In Vitro Fertilization IVF
OverviewIn vitro fertilization (IVF) is a sophisticated series of procedures used to treat fertility or genetic problems and assist with the conception of a child. IVF is the most effective form of assisted reproductive technology. During IVF, mature eggs are collected (retrieved) from your ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in your uterus. This process requires preparation and usually takes at least 8-11 days. The procedure can be done using your own eggs and your partner's sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — a woman who has an embryo implanted in her uterus — might be used. While, in general, chances of success with IVF are excellent, your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. There are additional factors that must be considered including time, cost and the need for significant intervention. If more than one embryo is implanted in your uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy). Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.
Why it's doneIn vitro fertilization (IVF) is a treatment for infertility, significant genetic problems, and patients with recurrent pregnancy loss. While IVF is often not the first-line treatment for most patients, it is always the most effective treatment. Many patients will arrive at this choice after trying other treatments such as controlled ovarian hyperstimulation or and/or intrauterine insemination. There are numerous reasons why IVF is used for patients. Age is often the single greatest factor, especially in women with diminished ovarian reserve, where chances become more limited. IVF can also be done if you have certain health conditions:
Tubal FactorFallopian tube damage or blockage, whether because of infection, surgery or previous tubal ligation, makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
Ovulation disordersIf ovulation is infrequent or absent, fewer eggs are available for fertilization.
Diminished ovarian reservePremature ovarian failure is the loss of normal ovarian function before age 35. If your ovaries fail, they don't produce normal amounts of the hormone estrogen or have eggs to release regularly.
EndometriosisEndometriosis occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
Uterine fibroidsFibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg and increase the risk of miscarriage.
Male FactorBelow-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.
Unexplained infertilityUnexplained infertility means no cause of infertility has been found despite evaluation for common causes. IVF is universally accepted as the most effective treatment for unexplained infertility.
Genetic AnomaliesIf you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic diagnosis — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems. Embryos that don't contain identified problems can be transferred to the uterus.
Fertility preservation for age, cancer or other health conditionsIf you're about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use. Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF, to allow for another woman to carry the pregnancy as a surrogate or gestational carrier
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How you prepareWhen choosing an in vitro fertilization (IVF) clinic, keep in mind that a clinic's success rate depends on many factors, such as patients' ages and medical issues, as well as the clinic's treatment population and treatment approaches. Ask for detailed information about the costs associated with each step of the procedure. Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various tests and investigations. These are the same tests we use to evaluate all fertility patients. To explore these tests click here. (hyperlink this to the list of tests that we’ve already outlined in the evaluation page) Before beginning a cycle of IVF, consider important questions, including:
How many embryos will be transferred?The number of embryos transferred is typically based on the age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs. Most doctors follow specific guidelines to prevent a higher order multiple pregnancy — triplets or more — and in some countries, legislation limits the number of embryos that can be transferred at once. Make sure you and your doctor agree on the number of embryos that will be transferred before the transfer procedure.
What will you do with any extra embryos?Extra embryos can be frozen and stored for future use for many years. Not all embryos will survive the freezing and thawing process, although most will. Cryopreservation can make future cycles of IVF less expensive and less invasive.
How will you handle a multiple pregnancy?If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. This is critical when dealing with more than 3 fetuses simultaneously. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences. Have you considered the potential complications associated with using donor eggs, sperm or embryos or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You also may need an attorney to file court papers to help you become legal parents of an implanted embryo.
What you can expect IVF processIn vitro fertilization Illustration of egg retrieval Egg retrieval technique Intracytoplasmic sperm injection (ICSI) ICSI Illustration of a blastocyst Blastocyst
In vitro fertilization (IVF) involves several steps— ovulation induction, egg retrieval, sperm retrieval, fertilization and embryo transfer. One cycle of IVF can take about two weeks, and more than one cycle may be required.
Specific steps of an in vitro fertilization (IVF) cycle carry risks, including:
- Ovarian hyperstimulation syndrome
- Ectopic pregnancy
- Multiple births
- Birth defects
Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful. Signs and symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more-severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath. We use the most advanced techniques to essentially eliminate severe ovarian hyperstimulation syndrome.
About 2 to 5 percent of women who use IVF will have an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can't survive outside the uterus, and there's no way to continue the pregnancy.
Use of IVF can be financially, physically and emotionally draining. Support from counselors, family and friends can help you and your partner through the ups and downs of infertility treatment.
Pain: Despite what you may hear, the procedure itself is essentially painless as we use adequate anaesthesia to keep you comfortable. However, depending on the number of eggs retrieved, there can be mild and occasionally moderate discomfort after the procedure lasting one or two days.
Injury at the time of IVF is extremely rare. We are pleased to report we have never had an injury in our program. We use every available safety precaution to avoid any chance of harm to patients.
IVF increases the risk of multiple births if more than one embryo is implanted in your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does. Premature delivery and low birth weight. Research suggests that use of IVF slightly increases the risk that a baby will be born early or with a low birth weight.
The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived. More research is needed to determine whether babies conceived using IVF might be at increased risk of certain birth defects. Some experts believe that the use of IVF does not increase the risk of having a baby with birth defects.
Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of cancer, more recent studies do not support these findings.