YOUR GUIDE TO IN-VITRO FERTILIZATION

Assisted reproductive technology (ART) includes all fertility treatments that involve the handling of eggs or embryos. 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*

*European Society of Human Reproduction and Embryology. ScienceDaily. 3 July 2018.

In-vitro fertilization (IVF) is the most common form of ART, accounting for over 99% of all ART 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.

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.

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.

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

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 (triplets, quadruplets, and high-order multiple births), 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 25% give birth to twins, and 1% give birth to triplets or higher multiples.

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

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 2020, the chances of having a baby on the first embryo transfer were as follows*:

AGE OF WOMEN	LIVE BIRTHS
<35	36.9%
35-37	27.4%
38-40	17.8%
41-42	9.0%
>42	2.8%

Data based on SART 2020 Preliminary Final National Summary Report, accessed July 13, 2022.

*Cycle success is measured by the live birth rate, with a singleton delivery occurring after 37 weeks of gestation being the optimal outcome of an IVF cycle. The percentage of triplet, twin, and singleton births contributing to the live birth rate is provided in the report for each cycle group and type of transfer, along with a summation of all deliveries (singletons and multiple births).

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

A large, UK-based study of more than 150,000 women who underwent more than 250,000 IVF cycles between 2003 and 2010 found that the rate of pregnancy increased from 30% after 1 cycle to 45% after 3 cycles.†

†Smith A, Tilling K, Nelson S, et al. Live-birth rate associated with repeat in vitro fertilization treatment cycles. JAMA. 2015;314(24):2654-2662.

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 OVULATION 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 stimulation injections that help follicles grow.

STEP 3: OVARIAN STIMULATION MEDICATIONS

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 follicles reach a certain size, you’ll receive a single injection of human chorionic gonadotropin (hCG) trigger shot, 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.

Ultrasound tests will give an approximation of how many eggs you might expect, but the actual number of eggs retrieved will depend on the number of follicles that have developed, as well as the number of ovaries and their accessibility. 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 eggs will be assessed after 16 to 20 hours to confirm successful fertilization, then every few days to monitor embryo 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, 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

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 (zona pellucida) of the embryo before transfer. This increases the chance of implantation inside the uterus.

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, or poor-quality sperm; there is a blockage in the male reproductive track; the eggs have not been fertilized by traditional IVF; previously frozen eggs are being used; or if eggs from in-vitro maturation are being used.

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.

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.

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 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.

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YOUR GUIDE TO IN-VITRO FERTILIZATION