility drugs and monitoring, but not for the cost of IVF or other artificial reproductive technology. Resolve: The National Infertility Association publishes a booklet called the "Infertility Insurance Advisor," which provides tips on reviewing your insurance benefits contract.

Sources

SOURCES:
American Society for Reproductive Medicine web site.
American College of Obstetricians and Gynecologists web site.
Human Reproduction Update , July-August 2002.
The Infertility Workup and Understanding Treatment Options , RESOLVE online.
The Merck Manual , Seventeenth Edition, 2000.
The Fertility Handbook: A Guide to Getting Pregnant , Addicus Books, 2002.
Assisted Reproductive Technology Success Rates , 2009, CDC.

Next Article
Artificial Insemination

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Today, in vitro fertilization (IVF) is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as "test-tube babies." Louise Brown, born in England in 1978, was the first such baby to be conceived outside her mother's womb.

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Average cost of In-Vitro Fertilization- MD 

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Average cost of In-Vitro Fertilization- MD 

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Average cost of In-Vitro Fertilization in the United States is between $12,000 and $15,000 without insurance.

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IHR.com - IVF Costs, In Vitro Fertilization Costs, Invitro Fertilization Costs

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Discusses the cost of IVF as well as ways to reduce IVF costs by refund programs, IVF insurance, IVF financing, mini-IVF, etc.

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First, medication is given to the female to stimulate egg production. A transvaginal ultrasound is then used to examine the ovaries, as well as blood tests to monitor hormone levels. Afterwards, a minor surgical procedure is scheduled to retrieve the eggs. After the male produces a sample of sperm, it is then mixed with the eggs to increase fertilization. This process is called insemination. Once an egg gets fertilized, referred to as an embryo, it is placed into the woman's uterus. This process usually takes place three to five days after fertilization.

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In Vitro Fertilization (IVF): What is it?

In Vitro Fertilization is an assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).

Why is IVF used?
IVF can be used to treat infertility in the following patients:
What is involved with in vitro fertilization?
There are five basic steps in the IVF and embryo transfer process:
Step 1: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. A transvaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.

Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.

Step 3: The male is asked to produce a sample of sperm, which is prepared for combining with the eggs.

Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilization. In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the woman's uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.

Side effects of in vitro fertilization

Although you may need to take it easy after the procedure, most women can resume normal activities the following day.
Some side effects after IVF may include:

Passing a small amount of fluid (may be clear or blood-tinged) after the procedure

Mild cramping

Mild bloating

Constipation

Breast tenderness

If you experience any of the following symptoms, call your doctor immediately: Some side effects of fertility medications may include:

Headaches

Mood swings

Abdominal pain

Hot flashes

Abdominal bloating

RARE: Ovarian hyper-stimulation syndrome (OHSS)

What are the risks associated with in vitro fertilization?

As with most medical procedures, there are potential risks. More severe symptoms, typically from OHSS, include the following:

Decreased urinary frequency

Shortness of breath

Faintness

Severe stomach pains and bloating

Ten-pound weight gain within three to five days

If you experience any of these symptoms above, contact your doctor right away.
Additional risks of IVF include the following:

Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder.

The chance of a multiples pregnancy is increased with the use of fertility treatment. There are additional risks and concerns related to multiples during pregnancy including the increased risk of premature delivery and low birth weight.

Though the rates of miscarriage are similar to unassisted conception, the risk does increase with maternal age.

The Mayo Clinic reports that the risk of ectopic pregnancy with IVF are 2-5%. An ectopic pregnancy is when a fertilized egg implants anywhere outside the uterus and is not viable.

Assisted reproductive technology (ART) involves a significant physical, financial, and emotional commitment on the part of a couple. Psychological stress and emotional problems are common, especially if in vitro fertilization (IVF) is unsuccessful.

IVF is expensive, and many insurance plans do not provide coverage for fertility treatment. The cost for a single IVF cycle can range from at least $12,000-$17,000.

How successful is in vitro fertilization?

The success rate of IVF clinics depends on a number of factors including reproductive history, maternal age, the cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates.
In the United States, the live birth rate for each IVF cycle started is approximately:
What if I don't produce healthy eggs or my husband is sterile?

You may choose to use donor eggs, sperm, or embryos. However, make sure to talk with a counselor experienced with donor issues. You will want to be informed about various legal issues related to gamete donation including the legal rights of the donor.

How many embryos should be created or transferred?

The number of embryos transferred typically depends on the number of eggs collected and maternal age. As the rate of implantation decreases as women age, more eggs may be implanted depending on age to increase the likelihood of implantation. However, a greater number of eggs transferred increases the chances of having a multiples pregnancy. Make sure to talk with your doctor before the procedure so you both agree on how many embryos to implant.

How do I choose an infertility clinic?

There are a number of questions to ask regarding the cost and details of specific centers and fertility programs. Some suggested questions are available online in Selecting Your ART Program.

Some couples want to explore more traditional or over the counter efforts before exploring infertility procedures. If you are trying to get pregnant and looking for resources to support your efforts, we invite you to check out the fertility product and resource guide provided by our corporate sponsor. Review resource guide here.

However, if you are looking for testing or options to increase your fertility chances of conception, you can find a fertility specialist with the search tool below:

For more information:
American Society of Reproductive Medicine
Compiled using information from the following sources:

1. American Society for Reproductive Medicine. (2014). Gamete and embryo donation: Deciding whether to tell.
https://www.asrm.org/FACTSHEET_Gamete_Donation_Deciding_Whether_To_Tell/
2. Human Fertilisation & Embryology Authority. (2014). IVF - What is in vitro fertilisation (IVF) and how does it work?
http://www.hfea.gov.uk/IVF.html
3. Human Fertilisation & Embryology Authority. (2014). Risks of fertility treatment.
http://www.hfea.gov.uk/fertility-treatment-risks.html
4. MedlinePlus. (2014). In vitro fertilization (IVF).
http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm
5. Mayo Clinic. (2013, June 27). In vitro fertilization (IVF).
http://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/basics/definition/prc-20018905
6. RESOLVE: The National Infertility Association. (n.d.) IVF/ART.
http://www.resolve.org/family-building-options/ivf-art/

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In Vitro Fertilization (IVF): Side Effects and Risks

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In Vitro Fertilization is an assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus.