Today IVF helps 1% of US couples conceive and in Europe and Japan those numbers are close to 5%. While IVF has been a game-changer for many hopeful parents, it is a complex and costly process for most patients. Here we explore IVF's benefits and shortcomings and how patients should consider choosing a doctor.

An Overview of IVF

There are a wide variety of patients who require IVF services each year: heterosexual couples, gay and lesbian couples, as well as single mothers by choice and single fathers by choice. The result is greater demand for IVF treatments with every passing year.

The process of IVF involves stimulating a woman's ovaries to release as many eggs as possible, retrieving those eggs, inseminating those eggs and then nurturing the resulting embryos to a promising stage of development before transferring an embryo, or embryos, into the uterus in hopes of creating a healthy pregnancy.

While it can be hard to generalize, the reality is that most IVF cycles do not lead to a live birth. As shown below, a patient's chances of success depend on several variables: principally, the quality of the egg retrieved, the quality of the sperm provided, the quality of the laboratory growing the embryos, and the condition of the woman's uterus.

Patients should realize that this means they will likely will not succeed at first and, according to our data, most patients will either give up or be forced to undergo multiple cycles. For this reason, many patients consider buying cycles in-bulk or with a refund feature, and here we suggest caution.

IVF carries enormous financial costs and today we estimate those to total more than $23,000 per cycle. These costs vary by the city in which a patient is treated, and what add-ons they purchase. For instance PGS often runs patients an additional $5,000 and ICSI fertilization can add another $2,500. In many cases, there is a debate as to whether PGS or ICSI is truly necessary.

Unfortunately, few, if any, employers cover the cost of treatment, but we have created a ranking of those who do. We've also detailed how patients can go about saving money in the process.

Another cost of IVF is the emotional pain it imposes on patients. IVF creates a sense of isolation partially because, according to our data, most patients don't have others they can talk to. That can exacerbate feelings of isolation, depression, and confusion.

Patients who struggle emotionally with the topic should know resources exist to help them. RESOLVE runs professionally-led support groups in most towns in the US and nearly 23% of clinics have in-house therapists prepared to listen and help. When you search for a clinic at FertilityIQ, you can see whether they offer on-site psychological services.

While some patients may need to proceed directly to IVF, plenty of patients have the option to try conceiving naturally while using Clomid, a medication that aids ovulations, or with IUI. IUI success rates are one third as high as IVF, but the treatment costs only a tenth of what IVF does. For many patients, it's a personal decision when to advance from IUI to IVF and, as you can see below, there is no standard procedure that patients and clinics follow.

If you decide to press forward with IVF, you will need to find a doctor and clinic to treat you. Clinics differ dramatically in terms of the protocols they like to use, the incentives they offer to promote certain procedures, the ways in which the clinic is set up, the quality of the laboratory they use, and the prices they charge, along with countless other factors. Most patients will eventually leave their first clinic.

Doctors within the same clinic have varying approaches, temperments and levels of skill. If we look at just one component of care, the embryo transfer, success rates differ substantially, even within the same clinic. 96% of clinics keep close tabs on each transferring doctor's success rate, and for that reason, we suggest patients push to learn the success rates of each doctor.

Quite possibly the foremost issue in the field today is whether IVF patients should have their embryos biopsied for pre-implantation genetic screening, PGS. This process involves taking a few cells from an embryo and counting the number of chromosomes within that sample to determine if it is likely to lead to a healthy pregnancy. Today, 35% of IVF patients have their embryos PGS tested. There are camps who believe we should be doing more PGS testing, and those who believe we should be doing less.

The arguments for PGS are that the test helps the doctor predict which embryo to transfer, helps promote single embryo transfers, and cuts down on the risk of miscarriage. The arguments against PGS are that the test results are more ambiguous than we first thought, it may cause us to erroneously discard useful embryos, and in light of all this, the test is not worth the $5,000 price tag.

Relatedly, another issue that weighs on patients and caregivers is whether to transfer a single embryo or multiple embryos. Transfering multiple embryos leads to higher rates of success per transfer and, for that reason alone, the average number of embryos transferred per cycle is still comfortably above one.

On the other hand, transfering multiple embryos raises the likelihood of a twin pregnancy and the risks that come with it both for the woman giving birth and the resulting offspring.

Frankly, the U.S. fertility field has been haphazard in standardizing on which patients should receive a certain number of embryos. In 2017, ASRM issued these guidelines, with the effective message, "if your doctor deviates from these, they better have a very compelling reason."

Finally, for some patients, there is the dilemna of if, or when, to try using another woman's eggs (donor eggs), uterus (surrogacy) or another man's sperm. For most this can be an arduous deision, rife with emotional and financial complexity. There are a number of clinics and doctors who simply will not allow certain patients to procede with IVF unless they pursue this path. Cynics say these doctors are "dodging" hard cases to improve their publicly-available success rates. Others might say these doctors are helping ensure patients don't waste their time, money, and hope on an effort that will be fruitless. Regardless, for many patients, using donor eggs dramatically improves their likelihood of having a child. For a quickly growing percentage of the IVF population (well over a tenth), this is the option they elect.

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