In vitro fertilization (IVF) Treatment
In vitro fertilization (IVF) Treatment
In vitro fertilization (IVF) helps with fertilization, embryo development, and implantation, so you can get pregnant.
IVF stands for in vitro fertilization. It’s one of the more widely known types of assisted reproductive technology (ART). IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in your uterus.
First, you take medication that makes several of your eggs mature and ready for fertilization. Then the doctor takes the eggs out of your body and mixes them with sperm in a lab, to help the sperm fertilize the eggs. Then they put 1 or more fertilized eggs (embryos) directly into your uterus. Pregnancy happens if any of the embryos implant in the lining of your uterus.
During IVF, mature eggs are collected (retrieved) from your ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in your uterus. One cycle of IVF takes about two weeks.
IVF is the most effective form of assisted reproductive technology. The procedure can be done using your own eggs and your partner’s sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — a woman who has an embryo implanted in her uterus — might be used.
Why Should I Start IVF Treatment?
In Vitro Fertilization is typically used when couples have continuously failed in attempts to conceive and after other types of fertility treatments were not successful. IVF can be used to treat infertility caused by a number of reasons, including female ovulation disorders, premature ovarian failure, uterine fibroids, genetic disorders, blocked, damaged or removed fallopian tubes, and male infertility, such as decreased sperm count.
Women who have damaged or removed fallopian tubes can get pregnant through IVF treatment because the eggs are retrieved from the ovaries, and the embryos are transferred through the cervix — no direct need for open fallopian tubes.
For couples who hope to use an egg donor or surrogate, IVF treatment is a viable option.
Common IVF Terms You May Have Heard
Starting IVF treatment isn’t just about what happens at the doctor’s office — you’ve probably already realized that there’s a lot of research involved in the process. To help, here are a few common IVF terms that you may have heard, explained.
- Blastocyst: Going through the IVF process can seem clinical, especially when it comes to what reproductive tissues and matter are called. After an egg is fertilized by sperm, it develops into blastocyst. Within five to seven days, these cells then turn into an embryo, which can be transferred to the uterus during IVF.
- Clomid: Clomid is a commonly used fertility medication that a doctor may recommend during IVF. It encourages the body to ovulate and release an egg.
- HCG levels: Human Chorionic Gonadotropin (HCG) is a hormone created by the body after conception has occurred. HCG can be tested for from blood or urine, and is the hormone that pregnancy tests identify to determine if conception has occurred. After an IVF cycle, your HCG levels will be checked to determine if you are pregnant.
- IVF with PGS: Some couples choose to undergo IVF after determining they have a family or genetic history of particular diseases, syndromes or other traits. Preimplantation Genetic Screening (PGS) can be used to study each embryo and determine if it has genetic or chromosomal abnormalities before being transferred to the uterus.
- PCOS: Polycystic Ovarian Syndrome (PCOS) is an ovarian issue that can cause irregular menstrual cycles and make it difficult for women to ovulate — a crucial part to the conception and pregnancy process. Women with PCOS do not release eggs regularly, and their ovaries often have many small cysts within. IVF is a strong option for women with PCOS, since it can help their bodies ovulate to achieve pregnancy.
Steps involved in IVF treatment
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 trans-vaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.
You may need several different medications, 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.
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.
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, your doctor will likely perform:
- 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
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 surgery or laparoscopy — a procedure in which a tiny incision is made near your navel and a slender viewing instrument (laparoscope) is inserted — 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.
Step 3: The male is asked to produce a sample of sperm, which is prepared for combining with the eggs. 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.
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.
Fertilization can be attempted using two common methods:
- Insemination. During 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.
- 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.
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.
Embryo transfer is done at your doctor’s office or a clinic and usually takes place two to six days after egg retrieval.
- You might be given a mild sedative. The procedure is usually painless, although you might experience mild cramping.
- The doctor or nurse 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 or nurse 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.
IVF Success Rate
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 percent. 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.
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.
What are the side effects of IVF?
Like all medications and medical procedures, IVF has some risks and possible side effects. These include:
- breast tenderness
- mood swings
- bruising from shots
- allergic reaction to medicines
- Cramping and abdominal pain: Period-like cramps are common during the IVF process, along with minor abdominal pain that feels similar to your menstrual cycle. You can combat general cramps with over-the-counter pain relievers or a heat pad to reduce discomfort.
- Bloating: Fertility medications can heavily impact how your body retains water, leading to the dreaded side effect of bloating. This is especially common in your midsection, where fluid can build up near the ovaries (creating abdominal tenderness, too). You can combat bloating by increasing your fluid intake, and participating in light exercise such as walking.
- Breast tenderness: Tenderness is often felt throughout your menstrual cycle, and can be amplified by IVF medications. You can help ease this discomfort by using warm or cold compresses on your breasts (whichever feels best) or by taking a warm or cool shower. Wearing a supportive but non-restricting bra can also help.
- Constipation: Constipation is an unfortunate side effect that can be remedied by eating more fiber, increasing your water intake, and avoiding dehydrating beverages such as coffee and soda.
- Headaches and mood swings: Headaches and mood swings are common IVF treatment side effects. Over-the-counter medications can ease headaches, and while no medication can help with mood swings, knowing that they’re a normal part of IVF treatment helps. If you find mood swings are disrupting your day, be sure to seek out self-care practices such as enjoying alone time, reading a book, taking a nice bath, or sharing feelings with a friend or loved one.
- Hot flashes: If you suddenly feel very warm, have a flushed face, or find yourself randomly sweating, you may be experiencing a hot flash. They can appear at random during the IVF treatment process, but you can help prevent them by reducing stress, avoiding spicy foods and warm environments, and cutting back on alcohol or caffeine intake.
Your doctor can talk with you about any questions or concerns you have about IVF risks and side effects.
IVF can also be difficult emotionally, both for the person having the procedures and for their partner and/or family. Many people doing IVF treatments struggle with depression and anxiety throughout the process.
The cost of IVF can vary greatly depending on your location, Doctor and Hospital you choose. Many couples prefer to travel to other cities with more affordable IVF treatment plans.
Other Important factors are
- Women’s Age
- Medical Condition of Wife
- Medical Condition of Husband
Understanding the cost of fertility treatments can be difficult, simply because there are so many factors that impact the final bill.
Special Scenarios That Can Impact IVF Costs
Only you and your reproductive specialist can determine the best ways to utilize IVF treatments. Sometimes, that means using donor eggs or sperm, or with the help of a surrogate.
IVF Cost With Donor Eggs
In some fertility cases, it is necessary to use donor eggs. Depending on the region and clinic, this can either decrease or increase the bill for IVF treatment. Some IVF clinics claim that IVF costs with donor eggs can be dropped by up to 50 percent, partially because of the reduced medication cost and the fact that donor eggs remove the need for egg retrieval. But, how the eggs are collected and stored can make a cost difference. IVF costs with egg donation can be impacted based the clinic or donor egg bank you select.
IVF Cost With Frozen Embryos
Choosing to undergo an IVF cycle utilizing frozen embryos can reduce the IVF price tag. This is because multiple eggs are fertilized at one time, developing into embryos that can either be implanted or frozen for later use. IVF costs with frozen embryos are reduced because there is no need to retrieve more eggs, speeding up the IVF process and cutting out parts of a complete cycle.
IVF Cost With a Surrogate
Contrary to popular believe, utilizing a surrogate is common among more people than just celebrities. Surrogates allow women who are unable to carry a baby to still have children. Though, the IVF cost with a surrogate can go far beyond other kinds of fertility treatments.
IVF Cost With PGD
PGD, short for Preimplantation Genetic Diagnosis, is a form of testing done on embryos created during the IVF process to ensure there are no genetic abnormalities. PGD testing is done before embryos are transferred to the uterus, allowing doctors to select the healthiest embryos possible. Because this is an additional service, the IVF cost with PDG can increase. Some clinics will include this cost in your total cycle price, while others charge separately.
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