Your Complete Guide to IVF – Written by a Top Fertility Specialist

IVF, or In Vitro Fertilization, is an assisted reproduction procedure that most people have heard of. But not very many people know exactly what the IVF process involves, or when it can be used. Quite often the very idea of IVF makes us realize how much we don’t know about it and gives rise to many more questions, such as who is IVF for, who does it benefit, and would I be eligible for IVF? How much does it cost, how long does it take and where should I go to look for the best IVF clinic?

We aim to answer these and many more questions in this RMA blog article. Here’s all you need to know in your complete guide to IVF.

What is In Vitro Fertilization (IVF)

IVF is the process in which human fertilization takes place outside the body, in the laboratory, resulting in an embryo that will later be transferred to the mother’s uterus.

“In vitro” means taking place outside of a living organism, while “in vivo” means taking place inside of a living organism. The process involves mixing sperm and egg together in a dish and waiting for fertilization to occur.

However, IVF involves several crucial steps before the meeting of egg and sperm can happen. What is the IVF process? Here is a brief summary.

1. Treatment begins with the first visit to the fertility practice. During this visit, our doctors review any records of past treatments or tests, family history, health history, and for the woman, perform a blood test to gauge baseline fertility and a vaginal ultrasound to look at the ovaries.
2. For the male partner, we may perform a semen analysis, or ask the partner to come back to give a sperm sample at a later date.
3. Next, doctors will schedule the female partner to undergo diagnostic testing to ensure she is in the best position to benefit from IVF. These tests can include a saline sonogram, which checks for abnormalities in the uterus, and a hysterosalpingogram (HSG), which checks for open fallopian tubes.
4. If issues – such as polyps, fibroids, or blocked tubes – are discovered during these tests, doctors may determine that the female patient requires reproductive surgery, which may occur before or after the IVF cycle.
5. In the case of the male, certain issues can also delay IVF. For example, if the male partner has very little or no sperm, he may need a Testicular Sperm Extraction (TESE) prior to proceeding to IVF. This is a surgery performed in order to obtain sperm directly from the testicle.
6. Once both partners have been cleared to proceed to IVF, the process can begin. The woman will begin ovarian stimulation so that her ovaries produce more than the usual one egg per month. This is achieved by a course of daily hormone injections, which may be self-administered at home, for about 10 days. Women typically inject 2-3 medications each night.
7. During this time she will visit her IVF clinic every several days to have ultrasounds scans and blood work to ensure the ovarian stimulation is proceeding correctly.
8. Once the follicle(s) are nearly ready for harvesting, she will take a final “trigger shot” injection that will release her eggs in about 24-36 hours. At that time, she will have her egg retrieval procedure at her IVF clinic.
9. Egg retrieval is a simple procedure that takes around 15–20 minutes. It is carried out in an operating room under light sedation so there is no discomfort. Each of the ovarian follicles are punctured and the fluid containing the eggs is aspirated through a fine needle. Once an embryologist counts how many retrieved eggs are mature several hours after the retrieval, they are ready to be fertilized in the laboratory.
10. Usually, each egg is fertilized through Intracytoplasmic Sperm Injection (ICSI), during which a single sperm is injected into each egg. This happens with all the eggs harvested from the woman so that multiple embryos can be made.
11. Once every egg has been injected with sperm, embryologists wait about 5-7 days for the eggs to develop into blastocysts, a stage of embryo development. At that point, the embryos may be biopsied or sampled for the purpose of preimplantation genetic testing for aneuploidy (PGT-A). This testing determines which blastocysts are genetically normal.
12. In the month following a retrieval cycle, women take an additional month of hormonal treatment to prepare for a frozen-thawed embryo transfer. One embryo is transferred back into the woman’s uterus. The rest of the normal embryos are frozen for later use.
13. The transfer, done with a catheter, is quick and painless and does not require any anesthetic. If everything goes well, the embryo will implant and a pregnancy test is performed in 7-10 days to confirm.

Who is IVF for?

There are no hard and fast rules about who can benefit from IVF. Each patient’s individual circumstances need to be carefully evaluated. However, it is likely your doctor could advise that IVF is your best option for getting pregnant if:

• You have not been successful with Intrauterine Insemination (IUI)
• You suffer from severe endometriosis, which can have an adverse impact on the quality of your eggs and prevent you from becoming pregnant due to scar tissue inside your fallopian tubes
• You are over a certain age
• You have Diminished Ovarian Reserve (DOR)
• Your fallopian tubes are damaged or even completely absent
• You are a couple with a known genetic disorder and want to eliminate the risk of your baby having the same disorder
• You do not have a uterus and need to create embryos for transfer to a gestational carrier
• The male partner has severe male factor infertility, requiring the use of ICSI and IVF to conceive

Do I need IVF?

If you are a woman or part of a couple who falls into one of the above categories, it’s likely that IVF could be your recommended treatment and that IVF could help you to fulfill your dream of being a parent, or of completing your family.

Even if you are not aware of being in any of these groups and you have unexplained infertility, it’s certainly worth finding out about fertility treatment.

Since the birth of the world’s first IVF baby just over forty years ago, new techniques are constantly being developing and success rates continue to improve. The most important factor in the potential success of your treatment is your age.

Am I too old for IVF?

There is no IVF qualification “rule” that says you must be under a certain age to have IVF but the fact is that your age and IVF success are closely linked.

Women under 35 have a higher chance of success than those who are older. This is because as a woman ages, and particularly after the age of 35, the quantity and quality of a woman’s eggs decrease, meaning that it’s harder to get pregnant, and if a pregnancy does occur, the rate of miscarriage is higher.

The rule of thumb is that for women aged 43-45, doctors will usually discuss donor eggs at their first consultation because the chances of conceiving with their own eggs are slim. And for the most part, doctors will strongly discourage – and likely not agree to – donor egg pregnancies for women older than 55.

How long does IVF take?

One full cycle of IVF normally takes about two to three weeks, not including diagnostic workups. This time includes ovarian stimulation, retrieval, and transfer. Then there is the 7-10 day wait to see if you are pregnant. In general, the odds of success increase with increased numbers of genetically normal embryos.

If your first cycle produces several good-quality embryos, you may use those in subsequent cycles, which will be quicker and easier since the woman does not require ovarian stimulation or retrieval.

How long do I have to wait between IVF cycles?

You can proceed with another cycle of IVF in the month following a retrieval cycle. In the case of patients who are able to use their frozen embryos, there is no need to wait for a particular length of time. Even so, any fertility treatment can be a highly emotional experience, being so bound up with your deepest hopes and fears, and many practitioners advise that you take the amount of time for the emotional recovery time that you may need.

What are the differences between fresh vs. frozen embryos?

There are two vital differences. First, fresh embryos are not tested for genetic abnormalities, meaning they could be normal or abnormal at the time of transfer and either lead to a healthy pregnancy, or a miscarriage, or affected baby.

Frozen embryos are able to be tested for chromosomal abnormalities, so doctors can choose to transfer a normal embryo. The other difference is that with Frozen Embryo Transfer (FET), doctors can transfer the embryo at the optimal time for the uterus to receive the embryo – this is called uterine synchrony or uterine receptivity. This allows doctors to increase the chances of implantation and pregnancy.

The likelihood of pregnancy is higher with frozen-thawed embryo transfer compared to fresh transfer.

 

 

What are the risks of IVF?

Any medical intervention carries a small level of risk. For example, the site of injection can become sore or infected, the use of an aspirating needle for egg retrieval carries a small risk of bleeding or other internal damage, and any use of sedation or anesthesia, whatever the purpose, gives rise to a minor risk of complications.

There is also a risk of ovarian hyperstimulation syndrome (OHSS), or fluid collection in the abdomen and other parts of the body that can occur with ovarian stimulation for IVF. Symptoms of OHSS include weight gain, nausea, abdominal distention/bloating, and potentially shortness of breath.

Your doctors will monitor your estrogen level and follicular growth closely and measures have now been developed to reduce your risk of OHSS dramatically.

So apart from the risks that go with any medical procedure, what about particular risks associated with IVF? The first one that springs to mind is that of multiple births.

IVF and twins

In Vitro Fertilization increases the risk of twin or multiple births if more than one embryo is transferred to the maternal uterus at the same time.

The problem with multiple births is that they carry a higher risk of premature birth and low birth weight than a pregnancy with a single fetus. And while in the early days of IVF it was common practice to transfer multiple embryos, that is no longer the case.

For example, RMA exclusively transfers only one embryo at a time through Single Embryo Transfer (SET). This practice drastically reduces the incidence of twins, and as such, complications to mother and baby.

Miscarriage after IVF

The rate of miscarriage following treatment with IVF is between 15 and 25 percent. PGT-A reduces the risk of miscarriage to approximately 5-10% through the transfer of a genetically normal embryo.

Stress and IVF

The experience of going through IVF can be a very stressful one and you could feel emotionally and physically drained. It’s really important to access all of the help you can from counselors, partners, friends, and family. Your care team at RMA is also here to provide emotional support at any time.

Genetic testing

Genetic testing is a game-changer when it comes to minimizing twin risk in IVF, decreasing miscarriage and giving birth to one healthy baby.

Prior to genetic embryo testing, or Preimplantation Genetic Testing for Aneuploidy (PGT-A), doctors didn’t know which embryos were normal or abnormal, so they transferred multiple embryos hoping at least one would stick. Often, both stuck, and the result was twins.

With PGT-A, doctors can test a small piece of the embryo to see what kind of cells it contains – based on the cells, doctors label the embryo normal or abnormal, meaning it has a high chance of leading to pregnancy and live birth or a high chance of leading to a miscarriage or an affected baby.

PGT-A has made possible SET, and is the standard of care at RMA, and increasingly utilized across the industry.

How much does IVF cost?

There is no standard answer to the question of cost since each patient’s treatment plan is tailored to their individual needs – some patients need 1 cycle of IVF to succeed and others need several cycles to succeed. In general, an IVF cycle – retrieval and transfer – at RMA costs approximately $14,750.

IVF and live birth weight

In a study analyzing nearly 20,000 births stemming from IVF treatment at RMA’s flagship center in Basking Ridge, New Jersey, from 2000 to 2017, researchers found a steady increase in birth weights over time that in 2017 reached parity with babies born without assisted reproduction. The gradual reduction in low birth weight risk has coincided with major breakthroughs in fertility medicine over the last two decades.

Of all the babies born to mothers that received IVF in 2017, only 10.7% were born with a low birth weight (less than 2,500 grams), RMA found, compared with 8.3% of babies conceived naturally, according to the Centers for Disease Control and Prevention (CDC).

Babies born through IVF in 2000, on the other hand, when the fertility industry was still in its infancy and multiples were routine, had a 36.5% chance of being born with low birth weight.

The decrease in risk comes as the industry, led largely by research conducted at RMA, practices an entirely new standard of care than it did even ten years ago. That standard of care, based on Single Embryo Transfer (SET), allows doctors to dramatically reduce multiple gestation pregnancy and increase the chances of implantation, full-term pregnancy and delivery of one healthy baby.

At RMA, 97% of all embryo transfers involve one embryo, and the practice’s twin rate is only 2.5%, on par with the national, naturally-conceived twin rate of 2.4%, according to the CDC. RMA’s very low birth weight risk for IVF babies, 2.1%, also mirrors the national risk of 1.4% for babies conceived naturally.

How to choose an IVF practice?

Choosing an IVF practice is an important decision, and there are several factors one should consider when making a choice.

First, it’s important to choose a practice with high success rates, because this will give an indication of your chances of success at the practice. Success rates for most clinics can be found at the Society for Assisted Reproductive Technology (SART), the industry group for IVF in the U.S.

Second, it’s important to choose a clinic with a good embryology laboratory, as this is directly tied to success rates.

It’s also important to choose a clinic that practices SET and FET.

On top of that, clinics that engage in their own fertility research, like RMA, tend to practice evidence-based care and be up to date on the latest advancements in the field.

Finally, choosing a clinic with staff who offer personalized care is vital.