Everything You Need To Know About In Vitro Fertilization

September 26, 2024

The options available to couples who desire to have children but cannot naturally conceive are far greater than they once were. It is becoming more common for couples to turn to in vitro fertilization (IVF) to expand their families. IVF is a modern infertility treatment that is considered to be a safe and effective option for many couples, albeit slightly cost prohibitive. Couples who are exploring IVF as an option should consider the following costs, success rates, and methods to decide if it is truly right for their family.

What Is IVF And How Does It Work?

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In vitro fertilization is a fertility treatment that manually combines a woman’s own (or donated) eggs and sperm in a laboratory culture dish. Once an embryo emerges, it is transferred into the uterus, whether your own or a gestational carrier. IVF is a common option for women who have damaged fallopian tubes or have had their fallopian tubes removed.

For women who have been suffering from endometriosis or if sperm are unable to survive in their cervical mucus, they are usually considered good candidates for IVF. For men who have decreased sperm count or poor sperm quality, IVF is usually recommended to them. A typical IVF cycle takes between four to six weeks to complete. Since 1978, thousands of IVF babies have been born, with that number rising every year.

Prescription Medications Involved In IVF

The in vitro fertilization process typically comprises of five stages for most couples. The first stage involves fertility medications. Women are prescribed medications to stimulate egg production. These self-administered injections contain gonadotrophin-releasing hormone (GnRH), also known as the folic stimulating hormone (FSH) are given daily. In some cases, a luteinizing hormone is also given. These drugs stimulate the ovaries to release more eggs than usual. Many eggs are necessary for the IVF process since not all will fully develop or fertilize after retrieval. During this stage, ultrasounds are done to check the ovaries and blood tests are done to check hormone levels. A third round of GnRH medications is injected to suppress ovulation. Female patients or their partners help to administer these injections for approximately 10 days.

The Egg Retrieval

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Inside the ovaries are follicles, which is where the eggs develop in fluid-filled structures. Each follicle contains one microscopic egg, which can be seen and measured by an ultrasound. The eggs loosely attach to the follicle walls. Once the eggs are fully developed, female patients are injected with a hormone called human chorionic gonadotropin (hCG), which prepares the eggs for final maturation and surgical retrieval.

During the second stage, the eggs are retrieved about 36 hours after the hCG injection. Through ultrasound imaging, the technician inserts a hollow needle into the pelvic cavity to retrieve eggs from the ovary. This procedure typically takes five to ten minutes with patients given anesthesia and undergo sedation to manage any pain and discomfort.

The Sperm Preparation

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It is during the third stage, that the male partner is requested to provide a sperm sample. Typically, sperm is provided the same morning as egg retrieval. Occasionally, the sperm is collected in advance and frozen until needed. When providing sperm the day of, it is best to abstain from sexual intercourse for at least two days prior to the IVF procedure, but no longer than 6 days for optimal sperm quality. If the sperm are deemed normal, sperm capacitation takes place, where technology is used to give sperm the ability to fertilize an egg outside of the woman’s body. If there are issues with the sperm, steps are taken to help inject the sperm into the egg using technology known as intracytoplasmic sperm injection or ICSI micromanipulation.

Insemination

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At this stage, the egg and sperm are joined for insemination. The andrologist will first rinse the semen sample with a solution to remove dead sperm and debris while protecting the living sperm. Now the prepared sperm can be used to inseminate the eggs. A small sample of the sperm is dropped into a culture containing the eggs. If a sperm is having trouble with fertilizing the egg on its own, it is directly injected into the egg via ICSI. At this point, there is a waiting period of two to five days for the eggs to be closely monitored and determine if cell division takes place. The embryos that are growing and shown to be viable are the ones chosen to be transferred into the uterus.

Embryo Transfer

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The fifth and final stage is where the embryo or embryos are placed into the woman’s uterus. This procedure is done via catheter, which is inserted into the cervix and uterus guided by an ultrasound. Women may experience cramping, and are advised to rest for at least an hour after the procedure. Once discharged and feeling well enough, women can get back to their daily routines. If the procedure is successful, the embryo will typically implant approximately six to 10 days after the eggs were initially retrieved. A pregnancy test to indicate if the IVF round was successful can be taken 17 to 18 days after egg retrieval. Vaginal progesterone supplements will be prescribed for women to take after egg retrieval leading up to the pregnancy test.

What Are The Side Effects Associated With IVF?

Following the procedure, women may have some spotting. Many women also experience bloating due to enlarged ovaries. There may also be some breast tenderness and constipation. If women experiences pelvic pain, heavy bleeding, blood in the urine or fever, it is important to notify your doctor right away. As is the case with most medical procedures, IVF has its risks. A risk of taking fertility medications is headaches, mood swings, hot flashes, abdominal pain and ovarian hyperstimulation syndrome (OHSS). Symptoms to watch for include nausea, bloating, vomiting, decreased urination, shortness of breath and severe stomach pain. The risks of multiple pregnancies is also much higher when undergoing IVF. Those considering undergoing IVF should also note that there are also risks to the baby such as low birth weight and premature delivery.

How Much Does IVF Cost?

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The cost of one cycle of IVF averages around $10,000 with prescription drugs taking up a major part of that cost. Most insurance plans do not provide coverage for IVF making this personal expense a very costly one for many people’s budgets. IVF success rates vary widely depending on factors such as age and lifestyle, but in general, most couples often need to budget for more than one round to increase chances of success. In the UK, couples are counseled to plan for three rounds of IVF to increase their chance of pregnancy. Ensure that you get the advice of doctors and details about the fertility clinic you are considering, including all costs before you make the decision of whether IVF is right for your family.

IVF Success Factors

The success rate of IVF is dependent on factors such as maternal age, the lifestyle of both partners, weight, reproductive history and the cause of infertility. Previous attempts at getting pregnant and miscarriages will also influence a woman’s chances of IVF success. While many women may be able to get pregnant naturally, there may be issues with carrying a healthy baby to full-term, which IVF can sometimes help to overcome. Choosing the right fertility clinic for you and your partner is also a factor in IVF success as each clinic has varying success rates. These factors can help determine not only if a couple can get pregnant, but their chances of carrying and delivering a full term healthy baby. The following are a few of the attributing factors of IVF success.

Age

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Age may be one of the most important factors in determining fertility and potential success with IVF. Women are born with all of her eggs, and as she ages so do her eggs, diminishing in both quantity and quality. Around the age of 32, a woman’s chances of conceiving begin to significantly decline. The male partner’s age can also affect conception, risk of miscarriage and baby’s health. It is possible to check both the quality of eggs and sperm. Some women have eggs found to be younger in age than their biological age. For others, their eggs can appear older in quality than their actual age. A blood test called Follicle Stimulating Hormone (FSH) can determine the quality of a woman’s eggs and what their chances of fertilization are.

Previous Pregnancies

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If a woman and her partner have had a successful pregnancy in the past, then this increases the chances of IVF being successful. Since her eggs and his sperm have intermingled with success before, then they have already been shown to be compatible. If a couple has a history of recurrent miscarriage, then this may be an indication of lowered success with IVF. Recurrent miscarriage is characterized by the loss of two or more pregnancies. For approximately half of these miscarriages, the cause is unknown. The most known causes of miscarriages are chromosomal abnormalities in either parents, advanced maternal age, hormone issues, medical conditions such as Celiac disease, Lupus, or thyroid problems. Family history could also influence issues with reproduction. See your doctor to get tested for the underlying causes of recurrent miscarriage.

Smoking And Alcohol Use

When either partner smokes, the chances of IVF success decline. Women who smoke may need a higher dosage of fertility drugs to stimulate their ovaries. Smokers, in general, have lower implantation rates than non-smokers. People who smoke often require twice as many IVF attempts. Alcohol can also impair fertility, but the exact impact is unknown. In a study of more than 2500 couples undergoing IVF, the researchers found that couples who drank four or more drinks a week just prior to undergoing fertility treatments, they had a 48% higher risk of failed fertilization and a 21% lowered chance of a live birth. While most couples undergoing IVF abstain from alcohol during the cycle, it may be important to limit it before starting IVF as well.

Weight Issues

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Being overweight or underweight can contribute to a decrease in IVF success. Both under and overweight women have an increased risk of miscarriage, as well as having irregular or absent periods. Being obese can cause the body to overproduce estrogen making it more difficult to become pregnant. Maintaining a healthy weight can help with issues such as high blood pressure, which could impede the flow of blood to the uterus and testes. Statistically, women who are overweight have less success with IVF than women of normal weight. This applies to women who are underweight as well, whose estrogen levels are often too low for successful pregnancies. Maintaining a healthy weight, whether it is to lose or gain a few pounds can greatly

Fertility Treatment Options

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Before deciding on whether IVF is the best option for you, it is important to get yourself and your partner assessed. It may be a matter of making simple lifestyle changes, or if a medical exam determines more serious issues such as polycystic ovarian syndrome, then it would be important to address treatment right away. There is also the option of trying fertility drugs before undergoing the full IVF process. Fertility medications such as clomiphene and gonadotropin can stimulate egg production and can be prescribed to women who might be having irregular periods.

Laparoscopy and laparotomy surgeries can be performed to remove scar tissue or other abnormalities if they may be impeding the ability to get pregnant. If the above options have been exhausted, then doctors may recommend IVF. If there are health issues for the female or male partner, then a donor egg, sperm donor or surrogate pregnancy can be an option. Just ensure that whatever choices are being considered, they are all done under the care of an experienced team of fertility specialists and doctors.

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