IVF, or in vitro fertilization, is a complex series of medical procedures designed to help a women get pregnant. At it’s core it refers to the egg being fertilized, in vitro, or outside the body. The fertilized eggs are then transferred back into the body with the hope of creating a pregnancy. It is primarily used as a fertility treatment for couple who have trouble conceiving. Although, it has has other applications such as helping screen/protect offspring from genetic disorders (when used in conjunction with PGD), help single or same sex couples have a baby, and even gender selection.
The process was first pioneered in the 70s by two British doctors, and the first baby born through IVF was in 1979. One of the physicians, Robert Edwards, won a Nobel Prize for this work in 2010. Since then there have been countless advancements in the science and techniques of IVF and the procedure is getting more effective at treating infertility every year.
The term “in vitro” is latin for “in glass”. It refers to the egg being fertilized in the laboratory and not “in vivo” or in the body. There is a lot of work that goes into a successful IVF cycle. The human reproductive system is quite complex and successfully replicating the small part of it surrounding fertilization takes an immense attention to detail. The process starts out with the female being hyperstimulated with fertility meds so that her ovaries will produce more mature follicles than normal. The women is closely monitored during this time and when the eggs are mature, they are removed during a process called an egg retrieval or trans-vaginal aspiration (TVA). The mature eggs are then fertilized in the embryology laboratory through either IVF or ICSI fertilization. In normal IVF fertilization the male partner’s sperm is processed and combined with the eggs and left overnight for the magic to happen. In ICSI, or intracytoplasmic sperm injection, sperm are selected and injected into the individual eggs one by one. Some clinics only do ICSI as they believe it will lead to higher fertilization rates, while others will do half and half or recommend ICSI only when clinically indicated.
The fertilized eggs, now referred to as embryos, are then monitored closely in the laboratory and transferred back into the woman’s uterus at an appropriate time, usually 2-6 days after the fertilization occurs. In the last couple years frozen only cycles have come into popularity, and for good cause. Preliminary success rates indicate that utilizing frozen only cycles can increase the success rate for a pregnancy by up to 10% regardless of the age group. Frozen only cycles are cycles where the embryos are frozen on day 5/6 and then warmed and transfered back into the uterus on a subsequent FET (frozen embryo transfer) cycle. In either treatment method, if the transferred embryos implant normally into the uterus the women then becomes pregnant, and hopefully will result in a live birth.
IVF is a widely accepted treatment that has helped hundreds of thousands of couples have babies who might not otherwise been able to. It is a really quite an amazing procedure.
The basic steps of an IVF cycle
- Diagnostic testing (this can be mostly skipped on repeat cycles, depending on the particulars of your case)
- Down regulation of the ovaries. This enables the clinic to take control of the woman’s cycle. Failure to down regulate generally results in a cancelled cycle.
- Hyperstimulation of the ovaries to create more mature follicles (eggs) for retrieval day.
- Trigger shot. Once the follicles appear to be mature the clinic with “trigger” the patient. This sends a chemical message to the eggs which tells them to undergo the final maturation process. Triggering at the incorrect time can impact fertilization rates.
- Egg retrieval. About 24-36 hours after the trigger shot is given the woman will undergo a surgical egg retrieval where the doctor will remove the eggs. The doctors will generally have a pretty good idea of how many eggs will be retrieved based on how the follicles look.
- Fertilization of the eggs. Once retrieved the egg then go into the embryology lab where they will be fertilized. This will occur by either conventional IVF or through ICSI. This occurs about 4-6 hours after the retrieval.
- Monitoring of the eggs. Once fertilized the eggs are closely monitored in the embryology lab for several days. Most clinics generally watch the embryos for 3-6 days before either freezing or transferring them back into the uterus.
- Transfer or freezing of the embryos. Depending on the practice, the embryos will be either transferred back to the woman on day 3-6 or they will be frozen for transfer on a subsequent cycle.
- (If no transfer on fresh cycle) the embryos will be warmed and transferred at a future date. Depending on the number of embryos frozen, multiple frozen cycles may be possible
- Successful pregnancy, or, if frozen embryos are available, another FET, or, another fresh cycle to repeat the process.
As you might guess, this whole process can get very expensive, very quickly. This site is dedicated to helping couple’s and individuals better understanding the potential costs for this process.