In vitro fertilization (IVF)

In vitro fertilization (IVF) is the process in which oocytes (eggs) are retrieved from the body and combined with sperm in the Embryology Lab to form embryos. These embryos are then transferred into the uterus in hopes of achieving pregnancy.

IVF includes the following steps:

• Hyperstimulating the ovaries: The ovaries are stimulated with hormones to produce multiple eggs. This is done by using fertility medications injected as shots in the abdomen.
• Egg retrieval: The eggs are retrieved from the ovaries through a needle inserted into the vagina. This is done under anesthesia and is overall low risk.
• Fertilization: The eggs are fertilized with sperm in a laboratory dish. This is routinely done by injecting a single sperm into each mature egg (intrasytoplasmic sperm injection - ICSI).
• Embryo transfer: The embryo(s) is/are transferred to the uterus using a thin catheter inserted through the cervix. This is usually done about 5 days after egg retrieval or in a subsequent cycle as a frozen embryo transfer.
• Pregnancy testing: We plan a blood test for hCG (pregnancy hormone) 11-13 days after embryo transfer.

The indications for IVF may include:

• Fallopian Tube Blockage or Damage: IVF is often recommended when one or both fallopian tubes are blocked or damaged. It allows fertilization to occur outside the fallopian tubes, overcoming this obstacle.
• Male Factor Infertility: IVF can be used when there are issues with sperm quality, low sperm count, or problems with sperm motility. Intracytoplasmic sperm injection (ICSI) is a specific IVF technique that can be used to address severe male factor infertility. In cases of azoospermia (no sperm), IVF with donor sperm may be an option.
• Unexplained Infertility: In cases where the cause of infertility remains unknown despite thorough evaluation, IVF may be considered as it can bypass any unidentified fertility issues.
• Endometriosis: Severe endometriosis can interfere with natural conception by causing pelvic scarring and inflammation. IVF can help bypass these obstacles and improve the chances of pregnancy. IVF is also helpful for embryo banking for those with endometriosis.
• Polycystic Ovary Syndrome (PCOS): Women with PCOS may have irregular ovulation or anovulation (lack of ovulation). IVF can be used if other treatment options have failed.
• Advanced Maternal Age: Women over the age of 35 may experience reduced fertility due to a decrease in the quantity and quality of their eggs. IVF can be used to improve pregnancy rates and to screen for abnormal embryos.
• Genetic Disorders: Couples with a risk of passing on genetic disorders to their offspring may opt for preimplantation genetic testing for monogenic disorders (PGT-M) as part of IVF to screen embryos for genetic abnormalities.
• Recurrent Pregnancy Loss: Couples who have experienced multiple miscarriages may opt for IVF with preimplantation genetic testing for aneuploidy (PGT-A) to select embryos with a higher likelihood of implantation and pregnancy and lower risk of miscarriage.
• Same-Sex Couples and Single Parents: IVF with the use of donor sperm or donor eggs allows same-sex couples and single individuals to have biological children.

While IVF is a safe procedure, there are some associated risks. These risks include:

• Ovarian hyperstimulation syndrome (OHSS): This is a rare but serious condition that can occur when the ovaries are overstimulated with hormones. Symptoms of OHSS include abdominal pain, difficulty breathing, nausea, vomiting, and weight gain.
• Ovarian torsion: Enlarged ovaries can twist on the ligament containing ovarian blood vessels. This is a rare complication but is a surgical emergency.
• Multiple pregnancy: IVF can increase the risk of having twins, triplets, or higher order multiples. Twin or multiples pregnancies are much higher risk for both the mother and the babies. The chance of twins/triplets has decreased significantly over the years as providers have moved to single embryo transfer.
• Surgical risks: While the egg retrieval surgery is very low risk, there is a <1% chance of bleeding, infection, or trauma to surrounding structures.

The specific indications for IVF can vary based on individual circumstances, medical history, and the recommendations of fertility specialists. IVF success rates depend on patient age, specific diagnosis, and the quality of the eggs and sperm. If you are considering IVF, schedule a consult with us to discuss your family building goals and determine the most appropriate treatment option.