In vitro fertilization (IVF): Process, preparation, procedure, Risk and cost

In vitro fertilization is a conception procedure done in the laboratory set up to treat some forms of infertility in women. The conception process is done outside the mother’s womb and then the embryo is planted to the woman’s uterus for development purposes.

The procedure was first successful in 1978 at England. Its first baby was Louise Brown, known as the first test tube baby. In vitro fertilization was later introduced in the USA in 1981.

Success rate for IVF varies from one woman to another. According to What to Expect, young women who are under the age of 35 years have higher success rates of about 53.9 percent than old women above the age of 41 years which range between 3.9-12.6 percent.

In vitro fertilization process.

Female eggs are extracted from the woman (the donor, or the wife of the infertile male) and the sperm sample is retrieved from the male counterpart (might be the husband of the infertile woman or an anonymous fertile donor).

Both the eggs and the sperms acquired are them manually combined in the laboratory for conception process.

Preparations for In Vitro Fertilization procedure.

When choosing an in vitro fertilization (IVF) clinic/ specialist, keep in mind that a clinic’s success rate depends on the number of patients the institution has handled and the number of successful procedures done.

Look at the details of the costs associated with each step of the procedure of every given specialist. Before beginning a IVF procedure, you and your partner need to do various screenings, which includes:

• Testing of the ovarian reserve: your doctor will test the levels of follicle-stimulating hormone, estrogen and antimullerian hormone in your blood in order to determine the quantity and quality of your eggs,
• Semen analysis: your male counterpart’s semen will be analyzed.
• Infectious disease screening: both of you will be screened for infectious diseases, including HIV.
• A mock embryo transfer will be done: your doctor might decided to conduct a mock embryo transfer in order to determine the depth of your uterine cavity and come up with a suitable technique which is more likely to successfully place the embryos into your uterus.
• Examination of your uterine cavity: your doctor will examine your uterine cavity with the help of a sonohysterography (fluid is injected through the cervix into your uterus) and an ultrasound is done to create images of your uterine cavity.

Related: Here is the difference between in vivo and in vitro

In vitro fertilization procedure

It is famously known as the five step of In Vitro Fertility Process an infertile couple has to undergo in order to successful conceive.

Step 1: Fertility medication

As an infertile woman, you will be given fertility drugs (drugs which has follicle hormone) to stimulate egg production.

Since you doctor need many eggs because some will die during the process, a transvaginal ultrasounds is regularly done on your ovaries and blood test samples are taken on a regular basis to check hormone levels.

Step 2: Eggs and sperm retrieval

Step 2A: Eggs retrieval

You will receive a hormone injection a day before your eggs are scheduled to be retrieved from your body to help your eggs mature quickly.

To remove the egg, you are given medications to avoid discomforts during surgery. Your doctor carries a minor surgical procedure known as follicular aspiration.

Follicular aspiration; through your vagina, your doctor will uses an ultrasound to guide a thin needle, which has a devise that suctions the eggs out one at a time, into each of your ovaries.

Step 2B: Sperm collection

Your husband is allowed to sniff you in estrus in order to ejaculates (prior to ejaculation, the penis is massaged inside its sheath) so that the semen is collected.

The semen is then drawn into a pipette and put through a high-speed wash and spin cycle in order to find the healthiest ones

Step 3: Insemination and fertilization stage

This is the core of the in vitro fertilization process because it’s the time when sperms and eggs unit for conception

Sperms and eggs are mixed in a laboratory dish and stored together in an environmentally controlled chamber to encourage fertilization. It takes a few (4 to 6) hours for a sperm to fertilize an egg.

In cases of a lower fertility probability, a process known as intracytoplasmic sperm injection is done; the doctor injects the sperm directly into the egg.

Step 4: Embryo culture

When the fertilized egg divides, it becomes an embryo thus leave the insemination stage. This step is done in specific hospitals with specific screening equipments.

The embryo culture stage is meant for an infertile couple with specific fears of genetically transferred disorder, couple with high risk of passing a genetic (hereditary) disorder to a child.

Laboratory staff will regularly check the embryo to make sure it is growing properly. A normal embryo has several cells that are actively dividing within 5 days.

In this stage the couple will require pre-implantation genetic diagnosis (PGD). Laboratory scientists will remove a single cell from each embryo and screen the cell for specific genetic disorders.

The procedure is usually done about 3 to 4 days (within the 5 days of IVF) after fertilization, when the embryo is fully developed

According to the American Society for Reproductive Medicine, PGD helps the couple to decide which embryos to implant and decreases the chance of passing a disorder to a child.

Step 5: IVF transfer also known as the transfer of the embryo(s) into the uterus

Once your eggs are collect you’ll receive another medication to prep the lining of your uterus in order to receive the embryos that will be planted in your uterus.

About three to five days after fertilization (formation of the embryo), your doctor will plant the embryos in your uterus.

With the help of a catheter, multiple embryos are planted into your uterus in the hopes that at least one will implant itself in the lining of your uterus and begin to develop.

Due to the situation of many embryos more than one embryo ends up implanting at times, which is why multiples pregnancies are common in women who use In Vitro Fertilization method.

Step 6: Success in vitro fertilization confirmation

In this stage, a pregnancy test is carried out, after the IVF process, pregnancy test is done to confirm whether the procedure worked. Research has shown that of all assisted reproductive technology IVF’s success accounts for 99%.

Success Rates of In Vitro Fertilization method of infertile couple treatment

Your age, as a couple, is a main factor in the success of IVF method. For instance, if you are under 35 years old and you need IVF as your infertility solution you have a 39.6% chance of having a baby, but if you are 40 years old you have an 11.5% chance.

However, with the technology advancement and increase in experiences IVF doctors experience, the CDC recently found that the success rate is increasing in every age group as the techniques are refined and doctors become more experienced.

According to CDC, Approximately 1.9% of all infants born in the US every year are conceived using ART. Success rates for IVF depend on a number of factors, which includes:

• The reason for infertility
• The clinic of choice for the IVF procedure

Other examples of assisted reproductive technology (ART) are;

• Gamete Intra Fallopian Transfer
• Zygote Intra Fallopian Transfer

Risks of IVF (In Vitro Fertilization)

For an IVF assisted reproductive technology, there specific risks in each steps

Step 1: Fertility medication risks

• Ovarian hyper-stimulation syndrome: Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause this type of sydrome, where your ovaries become swollen and painful.
• Ovarian cancer: 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 ovarian tumor but more recent studies do not support these findings.

Step 2: Egg and sperm retrieval risk

Egg-retrieval procedure complications: Use of an aspirating needle to collect eggs can cause infection, bleeding or damage to the bowel, a blood vessel or bladder. Risks are also associated with general anesthesia.

Step 3: Insemination and fertilization risks

• Miscarriage: Use of frozen embryos during stage 3 in IVF may slightly increase the risk of miscarriage.
• Ectopic pregnancy: when the fertilized egg implants in the Fallopian tube, outside the uterus. It can’t survive hence there’s no way to continue the pregnancy. Only about 2% to 5% of women who use IVF assisted reproductive technology tend to have an ectopic pregnancy.

Step 4: Embryo culture risks

Birth defects: The age of the expectant mother is the primary risk factor in the development of birth defects, no matter how the child is conceived.

Experts believe that the use of IVF decrease the risk of having a baby with birth defects. Due to the existence of pre-implantation genetic diagnosis (PGD in the embryo culture stage.

Step 5: IVF transfer risks

Multiple births: IVF increases the risk of multiple births if more than one embryo is implanted on a given uterus. The resulting pregnancy of multiple fetuses carries a high risk of early labor and low birth weight.

Step 6: Success IVF confirmation risks

• 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.
• Stress: Use of IVF is physically, financially and emotionally draining. Support from family and friends can help the couple go through the ups and downs of the treatment.

Costs of In Vitro Fertilization (IVF) In the U.S

According to the American Society of Reproductive Medicine, the average cost of an IVF cycle in the U.S.A happens to be around $12,400.

• This price will vary depending on your State.
• The amount of medications you’re required to take during and after the procedure.
• The number of IVF cycles you undergo for a successful result.
• The amount your insurance company will be willing to pay toward the procedure.

You should thoroughly investigate your insurance company’s coverage for infertility treatment and don’t forget to ask for a written statement of your benefits or buy Infertility Insurance Advisor booklet for more advice on insurance coverage of infertility.

Fifteen States have enacted laws requiring insurance companies to cover at least some of the costs of infertility treatment, they include;

• Arkansas, California and Connecticut
• Hawaii, Illinois and Louisiana,
• Maryland, Massachusetts and Montana,
• New Jersey, New York and Ohio,
• Rhode Island, Texas and West Virginia

Why IVF is done

In vitro fertilization an assisted reproductive technology used for treatment of infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to avoid less invasive treatment options, such as fertility drugs which increase production of eggs.

Sometimes, IVF is offered as a primary treatment for infertile women of over 40 years old. If you don’t have a functioning uterus IVF assisted reproductive technology can be used for a voluntary surrogate mother (gestational carrier).

In this case, your eggs are fertilized with sperm, but the resulting embryos are placed in the surrogate mother’s uterus. IVF may be the best option if you or your partners have certain health conditions like:

• Uterine fibroids: Fibroids are benign tumors in the wall of the uterus which sometimes interfere with implantation of the fertilized egg. They are in women of a particular age 30s and 40s.
• Ovulation disorders: dysfunctions of the hypothalamic-pituitary-ovarian axis and ovarian failure these conditions often leads to reduction of number of eggs available for fertilization.
• Fallopian tube blockage or damage: the condition makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Premature ovarian failure: Premature ovarian failure is the loss of normal ovarian function a condition known as hypothalamic pituitary failure (low gonadotrophins and oestrogen deficiency). It normally occurs before the age 40.
• Previous tubal sterilization: The Fallopian tubes are removed and tied with special thread to seal the Fallopian tube in order to prevents the sperm from reaching the egg. The procedure is normally done when a woman has a medical condition which indications that an additional pregnancy would be hazardous to her body.
• Endometriosis: Endometriosis can affect the function of the ovaries, uterus and Fallopian tubes because it occurs when the uterine tissue implants and grows outside of the uterus.
• Impaired sperm function or production: Weak movement of sperm, below-average sperm concentration or abnormalities in sperm size and shape of a sperm can make it difficult for sperm to fertilize an egg.
• Unexplained infertility: No exact cause of infertility has been discovered despite evaluation for common causes.
• Fertility preservation for cancer patients: Cancer patients prefer to have their eggs harvested from their ovaries, fertilized and frozen as embryos for future use because treatments like chemotherapy or radiation can destroy them.
• A genetic disorder: If you or your partner is at risk of passing on a given hereditary disorder to your child, you may be the best candidates for pre-implantation genetic diagnosis.

Types of infertility conditions treated by IVF

When it comes to infertility, IVF is the solution if you or your partner has been diagnosed with:

Female infertility cause

• Endometriosis
• Problems with the fallopian tubes or uterus
• Ovulation problems
• An unexplained fertility problem
• Antibody problems that harm eggs

Male infertility

• Antibody problems that harm sperm
• Low sperm counts
• The inability of sperm to penetrate
• Inability of the sperm to survive in the cervical mucus
• An unexplained fertility problem

Question guide on IVF institution inquiry in preparation for fertility treatment

As an infertile couple, you need to know what is in store for you by asking the following questions:

• What is the live birth rate for all couples who undergo this procedure each year at your facility?
• Does your clinic participate in an egg donation program?
• What is your pregnancy rate for couples in our age group and with our fertility problem?
• How much does it cost to store embryos and how long can we store them?
• How many of those deliveries are twins or other multiple births?
• What is your pregnancy ratio per embryo transfer?
• How much will the procedure cost, including the cost of the hormone treatments?

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