Planning to start or even enlarge a family is usually an exciting time for most couples, and when things don’t go as planned many couples now look to science to help make baby.
That usually means turning to a fertility specialist—typically, a reproductive endocrinologist. Most couples begin with fertility testing, which usually involves blood tests and perhaps ultrasound for gals, and for guys, a sperm analysis, to help your baby-making.
If you’ve tried other ways to get pregnant and are considering in-vitro fertilization (IVF), here’s how to make your way through this increasingly more successful, if costly, way to conceive.
Understanding IVF
In-vitro fertilization is a process in which a specialist joins a woman’s egg with her partner’s sperm in the lab with the hopes of creating an embryo that can be returned to her uterus to grow into a baby. IVF has been available since 1978, and it’s one of several types of assisted reproductive technology (ART), all of which involve the enhancement of fertility through the use of medication and/or procedures designed to allow couples to achieve pregnancy.
Infertility can affect a woman, her male partner, or both. Common causes of infertility for women include blocked fallopian tubes or being older, and for guys, poor sperm quality or a low count. There are also unknown reasons for infertility. Usually, couples choose IVF after trying other forms of treatments without success.
IVF Process
A typical IVF cycle usually goes like this:
Ovarian stimulation: In this case, the egg comes first, and you’ll need to give yourself injections to increase your egg production.
Egg retrieval: As those eggs mature (which is determined through a combination of ultrasounds and blood tests—no egg basket needed), you undergo minor surgery to retrieve your eggs from the ovaries.
Insemination and fertilization: Your partner’s washed, spun and optimized sperm are placed with your eggs in a lab petri dish, hopefully allowing the eggs to be fertilized.
Embryo growth: Eggs that get fertilized are then watched as they grow into embryos over 3-5 days.
Embryo transfer: Sometime between days 3 and 5, one or two of the most vigorous eggs are placed back into your uterus via a small, flexible tube. This all happens at your specialists’ office.
Wait for nature to take over: You continue injections while you wait to learn if an embryo has indeed implanted into the wall of your uterus and is now busy getting bigger every day.
Embryo storage: You may have additional embryos that developed during this cycle but weren’t implanted; discuss ahead of time if you want those frozen for future use.
IVF Variations
There are a few different ways your healthcare provider may choose to modify this process based on your particular fertility factors.
Intracytoplasmic sperm injection (ICSI): This process takes the chance out of fertilization and involves injecting the sperm through the outer layer of the egg in the lab to assist in fertilization. Some fertility clinics routinely do this, others assist when the chances of fertilization are quite low, such as with poor sperm quality.
Pre-implantation genetic diagnosis (PGD): This is particularly useful for couples who have a higher-than-normal chance of passing along a serious inheritable disorder. This allows for only those screened embryos not carrying the genes for the disorder to be implanted.
Donor eggs or sperm: IVF can occur via donor eggs, donor sperm, donor embryos, or frozen embryos if either egg or sperm quality or availability are a factor for you or your partner.
Success Rates
Successful implantation of a transferred embryo(s) into the womb results in pregnancy.
Experts describe success both by looking at the total number of pregnancies achieved and by counting the total number of live births resulting from IVF. You’ll typically see both numbers reported as a clinic’s success rates.
Look at both numbers when considering a clinic’s outcomes, but typically nationally averaged IVF outcomes are as follows (these numbers assume fresh embryos—not frozen—from the woman carrying the pregnancy—the mother):
| Woman’s age | % of successful pregnancies… | Leading to % of live births |
| 34 or younger | 47.7% | 41.7% |
| 35-37 | 38.8% | 31.9% |
| 38-40 | 29.9% | 22.1% |
| 41-42 | 20.1% | 12.5% |
Society for Assisted Reproductive Technology: SART.org
Critical Questions
IVF can be demanding physically, emotionally, and financially. Some components of IVF still remain controversial. This is a time for serious “soul-searching” to determine if IVF is the best option for you and your partner. Gather information, ask questions and then decide. To get started, discuss the following with your partner.
- How “far” do we want to go; Financially? Emotionally? Physically?
- Are we able to consider the idea of multiple births? Twins? Triplets? More?
- What do we do if this doesn’t work?
- What do we do with any remaining frozen embryos?
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