In vitro fertilization, or IVF, is the most effective fertility treatment available, but it’s also the most expensive and physically taxing. For these reasons it can be hard to determine when to start IVF, when to stop, and generally what to expect from the process.
IVF is a complex process, with over 350 steps, but to oversimplify there are really just five key phases of treatment.
A woman takes injectable hormones to spur her ovaries to grow multiple follicles that contain mature eggs
A fertility doctor surgically retrieves those eggs
A fertility clinic’s laboratory uses sperm to fertilize the retrieved eggs
The same laboratory nourishes the fertilized eggs to become more stable embryos
A fertility doctor transfers an embryo into the woman’s uterus with the hope that a healthy fetus, and eventually baby develops
During the IVF process patients and doctors need to make a number of crucial decisions to increase the odds the IVF “cycle” will work. We’ll cover most of these in detail in a following lesson.
For a woman to conceive naturally, she must grow a high quality egg, ovulate it, have sex just before ovulation so that sperm is present, have a partner with a sufficient number of high quality sperm, she must have open fallopian tubes for the egg and sperm to meet, and a uterus capable of absorbing and nourishing an embryo.
For those who are unable to conceive naturally, at least one of these processes doesn’t work. Each major step of IVF is meant to help rectify one of these fundamental breakdowns.
Poor Egg Quality: If a woman has a small number of high quality eggs, stimulating the ovaries can help by making a larger number of eggs available, increasing the odds of finding a good egg. This is especially relevant to women in their late 30’s and 40’s.
Woman Does Not Ovulate (Regularly or Ever): If a woman does not ovulate an egg, it can’t be fertilized and she can’t become pregnant. IVF rectifies this through drugs that help develop eggs to the point of maturity whereby they can be surgically-retrieved from the ovary and fertilized in the laboratory. This is especially relevant to women with PCOS or hormonal imbalances.
Problematic Sperm: If a man doesn’t produce enough high quality sperm, it’s unlikely any will survive the journey from the vagina through the cervix, into the uterus and towards the fallopian tube to fertilize an egg. IVF removes all of these roadblocks. During IVF, the clinic will place a woman’s eggs in a petri dish and then surround them with sperm or inject one sperm directly into the egg. In nearly half of the cases of infertility, part of the issue resides with a man’s sperm and so this is a crucial reason IVF has higher success rates than other treatments.
Fallopian Tubes: If the fallopian tubes are blocked, natural conception is impossible because egg and sperm cannot meet for fertilization to occur. As we mentioned above, in vitro fertilization (“in vitro” means “in glass” in Latin) entails removings eggs and sperm from the body to be placed into a petri dish for fertilization. As a result, eggs and sperm can meet, which would otherwise be impossible if a woman’s fallopian tubes are blocked.
Endometrium: A woman’s uterus must be capable of absorbing and nourishing an embryo. Here IVF can be helpful to ensure “endometrial synchrony” which means the embryo arrives at the uterus when the uterus is most ready to absorb it. However, most issues within the uterus that prevent a pregnancy from occurring are structural in nature (like fibroids, polyps, or scar tissue from a D&C) and IVF does nothing to fix those. Instead, surgery (sometimes many) are required to address these structural issues.
IVF is complicated and, while we wish we could say that it's possible to absorb all the details during the 5 - 30 minute visits with your doctor, that's really not the case. This comprehensive guide to IVF boils down every major issue you'll encounter -- a high level overview of the IVF process, a deeper dive into the IVF process, IVF success rates and how they differ depending on diagnosis and age, the medication protocols that can be used during IVF, the choice of inseminating eggs either using ICSI fertilization or conventional insemination, the pros and cons of growing embryos to Day 3 cleavage stage or Day 5 blastocyst stage, the decisions around genetic screening of embryos, deciding which embryo to transfer, deciding how many embryos to transfer at once, the ways the IVF laboratory can impact your odds of success and the things you need to know up front to avoid going to the wrong lab for you, the risks of IVF, and the costs of IVF. We're always sure to provide details about how data might be different depending on different unique types of patients -- because in the world of fertility, it's really not one-size-fits-all. We truly believe this guide is the foundation every fertility patient should start with when they're navigating the world of treatments.