In vitro fertilization (IVF): Process, who needs it, risks and FAQs

Infertility is a challenge that many couples face and it can affect both men and women. There are various reasons for infertility, such as hormonal imbalances, low sperm count, blocked fallopian tubes, and more. When other treatments like medication or intrauterine insemination (IUI) fail, many turn to in vitro fertilization (IVF). IVF is a process where eggs are fertilized outside the body, and the resulting embryo is then implanted in the uterus. It is one of the most successful fertility treatments available today, although success can depend on factors like age and overall health. While IVF brings hope to those struggling with infertility, it is important to know everything about the process before you decide to try it.

What is in vitro fertilization (IVF)?

In vitro fertilization or IVF is a popular assisted reproductive technology (ART) used to help couples struggling with infertility. It involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm outside the body. The resulting fertilized egg, called an embryo, can be stored or implanted into the woman’s uterus to become pregnant. IVF is usually recommended after a year of failed attempts to get pregnant. It can also help prevent genetic disorders from being passed on to the child. One IVF cycle usually takes up to 2-3 weeks. Although IVF is the most successful fertility treatment, its success relies on factors such as age and the underlying cause of infertility.

Why is IVF done?

In vitro fertilization (IVF) is often used to help individuals with infertility or genetic disorders who wish to conceive or have a baby. Since IVF is costly and invasive, couples usually try other treatments first, like fertility drugs or intrauterine insemination (IUI). According to the Mayo Clinic, IVF may be required for a number of reasons for infertility, including:

• Women over 40 with reduced fertility
• Blocked or damaged fallopian tubes
• Ovulation disorders or reduced ovarian function
• Endometriosis
• Uterine fibroids
• Male infertility (low sperm count or abnormalities)
• Unexplained infertility
• Genetic disorders
• Preserving fertility due to cancer or other health conditions
• Polycystic ovary syndrome (PCOS)

IVF provides a solution when other options have not been successful.

How is IVF performed?

There are five steps involved in IVF, according to the Johns Hopkins Medicine:

1. Stimulation (super ovulation)

A woman normally produces one egg per cycle, but IVF requires multiple eggs for the best chances of success. Fertility medications are prescribed to stimulate the ovaries to produce more eggs. During this stage, the woman will undergo regular blood tests and ultrasounds to monitor hormone levels and check the development of the ovaries. This ensures that the eggs are growing properly.

2. Egg retrieval

Egg retrieval, or follicular aspiration, is a minor surgical procedure performed under anesthesia. The doctor uses an ultrasound wand to guide a needle through the vagina and into the ovaries. The needle suctions the eggs from the follicles. Afterward, the woman may experience mild cramping or a feeling of fullness, which typically goes away within a day. The retrieved eggs are placed in a special liquid to help them mature and are prepared for fertilization.

Also read: Stop believing these common IVF myths

3. Insemination and fertilization

The male partner provides a semen sample, which is then combined with the eggs in a petri dish in the laboratory. This process is known as insemination. The fertilization process occurs naturally when sperm enters the egg within a few hours. If fertilization is unlikely, a technique called intracytoplasmic sperm injection (ICSI) may be used, where a single sperm is injected directly into an egg. The fertilized eggs are then stored in a controlled environment for proper development.

4. Embryo culture

Once fertilization occurs, the embryos are monitored to ensure they are dividing and growing properly. Over the next few days, the embryos will develop into several cells. By day five, the healthiest embryos will have formed and will be ready for transfer.

5. Embryo transfer

Once the embryos have developed enough, one or more are selected for transfer into the woman’s uterus. This procedure is typically done three to five days after fertilization. A thin tube called a catheter is inserted through the vagina, past the cervix and into the uterus, where the embryos are gently released. The number of embryos transferred depends on various factors, especially the woman’s age. Multiple embryos can lead to the possibility of twins, triplets, or more.

If the IVF process is successful, the embryo will implant into the uterine lining about 6 to 10 days later. A blood test will confirm if you are pregnant.

How can you prepare for in vitro fertilization (IVF)?

To prepare for in vitro fertilization, you will need a thorough medical evaluation and fertility tests before IVF. Both you and your partner will be tested. Some of the key preparations include:

• IVF consultation to discuss the process
• Uterine exam, pap test, and mammogram (if over 40)
• Semen analysis
• Screening for sexually transmitted infections (STIs) and other diseases
• Ovarian reserve testing, along with blood and urine tests
• Instructions on administering fertility medications
• Genetic carrier screening
• Signing consent forms
• Uterine cavity evaluation (hysteroscopy or saline-infused sonography)Additionally, your healthcare provider will recommend starting folic acid supplements at least three months before embryo transfer.

Is IVF a solution to fertility?

The success rate of IVF varies based on several factors. For women under age 35, the live birth rate is around 41-43 percent, according to the American Pregnancy Association. However, for women over 40, this rate drops to 13-18 percent. Key factors influencing success include:

• The cause of infertility, such as endometriosis or a low egg count
• Where you are having the procedure done
• Whether the eggs are fresh or frozen
• Whether the eggs are your own or donated
• Your age

Younger women tend to have higher success rates. IVF is usually not recommended for women over 42 due to lower chances of success. Maintaining a healthy weight and avoiding alcohol, smoking, and caffeine may improve IVF outcomes.

Why do IVF treatments fail?

IVF treatments can fail for several reasons, including:

• Premature ovulation
• No eggs developing
• Too many eggs developing
• Eggs not fertilized by sperm
• Poor sperm quality
• Embryo not growing or implanting
• Issues with egg retrieval or embryo transfer

Each step of the IVF process can impact the outcome, and failure can occur at any stage. Your healthcare provider will review the process with you to identify the cause and determine the best course of action for future treatments.

What are the complications associated with in vitro fertilization?

IVF, like any medical procedure, carries risks and potential complications, suggests the National Health Service. These include:

• Multiple pregnancies, which increase the risk of low birth weight and premature labor
• Premature delivery or miscarriage
• Ectopic pregnancy, where the egg implants outside the uterus
• Rare complications, such as bleeding, infection, or damage to the bowels or bladder
• Ovarian hyperstimulation syndrome (OHSS) is a condition caused by excessive fluid in the abdomen and chest

Additionally, side effects from the procedure may include cramping, bloating, nausea, tender breasts, headaches, and hot flashes. Rarely, bleeding, infection, or organ damage can occur from the egg retrieval needle.