Your fertility plan should be too.
IVF (in vitro fertilization) is an infertility treatment that combines sperm and egg(s) to achieve fertilization outside of the body in our laboratory.
The resulting embryo (fertilized egg) is then transferred into the uterus. IVF offers the highest rate of success out of all treatment options for infertility, but it may not be the best option for every couple or individual. Due to its complexity, IVF is often the most costly treatment.
In vitro fertilization was developed to provide a method through which individuals with blocked fallopian tubes could conceive a child. The first successful baby from IVF, Louise Brown, was born in 1978. In the years since, IVF has evolved and success rates continue to improve. IVF can now treat a wide range of infertility causes. IVF statistics are reported annually by the Society for Assisted Reproductive Technology, SART.
IVF is often not the initial recommended treatment but could be the first step for those who have absent or nonfunctional fallopian tubes and if the sperm quality is very poor. IVF used to treat infertility is also a good option for those wishing to have a large family, due to the prospect of multiple frozen embryos.
In vitro fertilization is also used for potential fertility preservation, in collecting and freezing sperm or eggs for later pregnancy, either due to individual preferences or an upcoming medical treatment such as fertility harming chemotherapy.
We always evaluate people who come to us for infertility solutions with an eye toward using the least invasive treatments when possible. These can be as simple as lifestyle changes or medications.
In many cases, other infertility treatments such as intrauterine insemination (IUI) should be considered before IVF. If these are not successful, IVF is often the next step.
Additionally, in vitro fertilization can help those who otherwise could not experience pregnancy and/or parenthood biologically. This includes patients who need donor eggs or another individual to carry the pregnancy (a gestational carrier, also known as a surrogate) to build their family.
IVF and IUI have opened up family-building prospects for individuals in the LGBTQ+ community, whom we proudly serve.
In vitro fertilization can help same-sex, transgender, or intersex couples or individuals build their family via the use of donated eggs, donated sperm, and/or use of a gestational carrier.
In vitro fertilization can allow for one patient’s eggs to be retrieved and combined with sperm to create embryo(s). These embryos can be transferred into the partner to carry the pregnancy, allowing both individuals to be biologically involved in the pregnancy.
At Fertility Specialists Medical Group, we call this receipt of partners eggs or ROPE.
At Fertility Specialist Medical Group, we are experienced in counseling same-sex couples and individuals about their options for starting a family, including coordinating the complex process of sperm or egg donation and the use of a gestational carrier.
The IVF process includes controlled ovarian stimulation, egg retrieval, optional sperm injection into the egg via intracytoplasmic sperm injection (ICSI), embryo growth, possible preimplantation genetic testing, and embryo transfer. These steps are described in further detail below. It can take one to three months to complete the entire IVF process.
To help our patients have more options with their fertility, we offer cryopreservation, which preserves the patient’s ability to have children at a later time. This can be due to personal choice or to preserve one’s fertility before a medical condition or a treatment, such as for cancer, damages one’s fertility.
Fertility preservation includes freezing eggs, sperm or embryos created through IVF. Eggs and embryos are generally frozen through vitrification, which brings the tissue to subzero temperatures without creating ice crystals that can damage the egg or embryo. The eggs and sperm can be unfrozen and used for fertilization at a later date, and embryos also can be thawed and transferred for pregnancy later.
Typically, the ovaries release one mature egg each month. Women go through around a thousand eggs every month and only release one and the other 999 dies.
The eggs are then retrieved through a transvaginal ultrasound aspiration. Patients are given anesthesia, and they do not feel nor remember the procedure. The ultrasound has a thin needle on it that is inserted through the vaginal wall into the ovary where the eggs are collected. All eggs that can safely be accessed are removed.
Retrieving multiple eggs maximizes the potential of creating more than one embryo. The more embryos an individual or couple has, the higher the probability of having an embryo that will result in a baby. Extra embryos can be kept frozen and can be used in the future for creating more babies.
Sperm can be collected through ejaculation, either at home or in our andrology lab. In some settings such as low sperm count or after a vasectomy, sperm may be directly taken from the testicle by a urologist. After collection, the sperm and semen are separated, the sperm is washed and a single sperm is used for each egg when performing intracytoplasmic sperm injection (ICSI).
ICSI is generally recommended when male infertility is an issue and/or the patient has experienced previous IVF failure. Sperm must break through the egg’s surface for fertilization to occur, and ICSI accomplishes this in cases where the sperm is likely to fail.
Once the egg(s) have successfully fertilized and embryo(s) develop to the blastocyst stage (five, six or seven days after egg retrieval), patients may choose to do preimplantation genetic testing (PGT). Genetic abnormalities are the main cause of failed implantation and miscarriage.
PGT can determine if the embryo(s) have the right number of chromosomes (genetic material) or if they are abnormal in that regard, as well as if they carry a specific genetic defect such as cystic fibrosis. This testing reduces the risks of a failed embryo transfer (not being pregnant), miscarriage or having a baby with some genetic condition such as Down syndrome. It does not eliminate the possibility of having a baby with birth defects or congenital diseases.
Preimplantation genetic testing can be beneficial:
In the past, embryos were often transferred on day 2 or 3 of their development. With improved culture techniques, embryos are now transferred at the blastocyst stage, which they may reach on days 5, 6, or 7.
In the early days of IVF, it was common practice to transfer multiple embryos. As success rates have increased and our understanding of the risks of multiple pregnancies (twins, triplets or more) has improved, the infertility field is moving to single embryo transfer. The American Society for Reproductive Medicine (ASRM) has established that the goal of assisted reproductive technology is a healthy single pregnancy.
We often recommend elective single embryo transfer (eSET) during IVF so the patient(s) can voluntarily transfer only a single embryo. This reduces the risk of multiple birth pregnancies, which can have negative health effects on the individual carrying the pregnancy, the babies, and the entire family unit.
Serious complications from IVF are rare, but as with all medical procedures, there are some risks that include the following.