Your guide to in-vitro fertilization

Your guide to in-vitro fertilization

Assisted reproductive technology (ART) is an umbrella term used to define fertility treatments in which both eggs and sperm are handled. In ART procedures, eggs are surgically removed from a woman’s ovaries and combined with sperm in the laboratory. The embryos are then either returned to the woman’s body, donated to another woman, or frozen for future use. ART is used to conceive around 1 in every 100 babies born in the US each year.

Did you know

8 million IVF babies have been born worldwide over the past 40 years

In-vitro fertilization (IVF) is the most common form of ART, accounting for over 99% of all procedures. It’s a complex and emotional process, but worldwide, IVF has resulted in the birth of 8 million babies over the past 40 years.

IVF by the numbers
Note: Treatment cycles can be affected by many variables. The numbers above represent ranges and may not reflect your experience. Please discuss your personal treatment protocol with your healthcare provider.

How it works

IVF cycles include many different stages involving a range of specialists over a 4- to 6-week period. First, medication will be prescribed to stimulate the woman’s ovaries in order to grow multiple eggs. Her eggs will then be retrieved and fertilized in the lab with sperm. Embryologists in the lab will monitor the embryos for a short period of time before placing the best embryo(s) back into the woman’s uterus.

Who it’s for

IVF may be a good choice if you have:

  • Difficulty ovulating 
  • Endometriosis 
  • Polycystic ovaries 
  • Blocked or absent fallopian tubes 
  • Sperm impairment, such as low sperm count
  • Unexplained infertility

Possible side effects*

Because IVF is a multi-step process, there’s a higher risk of side effects from treatment, including:

  • Nausea, mood swings, fatigue, breast tenderness, increased vaginal discharge, or ovarian hyperstimulation syndrome from fertility medications 
  • Pelvic or abdominal pain, injury to organs near the ovaries, or pelvic infection from egg retrieval
  • Mild cramping, spotting, or infection from embryo transfer 
  • Increased chance of getting pregnant with multiples (twins, triplets, or more), which can have health risks for both the mother and babies 

The chance of multiples in IVF depends on how many embryos are transferred. Most women give birth to one baby, about 20% give birth to twins, and 1% give birth to triplets.

*This may not represent all side effects. Please discuss with your healthcare provider.

Success rates

For most people, IVF is more successful than the 20% chance a healthy 30-year-old woman has of conceiving each month. However, it’s important to remember that many factors can influence the chances of IVF working, such as your age and whether you have any other medical conditions.

Success rates are higher for younger women. For women using their own fresh eggs in 2015, the chances of having a baby on the first cycle were as follows:

Age of women Live Births
<35 41.7%
35-37 32.3%
38-40 21.8%
41-42 11.1%
>42 3.6%
Data based on SART 2015 Final National Summary Report


It can be disheartening if a treatment cycle does not work on the first attempt, but cycles can vary, increasing your chance of success next time. This is because:

  • Your doctor can tailor medications based on your previous response to treatment
  • More eggs, or healthier eggs, may be produced during a different cycle
  • You may be able to adapt treatment using frozen or donor sperm and/or eggs

Studies have shown the rate of pregnancy increases with each additional round of IVF, with over half of women conceiving after 3 cycles, and around two-thirds conceiving after 6 cycles.

What women can expect in a cycle

STEP 1: Pre-cycle testing and treatment

Before your IVF cycle begins, your doctor may start you on oral contraceptives to regulate your menstrual cycle and prevent ovarian cysts. Progesterone may also be prescribed if you don’t ovulate regularly. In some women, a mock transfer may be performed to check for problems that could affect embryo transfer.

You’ll also undergo a physical examination and sometimes, blood work, to ensure your ovaries are clear of cysts.

STEP 2: Controlling the menstrual cycle

To stop the ovaries from releasing eggs too early, your doctor will control your menstrual cycle with fertility drugs. Depending on your situation, your doctor will recommend either:

  • Long agonist protocol
    An older, more established method in which daily injections are taken for 10 days before ovarian stimulation begins.
  • Short antagonist protocol
    This protocol involves taking daily injections in addition to the simulation injections.
STEP 3: Hormonal therapy

You’ll take hormonal injections for 8 to 14 days to stimulate the ovaries to produce and mature several eggs. Regular ultrasounds or blood tests will be conducted to monitor the growth of your follicles (fluid-filled sacs containing eggs) and your hormone levels.

STEP 4: Egg retrieval

When the eggs are nearly mature, you’ll receive a single injection of human chorionic gonadotropin (hCG), which mimics the natural luteinizing hormone (LH) surge your body experiences before ovulation. This will trigger your ovaries to fully mature and prepare to release eggs.

Within 34 to 38 hours of the ovulation “trigger shot,” your doctor will remove your mature eggs, along with the fluid in your follicles, using a long needle and ultrasound guidance. Anesthesia will be used during the procedure to minimize discomfort.

On average, 8 to 15 eggs are retrieved. Some women may have spotting or discomfort for a few days after the procedure, but injury and infection are rare.

STEP 5: Sperm collection

On the same day as the egg retrieval, a semen sample will be collected. Your male partner will be asked to masturbate into a sterile, non-toxic plastic cup provided by the lab. For women using a donor, the sperm will be thawed at the time of egg retrieval. 

STEP 6: Fertilization and embryo development

In the lab, your embryologist will combine sperm and eggs in a small petri dish. ICSI or other ART procedures may be conducted. The dishes will be placed into incubators that control temperature and gas, designed to mimic the natural conditions inside your body. Your embryos will be assessed after 16 to 20 hours to confirm successful fertilization, then every few days to monitor development and growth.

STEP 7: Embryo transfer

3 to 5 days after egg retrieval, your embryologist will select the healthiest looking embryo(s) to transfer into the uterus. The number of embryos transferred will depend on your age and embryo quality.

The embryos are transferred through the cervix into the uterus using a thin tube. This procedure does not require anesthesia, and you’ll be able to go home after a brief recovery period.

If you have additional good quality embryos that are not transferred, they can be frozen for future use. Learn more about embryo storage fees.

STEP 8: Two-week wait

After transfer comes a 9- to 12-day waiting period before a pregnancy test can be taken, known as the “two-week wait.” This can be a difficult time, filled with hope and anxiety. Building a support network can help you during the wait.

During this time, your doctor may prescribe a hormone called progesterone, which helps thicken the uterus lining to help the embryo attach and grow. This is given either as injection, an oral tablet, a capsule, or a gel inserted into the vagina.

STEP 9: Pregnancy testing and care

You’ll be able to be tested for pregnancy around 9 to 12 days after transfer. If you get the joyous news of a positive pregnancy test, your clinic will closely monitor your pregnancy with scans and blood work to ensure the health of you and your baby. You’ll be released to your OB when your pregnancy is 8 to 10 weeks along.

5 types of ART that aren’t IVF

Assisted hatching

Before an embryo implants in the uterus, it must “hatch” from the outer coating that covers the egg. Your embryologist can help the hatching process by making a small hole in the sac of the embryo before transfer. This increases the chance of implantation inside the uterus.

Assisted hatching is usually done on embryos that are on day 3 of development in the lab.

Intracytoplasmic sperm injection (ICSI)

Some patients who undergo IVF will also have ICSI treatment. In this process, a single sperm is injected directly into the egg. This is different from IVF, which combines sperm and the egg in the same dish and allows the sperm to fertilize the egg on its own.

ICSI may be suggested if a man has a very low sperm count, low sperm motility, poor-quality sperm, or blocked sperm ducts—or if donor sperm is being used.

Intracytoplasmic-sperm-injection

 

Gamete intrafallopian transfer (GIFT)

In a GIFT procedure, sperm and an egg are combined in the fertility clinic’s lab and then transferred to a woman's fallopian tubes. This allows fertilization to happen inside the woman’s body.

Gamete intrafallopian transfer

Zygote intrafallopian transfer (ZIFT)

In this procedure, sperm and an egg are combined in the fertility clinic’s lab. After fertilization, a very early embryo, known as a zygote, is transferred to the woman’s fallopian tube.

Zygote Intrafallopian Transfer

 

Preimplantation genetic testing (PGT)

Some couples have a higher risk of having a baby with a genetic disorder, either for hereditary reasons or because of their age. PGT is a technique used to test your embryo’s cells for nearly 400 genetic disorders to avoid them being passed on to the child. PGT can be used with any ART treatment in which embryos develop in the lab.

How military families can combat infertility

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Know your options for stateside infertility treatment and fertility preservation before deployment. 

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