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Family Fertility Center

 In Vitro Fertilization (IVF)

Using assisted reproductive technology (ART) to achieve a successful pregnancy

IVF is a multi-step procedure used to join an egg and sperm outside a woman’s body. When an egg is fertilized, it divides and is called an embryo. The embryo can then be implanted in the woman’s uterus. This form of assisted reproductive technology (ART) can be performed with eggs and sperm from a woman and her partner, or from a donor(s).

IVF requires five steps:

  1. Ovarian stimulation: Medications will be prescribed to stimulate the woman’s ovaries to produce multiple eggs. Medications may also be prescribed to promote maturation of the eggs, prevent early ovulation and prepare the uterine lining for implantation. During this time, vaginal ultrasounds and blood tests will be used to monitor egg development and the body’s response to the medications. This process takes 1 to 2 weeks.
  2. Egg retrieval: Eggs are removed from structures called follicles in the ovaries. The follicles are located via ultrasound. A thin needle is then inserted into a follicle and eggs are suctioned through the needle. Mature eggs are incubated in culture media, a fluid that contain nutrients to help the eggs maintain their viability.
  3. Sperm retrieval: If a partner’s sperm are to be used for IVF, a semen sample will be collected on the same day as egg retrieval. The sperm are then isolated from the semen sample. Alternatively, a procedure can be performed to remove sperm directly from the testicles with a needle. Donor sperm can also be used.
  4. Fertilization: Two methods are available for fertilizing the eggs: The sperm and eggs may be incubated together and the sperm will eventually enter the eggs, or a technique called intracytoplasmic sperm injection (ICSI), in which the sperm is injected directly into the eggs, may be performed.
  5. Embryo development and transfer: Once eggs are fertilized, they begin to divide and are called embryos. About 5 to 7 days after the embryos have developed, they can be genetically tested to identify those with a normal number of chromosomes. This enables the selection of a single healthy embryo with the greatest potential for pregnancy to be transferred via a catheter to the woman’s uterus, maximizing pregnancy rates while minimizing multiple births and the associated risks. This process is known as elective single embryo transfer, or eSET. The biopsied embryos are frozen (cryopreserved) while awaiting genetic testing. Additional healthy embryos identified can be stored for future transfer. Pregnancy results when an embryo implants in the lining of the uterus. The transfer of more than one embryo can potentially result in multiple births.

Reasons for pursuing IVF

IVF may be considered when a woman has been unable to become pregnant with the aid of other less costly and more conservative methods, or for cases involving:

  • A desire for genetic testing of embryos before implantation
  • Blocked, damaged or missing fallopian tubes
  • History of a genetic disorder that’s preventing pregnancy or causing recurrent pregnancy loss
  • Endometriosis
  • Male infertility
  • Malformed uterus
  • Reduced capacity of ovaries to provide viable eggs
  • Scar tissue that causes pelvic organs to adhere to each other
  • Unexplained infertility

Risks and side effects

Like many fertility treatments, IVF has some potential risks and side effects to consider:

  • Multiple gestation. IVF increases the likelihood of becoming pregnant with multiples. It also increases the chances of premature delivery and low birth weight, even in pregnancies that don’t involve multiples.
  • Medication side effects. Possible side effects of fertility medications include headaches, mood swings, abdominal pain and bloating.
  • Ovarian stimulation syndrome. In rare cases, the ovaries may become swollen and cause pain and bloating, a condition known as ovarian hyperstimulation syndrome. Additional symptoms may include nausea, vomiting, rapid weight gain due to the accumulation of fluid, shortness of breath and decreased urine output. Rest may be all that’s required to resolve symptoms of ovarian hyperstimulation. In severe cases, drainage of excess fluid and hospitalization may be necessary.
  • Surgical risks. Risks associated with the egg retrieval procedure include anesthesia-related risks, bleeding, infection and injury to organs in close proximity to the ovaries.
  • Embryo transfer side effects. Common side effects include bloating, cramping, tender breasts, constipation and secretion of a small amount of fluid from the vagina.

 

Reproductive psychiatry

IVF can be a long, stressful process with many steps. IVF is also expensive, with no guarantee of success. Although most people cope well, before undergoing IVF, it’s critical to understand the decisions that may need to be made along the way and if a spouse or partner is involved, to discuss how you’ll address them.

The Family Fertility Center offers support through reproductive psychiatry at The Women’s Place, one of only a handful of programs in the United States dedicated to the care and treatment of women’s reproductive mental health.