In Vitro Fertilization (IVF)

IVF at a glance

  • In vitro fertilization, or IVF, is the most effective fertility treatment. During IVF eggs and sperm are combined in our laboratory in order to create embryos.
  • After the resulting embryo(s), or fertilized egg(s), have grown for several days in an incubator to the blastocyst stage of development, one or more can be transferred into the uterus.
  • The embryo(s) can be transferred in to the uterus as soon as they have matured in the lab or the embryo(s) can be cryopreserved (frozen and stored) to be transferred at a later time for another attempt at pregnancy or for an additional child.
  • The stored embryos remain frozen in time, meaning that whenever they are transferred they carry the same reproductive promise and risks of failure as was present due to the age of the sperm and the egg at the time of embryo cryopreservation.
  • IVF can be a good option for individuals and couples with ovulation (egg release) problems, abnormal anatomy (fallopian tubes or uterus), poor sperm, and/or other issues, as well as for LGBTQIA patients.
  • Patients can elect to have the genetic makeup of their embryo(s) tested prior to transfer to increase their chance of a successful transfer. Genetically abnormal embryos are less likely to result in a pregnancy or a baby.
  • Preimplantation genetic testing of an embryo(s) does not guarantee a healthy baby. However, it reduces the risk of biochemical pregnancy, miscarriage, and having a baby with a chromosomal abnormality like Down syndrome.

 

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What is IVF?

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.

Advances in IVF

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, or SART.

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Who can benefit from in vitro fertilization?

IVF is often not the initial recommended treatment but may 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 a 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.

IVF can help those with issues such as:

  • Endometriosis
  • Fallopian tube or uterine abnormalities
  • Poor quality sperm
  • Ovulation disorders
  • Unexplained infertility
  • Recurrent miscarriage

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 for LGBTQIA individuals and couples

IVF and IUI have opened up family-building prospects for individuals in the LGBTQIA community, whom we proudly serve. In vitro fertilization can help same sex, transgender or intersex couples or individuals build their family via 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.

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We understand the path to parenthood isn’t always straight

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 use of a gestational carrier.

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What is the IVF treatment process?

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.

Video: The difference between IUI & IVF

  • Some IVF patients have the option of transferring an embryo as soon as it has matured in the lab. This is called a fresh embryo transfer and requires that embryo transfer occurs within a few days after egg retrieval.
  • More commonly, patients allow their bodies to return back to normal after their surgery and then undergo a frozen embryo transfer the following month.
  • Some patients are electing to complete testing of the lining of their uterus to ensure optimal timing of the embryo transfer in a mock transfer cycle called an endometrial receptivity analysis (ERA) cycle. The uterus is prepared as it would be for an embryo transfer, but the embryo remains frozen while a small biopsy of the uterine lining is taken and sent for testing to determine the best timing for embryo transfer.

 

Fertility preservation

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 a pregnancy later.

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Ovary stimulation

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 die.

  • IVF allows us to rescue some of the eggs that would have otherwise died off and use them to help achieve a pregnancy. It does not steal eggs from the future and does not decrease your egg supply.
  • Retrieving multiple eggs during an IVF cycle helps increase the probability of finding a healthy egg. Not every egg is healthy and not every egg can result in a baby.
  • In order to save eggs from dying and increase the number of eggs retrieved, individuals undergoing IVF will administer fertility medications. These medications act the same as the hormones released from the brain that normally stimulate the ovary: follicle stimulating hormone (FSH) and luteinizing hormone (LH). This process is known as controlled ovarian hyperstimulation.

Egg retrieval

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 collection

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 are washed and a single sperm is used for each egg when performing intracytoplasmic sperm injection (ICSI).

ICSI, fertilization and culture

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.

  • Sperm and egg(s) are combined in our lab via ICSI and then placed in an incubator.
  • ICSI uses a needle to inject a single sperm cell directly into the cystoplasm of the egg(s), which is where fertilization occurs.
  • These are assessed the day after egg retrieval and ICSI to determine if an embryo (a successfully fertilized egg) has formed.
  • The embryo(s) are grown in the incubator for up to seven days, and our lab embryologist monitors their growth over this time.

Embryo preimplantation genetic testing option

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:

  • When there is a large number of embryos that make it to the blastocyst stage
  • For individuals of advanced age with high egg abnormality rates
  • In settings of previous IVF failures
  • In cases of known genetic mutations or inherited conditions to prevent having a child with the condition
Preimplantation Genetic Testing (PGT & PGT-M)

Preimplantation genetic testing (PGT – formerly known as PGD & PGS) identifies genetic & chromosomal disorders in embryos during IVF.

 

Blastocyst stage embryo transfer

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 day 5, 6 or 7.

  • Blastocyst(s) are transferred into the uterus under ultrasound guidance.
  • A speculum is placed into the vagina and a catheter is placed into the uterus.
  • The blastocyst(s) are transferred into the uterine cavity through the catheter, and will implant or not within the next one to five days.
  • Our physicians cannot implant the embryo into the uterus. They transfer it into the uterus and allow it to implant on its own.
  • Not every embryo implants in the uterus and results in a pregnancy.

The move to transferring a single embryo

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 a multiple pregnancy (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.

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What are the risks of IVF?

Serious complications from IVF are rare, but as with all medical procedures, there are some risks that include the following.

  • Egg retrieval, like any surgery, carries a risk of infection, bleeding, pain, injury to surrounding structures (bowel, bladder, vessels, uterus), and/or need for additional surgery or procedure(s).
  • Blastocyst transfer places the embryo into the uterus, but implantation does not occur immediately. An embryo can float into the fallopian tube and become an ectopic pregnancy, which the baby cannot survive and can be life-threatening for the mother.
  • Following the blastocyst transfer, there may be spotting, cramping or bleeding.
  • If multiple embryos are transferred, there is a high chance of a multiple pregnancy.
  • Typically, the side effects of the IVF medications are mild. In some cases, these symptoms can become more severe and include abdominal pain, nausea, shortness of breath, decreased urinary frequency, and/or weight gain.
  • In vitro fertilization also includes the risk of under response or cycle cancellation.
  • Infertility is stressful and has been shown to have the psychological impact equal to a diagnosis of cancer. In vitro fertilization, and all assisted reproductive treatments, can cause emotional and psychological stress. This stress can increase with unsuccessful treatments or miscarriage. We often recommend counseling in these instances.

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