IVF, or in vitro fertilization, is a more intensive and expensive treatment option than IUI — it requires that eggs are removed from the ovaries, that those eggs are inseminated with sperm in a laboratory, and that a resulting embryo is placed in a woman’s uterus with the hopes that it implants and leads to a healthy baby.
A lesbian couple might strongly consider IVF if:
Generally speaking, IVF success rates vary by age. If a woman has an underlying fertility issue, as you can see below, the cumulative odds of success vary dramatically.
More than half of women under age 40 deliver a child after 3 IVF cycles whereas for women over the age of 40, rates of IVF success tend to be much lower.
The above data reflects success rates for heterosexual couples with an underlying fertility issue.
A better analogue for lesbian couples might be IVF success for women with no underlying fertility issue and who underwent treatment (using donor sperm) on account of their partner’s male factor infertility issues. The below chart reflects data from all couples meeting this criteria treated in the UK from 2003 to 2010. As you can see below, after 3 cycles, roughly 70% delivered a child.
IVF is a complex process, with myriad decisions going in to a single cycle. We’ll summarize it below, but if you want the full set of details, head to our comprehensive guide to IVF here.
A woman is usually given injectable hormones to make her ovaries develop as many eggs as they can (say 8 to 20) instead of the usual 1 - 2 that would be matured each month. This continues for an average of 10 days, until a “trigger shot” is taken to start the ovulation process where eggs become mature.
Eggs are surgically retrieved from the ovaries, and typically general anesthesia is used during the procedure. A doctor usually uses a vaginal ultrasound to guide a needle that suctions out each egg.
Over the next 3 - 7 days, a fertility clinic’s laboratory will take all of the collected, mature eggs and try to grow them into healthy embryos.
First, they fertilize the eggs with sperm either by surrounding an egg with sperm in a petri dish, or using ICSI, a micro-procedure where a single sperm is injected into an egg. If you’re using frozen donor sperm there’s a good chance your doctor will want to use ICSI.
Then they try to grow the embryos into either Day 3 “cleavage stage” embryos or heartier Day 5, 6, or 7 “blastocyst stage” embryos.
Once embryos have reached the blastocyst stage, there is an option to remove a few cells and have them sent out for genetic testing, sometimes referred to as PGT or PGS screening. This testing can either test for a single genetic disorder that you have a family history of, or testing can predict if an embryo is likely or unlikely to lead to a healthy pregnancy.
After developing embryos, whether or not genetic screening has been done, more clinics and patients are using the option to freeze all their embryos. Then embryos will be transferred later on.
An embryo will be transferred into the uterus, with the hopes that it implants and leads to a healthy pregnancy. The safest option is to transfer one embryo at a time.
Any embryos of reasonable quality that were not transferred will be frozen and can be used later, either in the event that the transfer doesn’t work, or if it does work, for more children in the future.
In some senses, you can think of IVF like a funnel. Unfortunately every developed ovarian follicle won’t contain a mature egg, and every mature egg won’t necessarily lead to a healthy embryo or a baby. At each stage throughout the process, you’ll lose something. That’s why the goal is to have a high number of eggs to start off with.