In-vitro fertilization treatment is a method where eggs are fertilized with sperm outside the body, typically in a laboratory setting at a gynecology hospital. This technique is employed by individuals or couples facing difficulties in achieving pregnancy through natural means. IVF comprises several intricate steps and is recognized as an effective form of assisted reproductive technology.
What is In-Vitro Fertilization (IVF)?
In vitro fertilization (IVF) is a form of assisted reproductive technology (ART) in which sperm and an egg are fertilized outside the human body. This intricate process involves retrieving eggs from the ovaries and combining them with sperm in a laboratory to facilitate fertilization. After several days of development, the fertilized egg, now referred to as an embryo, is implanted into the uterus. Pregnancy occurs when this embryo successfully attaches itself to the uterine wall.
How is IVF Performed?
In-vitro fertilization treatment involves the fertilization of mature eggs extracted from a woman’s ovaries in a laboratory setting. Sperm, obtained through natural means or auxiliary techniques like micro TESE, is used to fertilize the egg cells. Following fertilization, one or two high-quality embryos are selected and transferred to the uterus of the prospective mother.
How does IVF Happen?
In in-vitro fertilization treatment, eggs retrieved from the prospective mother are fertilized in a laboratory setting with sperm from the prospective father. Subsequently, one or two embryos of the highest quality resulting from this process are chosen and then transferred to the uterus of the prospective mother using a thin catheter.
Stages of In-Vitro Fertilization Treatment
In-vitro fertilization treatment involves the following steps:
1. Birth control pills or estrogen
Before commencing IVF treatment, your healthcare provider might prescribe birth control pills or estrogen. This serves to halt the development of ovarian cysts and regulate the timing of your menstrual cycle. The objective is to enable your healthcare provider to manage your treatment more effectively and enhance the number of mature eggs during the egg retrieval procedure. Depending on individual cases, some individuals may receive combination birth control pills (containing estrogen and progesterone), while others may be prescribed estrogen alone.
2. Ovarian stimulation
During each natural cycle in a healthy individual of reproductive age, a group of eggs begins to mature each month. Typically, only one egg becomes mature enough to ovulate, and the remaining immature eggs in that group disintegrate.
In an IVF cycle, injectable hormone medications are administered to encourage the entire group of eggs from that cycle to mature simultaneously and fully. This means that instead of having just one mature egg, as in a natural cycle, you may have many mature eggs available for retrieval. The type, dosage, and frequency of medications prescribed are tailored to each individual based on their medical history, age, AMH (anti-mullerian hormone) level, and response to ovarian stimulation in previous IVF cycles.
3. Egg retrieval
During egg retrieval in IVF, a needle is guided into your ovaries via ultrasound, connected to a suction device to collect eggs. Extracted eggs are placed in a special solution and incubated. Mild sedation is used for comfort, and the procedure occurs 36 hours after the “trigger shot.”
4. Fertilization
The day after egg retrieval, the embryologist attempts fertilization using ICSI, injecting sperm into mature eggs. Around 70% of mature eggs typically fertilize. If it succeed, the fertilized egg becomes an embryo. Excess eggs or if not all need fertilization, some may be frozen before fertilization for future use.
5. Embryo development
Over the next five to six days, the development of embryos is closely monitored. About 50% of fertilized embryos progress to the blastocyst stage, considered suitable for transfer to the uterus. For instance, if seven eggs were fertilized, three or four might develop to the blastocyst stage. The remaining 50% that don’t progress are usually discarded. Suitable embryos are frozen on day five or six for future transfers.
6. Embryo transfer
Embryo transfers are 2 types: Fresh and frozen. In a fresh embryo transfer, the embryo is inserted into the uterus three to seven days after the egg retrieval procedure. It’s a “fresh” embryo that hasn’t been frozen. In a frozen embryo transfer, previously frozen embryos (from a past IVF cycle or donor eggs) are thawed and inserted into the uterus. This method is more common for logistical reasons and is often more likely to result in a live birth. Frozen embryo transfers can be done years after egg retrieval. The preparation process for a frozen embryo transfer involves taking hormones to prepare the uterus, with monitoring appointments and a scheduled transfer procedure when the uterus is ready. The process is similar for fresh embryos, but the transfer occurs within three to five days of retrieval.
7. Pregnancy
Pregnancy occurs when the embryo implants into the lining of the uterus. A blood test, performed approximately nine to 14 days after embryo transfer, is used to determine if you’re pregnant. If donor eggs are used, the same process is followed, with the donor completing ovarian stimulation and egg retrieval. After fertilization, the embryo is transferred to the intended pregnancy carrier, with or without fertility medications. It’s crucial to consult with your healthcare provider to thoroughly understand the in-vitro fertilization treatment process and expectations.
Risks of In-Vitro Fertilization Treatment
In-vitro fertilization treatment comes with several associated risks, including:
- Multiple Births: A higher risk of multiple babies, leading to a higher likelihood of premature labor.
- Premature Delivery: There is a slightly increased risk of the baby being born early or at a lower birth weight.
- Miscarriage: The rate of miscarriage is comparable to pregnancies from natural conception.
- Ectopic Pregnancy: A condition where the fertilized egg implants outside of the uterus.
- Complications during Egg Retrieval: Possible complications include bleeding, infection, and damage to the bladder, bowel, or reproductive organs during the egg retrieval process.
- Ovarian Hyperstimulation Syndrome (OHSS): A rare condition causing symptoms such as abdominal pain, nausea, vomiting, diarrhea, rapid weight gain, bloating, shortness of breath, and inability to urinate.
It’s essential to discuss these risks with your healthcare provider and make informed decisions based on your individual circumstances.
Difference Between Intrauterine Insemination and IVF
Intrauterine insemination (IUI) differs from in vitro fertilization (IVF) as fertilization occurs inside a person’s body. In IUI, a sperm sample is collected, processed to retain high-quality sperm, and then inserted into the uterus during ovulation using a catheter. This aims to facilitate the sperm’s journey to the egg for fertilization.
In contrast, in-vitro fertilization treatment involves fertilizing the egg with sperm outside the uterus in a laboratory, and then placing the resulting embryo into the uterus.
IUI is generally less costly and invasive than IVF, but it tends to have a lower success rate per cycle.
How Many Times Can In-Vitro Fertilization Treatment Be Tried?
Many treatment centers recommend allowing one complete menstrual cycle between IVF cycles. The duration of a menstrual cycle varies, but typically, there is a suggested waiting period of four to six weeks after receiving a negative test result before starting another in-vitro fertilization treatment. This break between cycles is often recommended for health, financial, and emotional considerations.
What Medications are Used for IVF?
During in-vitro fertilization treatment, various medications are utilized, administered in different forms depending on your treatment plan. In the ovarian stimulation phase, injectable hormones are commonly used, including:
- Follicle Stimulating Hormone (FSH): These hormones stimulate the ovaries to produce eggs. You may receive one or a combination of FSH hormones for approximately 9 to 14 days.
- Human Chorionic Gonadotropin (hCG): Given as a final shot to trigger egg maturation and initiate ovulation.
- Leuprolide Acetate: A type of Gonadotropin-Releasing Hormone (GnRH) agonist, administered as an injection. It helps control the stimulation process or can be used as a trigger shot.
Your healthcare provider will determine the specific dosage and timing based on your individualized treatment plan.
How Effective is IVF in Getting Pregnant?
Age significantly influences the success of in-vitro fertilization treatment. The chance of pregnancy through IVF is higher for individuals under 35, and success rates decline with age. The live birth rate is closely linked to age, with examples such as:
For those under 35 using their own eggs, the live birth rate is around 46%.
A 38-year-old using their own eggs has a live birth rate of about 22%.
Understanding these age-related variations is crucial when considering IVF, and discussions with your healthcare provider can provide more personalized insights.
What is The Success Rate of IVF by Age?
In 2019, the average percentage of live births per egg retrieval varied based on age:
- Younger than 35: 46.7%
- Ages 35 to 37: 34.2%
- Ages 38 to 40: 21.6%
- Ages 41 to 42: 10.6%
- Ages 43 and up: 3.2%
These percentages reflect the success rates of in-vitro fertilization treatment in different age groups.
