All About IVF 

In Vitro Fertilization (IVF) has revolutionized fertility care, offering hope to millions of families struggling with infertility. Since it was created in the late 1970s, IVF has become one of the most common fertility treatments worldwide. However, understanding when IVF is recommended, success rates, and other details can be complicated. Dr. Paul Dudley, Reproductive Endocrinologist with Pinnacle Fertility Atlanta, helps shed light on the ins and outs of IVF.

What is IVF?

IVF is a medical procedure meant to help people achieve pregnancy when conception proves to be difficult or impossible. The process involves inseminating an egg then culturing the resulting embryo in a laboratory setting – hence the term “in vitro,” which means “in glass” in Latin.

When is IVF recommended?

IVF isn’t the first line of treatment for all infertility issues, but it is recommended in several scenarios: 

• Blocked or Damaged Fallopian Tubes: If the fallopian tubes are blocked or damaged it can be difficult for an egg to be fertilized by sperm or for an embryo to travel to the uterus. IVF provides a solution by bypassing the fallopian tubes entirely. 

• Male Infertility: In cases of low sperm count or poor sperm motility, IVF can be beneficial. Techniques like intracytoplasmic sperm injection (ICSI) — where a single sperm is injected directly into an egg — help improve the chances of fertilization during the IVF process. 

• Ovulation Disorders: Women with irregular ovulation or those who do not ovulate  can benefit from IVF, as it involves controlled stimulation of the ovaries to produce multiple eggs. 

• Uterine Fibroids: Fibroids are benign tumors within the wall of the uterus. They are commonly seen in women in their 30s and 40s and can interfere with the implantation of the fertilized egg in the uterus. IVF and targeted embryo transfer may bypass potential implantation issues. 

• Unexplained Infertility: For couples who have undergone fertility testing and treatments with no identified cause of infertility, IVF may be suggested as an effective treatment option. 

• Genetic Disorders: Couples with a history of genetic disorders may opt for IVF with preimplantation genetic testing (PGT). This allows embryos to be screened for genetic conditions before being transferred to the uterus. 

• Age-Related Infertility: Fertility significantly declines with age. IVF can be an effective treatment option for people attempting to conceive later in life. It allows for the selection of the best quality embryos through PGT, thereby increasing the chances of a healthy pregnancy. 

• Recurrent Pregnancy Loss (RPL): For couples who have experienced two or more consecutive miscarriages, IVF can help. It allows for comprehensive evaluation and treatment plans, including genetic testing of embryos, to increase the chances of a successful pregnancy. 

What is the IVF cycle process?

Ovarian Stimulation

IVF begins with ovarian stimulation. Your doctor will prescribe medications to coax your ovaries into recruiting multiple eggs that would have otherwise simply have been absorbed by your body. The goal of ovarian stimulation is to increase the number of mature eggs your body produces that month so that multiple eggs can be retrieved from your ovaries at the same time. Although there are exceptions, more eggs tend to translate into a higher success rate.  

IVF medications mimic hormones naturally produced by your body, just in higher quantities. Broadly termed gonadotropins, they include but are not limited to follicle stimulating hormone (FSH), luteinizing hormone (LH), and human chorionic gonadotropin (hCG) usually in the form of a self-administered injection. 

Egg Retrieval

The next step is egg retrieval. This procedure, also known as oocyte retrieval or follicle aspiration, is typically performed under sedation or anesthesia to minimize discomfort. 

Inside each of your ovaries, the eggs develop inside small fluid-filled, cyst-like structures called follicles. During the egg retrieval procedure, a doctor will insert a thin needle through the wall of the vagina and into each ovary to collect the follicular fluid containing the eggs. The entire process usually takes about 20-30 minutes and you can go home afterward. 

Fertilization

After the egg retrieval procedure, your eggs are transferred to the embryology laboratory for insemination. There are two main ways that eggs are fertilized in IVF: 

• Conventional Insemination: In this method, the retrieved eggs are placed in a culture dish along with a sample of sperm collected from the male partner or a donor. The sperm naturally fertilizes the eggs the same way they would inside of the body. 

• Intracytoplasmic Sperm Injection (ICSI): ICSI is a technique used when there are issues with sperm quality or quantity. In this procedure, a single sperm is selected under a microscope and injected directly into a mature egg using a needle. 

After fertilization, the resulting embryos are grown and monitored in the lab for about 6 days. 

Embryo Transfer or Cryopreservation

After 5-6 days, an embryo should grow to reach the blastocyst stage – a cluster of several hundred cells which are assigned an Embryo Grade.  Embryo Grade does not predict the person an embryo may become.  Rather, Embryo Grade is a means of ranking relative implantation potential.  Historically, embryos were then transferred into the uterus using a thin painless catheter – termed “Fresh Transfer”.  It is now more common for embryos to be frozen, tested via PGT, thawed and transferred in a subsequent frozen embryo transfer cycle.  Unused embryos can remain frozen for future use, donated, or discarded. 

Pregnancy Test 

Approximately two weeks after embryo transfer, a pregnancy test is conducted at your clinic to determine whether the procedure was successful. 

How successful is IVF?

IVF success rates can vary widely depending on factors such as the woman’s age, the cause of infertility, the quality of the embryos, and a clinic’s expertise. On average, the success rates for IVF ranges from 30% to 60% per cycle, with higher success rates observed in younger women and those using donor eggs. 

Advances in reproductive technology, such as genetic screening of embryos and improvements in embryo culture techniques, have greatly improved IVF success rates. Technologies like preimplantation genetic testing (PGT) can help select embryos with the best genetic potential, thereby increasing the chances of a successful pregnancy. 

It’s important to consider all factors when evaluating the potential for a successful outcome: 

• Age: Age is the most significant factor affecting IVF success. Patients under 35 years of age typically see higher success rates, with success rates gradually decreasing as age increases.  

• Previous Pregnancy: People who have previously conceived and carried a pregnancy to term generally have higher success rates with IVF compared to those who have never been pregnant. 

• Lifestyle Factors: Factors such as smoking, weight, and general health can influence the success of IVF treatments. Maintaining a healthy lifestyle can improve the chances of success. 

• Reproductive History: A patient’s reproductive history, such as previous miscarriages, can also affect IVF outcomes. 

It is important to have open and honest discussions with your fertility specialist to understand your specific circumstances and how they may impact your chances of success with IVF. 

Does IVF have side effects?

Although IVF has helped many people build their families, it can be a challenging journey for many couples. The process involves complex medical procedures and presents a range of emotional, physical, and financial challenges. 

Emotional Challenges

• Stress and Anxiety: The uncertainty of outcomes and the high stakes involved can lead to significant stress and anxiety. The emotional toll of possibly undergoing repeated cycles, dealing with failures, or coping with miscarriages can add to this stress. 

• Relationship Strain: IVF can put a strain on relationships, not just between partners, but also with family and friends. The intense focus on treatment and the potential for disappointments can impact personal interactions and emotional well-being. 

• Emotional Rollercoaster: The IVF process involves a cycle of hope and disappointment that can feel like an emotional rollercoaster—high hopes during treatment followed by anxiety during the waiting period and sometimes grief with unsuccessful attempts. 

• Impact on Mental Health: The pressures of undergoing IVF can lead to depression or exacerbate existing mental health conditions. The uncertainty and repetitive nature of the treatments can be mentally exhausting. 

• Social Isolation: Couples may feel isolated from friends or family who do not understand their struggles. Social interactions can become strained, especially when surrounded by peers who are having children naturally. 

Physical Challenges 

• Side Effects of Medication: IVF medications can cause side effects such as headaches, mood swings, abdominal pain, hot flashes, and in rare cases, ovarian hyperstimulation syndrome (OHSS).  Fortunately, protocols have improved over time with a focus on mitigating side effects while maintaining outcomes. 

• Procedural Risks: While generally safe, the procedures involved in IVF such as egg retrieval and embryo transfer carry risks such as infection, bleeding, and damage to surrounding organs.  Gratifyingly, complications such as these are rare. 

• Fatigue: The physical demands of treatment can lead to fatigue but it is typically manageable with a bit of planning ahead e.g. avoid demanding work commitments during your cycle.  

Financial Challenges 

• Direct Expenses: IVF is a significant expense particularly when treatments are not covered by insurance. Moreover, multiple cycles may be necessary to achieve a pregnancy. 

• Insurance Coverage: The level of insurance coverage for IVF varies widely depending on the policy and the region. Be certain to investigate coverage options with your Insurer or Human Resources Representative. 

Understanding and preparing for these challenges can help individuals and couples navigate the complex path of IVF more effectively, leading to better emotional and physical resilience throughout the process. 

Build your family with IVF

IVF has transformed the landscape of reproductive medicine, offering hope to millions of couples struggling with infertility. While IVF comes with its challenges, it remains a valuable option for individuals and couples seeking to build their families. 

If you are considering IVF, it’s important to consult with a fertility specialist. They can provide personalized advice based on your specific health needs and fertility goals. Remember, every person’s fertility journey is unique; what works for one may not work for another. Fortunately, the basics are most impactful – get an adequate amount of sleep, find a healthy outlet for stress, abstain from alcohol/tobacco/drugs, exercise consistently, and eat a balanced diet of self-prepared foods.  Being well-informed and supported is key to navigating this complex process.