11 April 2019

Do I need IVF?

If you’ve been struggling to get pregnant and looking into fertility treatments, you’ve probably heard of In Vitro Fertilization (IVF).

And if you have, you might be wondering if it’s right for you, what you can expect and what the chances of success are. Most importantly, you’re probably wondering where to go to get care.

While all these thoughts – and questions – might seem overwhelming, the fact that you’re seeking more information is a positive thing. With infertility, knowledge really is power. So congratulations, you’re in the right place.

At Reproductive Medicine Associates of Northern California (RMANorCal), with offices in San Francisco and Palo Alto, IVF is a common treatment for both female and male factor infertility. It is also used for LGBTQ couples looking to start their families.

RMANorCal physicians Dr. Jonathan Kort and Dr. Scott Morin answer all of your questions about IVF below:

What is IVF?

Dr. Kort: IVF is the process by which eggs are fertilized by sperm outside the body and a resulting embryo is transferred into a woman’s uterus in hopes of implantation.

What is IVF like?

Dr. Morin: Because infertility is such an emotional experience, IVF can be equally emotional, especially if you need more than one cycle to succeed. That said, IVF is relatively simple: first, a woman takes injections of ovary stimulating medication to bring multiple eggs to maturity in one menstrual cycle. These daily injections go on for 8-12 days, during which time the patient comes to the doctor’s office for a few quick appointments to monitor the development of the follicles in her ovaries. These appointments consist of blood work and ultrasounds and are scheduled early in the morning so as not to interfere with work and the rest of the patient’s daily life.

Once the doctor determines the eggs are grown and ready for ovulation, the woman takes a trigger shot to induce the release of the eggs. 36 hours after the trigger, the patient comes in for a 15-minute egg retrieval procedure where she is lightly sedated and the eggs are removed through her vagina under ultrasound guidance. After a short recovery period following the procedure, the patient is free to go home (with a companion to drive her) and can usually resume work the next day. Around this time, her partner will give doctors a semen sample, which will be ‘washed’ to isolate the sperm from the semen.

Next, the mature eggs that were retrieved will be fertilized with the sperm collected using a procedure called Intracytoplasmic Sperm Injection (ICSI). Through this process, an individual sperm is injected into an individual egg to improve fertilization rates. The embryos are then monitored in the lab until they grow to day 5, 6 or 7, at which point they are big and strong enough to undergo an embryo biopsy to determine whether they are euploid (chromosomally-normal) or aneuploid (chromosomally-abnormal).  A small amount of biopsied tissue from each embryo is analyzed using a test called NexCCS. All the fertilized embryos are frozen until a chromosomally-normal embryo is chosen for transfer.

Then, once the patient’s uterus is at its most receptive, a chromosomally-normal embryo is thawed and transferred back into the woman’s uterus through Frozen Embryo Transfer (FET). At that point, the couple should wait about nine days to take a pregnancy test to see if implantation has occurred. If it did, the woman will soon be released to her OB/GYN for prenatal care. If there was a failure to implant or a loss, the couple can try another transfer with another normal embryo or begin another cycle to create more embryos.

Does IVF work?

Dr. Kort: IVF does work. While it doesn’t always work on the first try, or may not work for everyone, IVF is a very effective form of fertility treatment, and the most advanced option available today. Thanks to research done by IVI-RMA Global – the fertility network to which RMANorCal belongs – we know more about creating babies in vitro than ever before, and patients are seeing higher success rates because of it. For individuals or couples who do not find success in IVF, there are still other options available, such as egg, sperm or embryo donation and gestational surrogacy. 

Is IVF safe?

Dr. Morin: Overall, IVF is very safe. While there are, like with any other procedure, potential risks and side effects, the risks of IVF are very low. As science and the industry have advanced, risks have decreased, success rates have increased, and more than 8 million babies have been born around the world using the technique in the last 40 years.

Is IVF expensive?

Dr. Kort: IVF is expensive, but it is becoming more affordable thanks to more progressive employers offering fertility coverage to their employees, as well as different fertility financing options and plans. More and more, IVF is becoming accessible to the tens of thousands of people across the country who need it. And at RMA of Northern California, we don’t ever want cost to be a barrier that keeps you from building your family. If you’re hesitant to seek treatment because of this big unknown, don’t be. Call our office today to speak to one of our financial coordinators – we’re here to help you in every aspect of your fertility journey.

How can I tell if IVF is right for me?

Dr. Morin: One of the most important aspects of reproductive medicine is matching patients with the right treatment at the right time. While IVF is necessary for many patients, other patients have success with Intrauterine Insemination (IUI) or even Ovulation Induction (OI). Treatment paths are chosen after a careful analysis of the patient’s medical and fertility history and a full diagnostic workup. Doctors will check blood hormone levels, fallopian tubes, the uterine environment, semen quality and more to determine which treatment plan is right for you. And again, our recommendations are based on what we think is going to be the most successful for you. So if we think you have a good chance of getting pregnant without having to do IVF, that’s what we’ll recommend first.

How do I choose an IVF clinic?

Dr. Kort: Choosing the right clinic is important, because not all clinics are created equal. When choosing a fertility clinic for IVF, look for a place that routinely performs FET and Single Embryo Transfer (SET), the process of putting back only one embryo at a time to avoid the risk of multiples. Second, look for a clinic that offers genetic embryo testing like RMANorCal’s NexCCS test. This test saves you time, money and stress during your IVF cycle because it lets you know which embryos have the best chance of implanting and leading to a live birth. Third, make sure the clinic has an on-site embryology lab where embryologists perform blastocyst biopsy (day 5, 6, or 7 biopsy) as part of their genetic embryo testing. You should also see if the clinic is doing vital research that benefits patient outcomes. Finally, and perhaps most importantly, do you like your doctor? Do you feel heard and respected? Compassion and a connection with this person who you’re placing a lot of trust in should not be underappreciated.

If you’ve read this far, you probably understand IVF a lot better now, but still might not be sure if it’s the right path for you. That’s completely normal. IVF is a big decision and one that requires careful consideration. Not sure where to start? A fertility workup – complete with bloodwork and semen analysis that will help you and your partner understand your fertility timeline – is a good first step.

Have a question that wasn’t addressed above?  Call our office at (415) 603-6999 and we’ll get an answer for you. It doesn’t matter where you are on your fertility journey – just collecting information, serious about seeking treatment, or know exactly what you’re looking for – we’re here for you. Speak to one of our patient liaisons for more information or to book a consultation with Dr. Kort or Dr. Morin today.

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