IVF 101 | A comprehensive guide to in vitro fertilization

IVF 101:

A guide to in vitro fertilization

Learn everything you need to know about IVF with our comprehensive guide. From the process to costs and emotional impact, we've got you covered.

What is IVF:

A complete guide

In vitro fertilization (IVF) refers to a series of different processes that can help a person become pregnant.

Chapter 1

IVF is the most effective type of assisted reproductive technology (ART) and incorporates the use of various medications and procedures that help a sperm cell fertilize an egg cell to produce an embryo and to help the embryo implant in the uterus.

The retrieval process

  1. During IVF, medications are used to stimulate multiple eggs to grow to maturity inside the ovaries.
  2. These eggs are then retrieved from the ovaries during a minor medical procedure and fertilized by sperm in a laboratory.
  3. A thin needle is inserted through the vaginal wall and the collected eggs are fertilized with sperm from the partner or sperm donor.
  4. The fertilized eggs, now embryos, are cultured in a controlled environment in the laboratory.
  5. They are monitored for growth and development over the next few days.
  6. The embryo is then transferred to the uterus.

This process can take about three weeks from start to finish if the full IVF cycle is done all at once. In some cases, people going through IVF may split the process up into different steps, which can make the process take longer.

People may go through IVF for a variety of different reasons, but it is often used to treat infertility in women over 40. IVF may also be an option for individuals with certain health conditions such as endometriosis, uterine fibroids, ovulation problems, fallopian tube issues, and more. If the fallopian tubes are blocked or damaged, getting pregnant without medical help may be difficult or impossible. IVF bypasses the need for fallopian tubes by allowing fertilization to occur outside the body.

IVF is also often used if there are problems with a partner’s sperm, or if an individual or couple is at risk for passing along a genetic disorder to a child. Individuals preparing to start cancer treatments or other types of medical treatments that can harm fertility may also choose to go through IVF for fertility preservation purposes.

Fertility preservation refers to the process of preserving reproductive potential, specifically eggs, sperm, or embryos for future use. When IVF is used for fertility preservation, mature eggs can be retrieved from the ovaries and can be frozen (either as unfertilized eggs or as fertilized embryos) for later implantation.

Did you know?

The history of IVF dates back to the 1960s and 1970s, when scientists started exploring the possibility of fertilizing human eggs outside the body, often in a test tube or culture dish in a laboratory setting.

During the 1970s, significant progress was made in refining the techniques for human IVF. The first "test-tube baby” was born in England in 1978, and three years later, the first IVF baby was born in the U.S.

The IVF process has evolved considerably since its inception and today accounts for about 1–3% of all annual births in the U.S. and Europe.

Who are candidates for IVF?

There are many different types of people who may consider IVF.

Chapter 2

Some of the most common reasons people pursue IVF include:

How to prepare for IVF

There are many physical, emotional, and logistical considerations that go into preparing for IVF.

Chapter 3

In addition to a comprehensive medical evaluation that includes an examination of both partners' reproductive health and hormone levels, and a genetic screening, the preparation process may also include lifestyle modifications such as the incorporation of a balanced diet and regular exercise, and the avoidance of tobacco, excessive alcohol, and other harmful substances.

What to consider

Choosing a fertility clinic

Selecting an IVF clinic is a crucial decision, as it can significantly impact the chances of success and the overall experience. Here are some important factors to consider when choosing an IVF clinic:

  1. Success rates: Patients should look for clinics with a track record of successful pregnancies
  2. Accreditations and certifications: Patients should ensure the clinic is accredited by relevant medical associations and regulatory bodies in their country.
  3. Experience and expertise: Patients should research the clinic's medical team, including their specialization in reproductive medicine and any advanced training they might have.
  4. Technology and facilities: Modern, well-equipped facilities contribute to better outcomes.
  5. Services offered: In addition to IVF, clinics may offer a range of services like egg freezing, embryo freezing, preimplantation genetic testing (PGT), and more.
  6. Personalized care: It’s important to find a clinic that provides personalized treatment tailored to each patient’s specific needs.
  7. Patient reviews and testimonials: Patients should read reviews and testimonials from others who have undergone treatment at the clinic and can offer insight into their experience.

Initial consultation and evaluation

The first step in seeking fertility guidance and care is to schedule an initial consultation and health evaluation with a fertility specialist or reproductive endocrinologist.

While every person’s fertility journey is unique, the initial consultation is typically the time for the medical provider to gather comprehensive information to understand specific fertility issues or potential causes of infertility.

  1. The appointment usually starts with a detailed medical history review, during which the medical provider will ask questions about the patient’s reproductive health, menstrual cycles, sexual history, prior pregnancies, and any relevant medical conditions.
  2. This conversation may also include a discussion about lifestyle factors including diet, exercise, and stress levels which may influence fertility.
  3. The medical provider may also perform a physical examination (usually a pelvic exam or a semen analysis) and order additional diagnostic tests.

Transvaginal/pelvic ultrasound

A transvaginal/pelvic ultrasound is an imaging procedure that visualizes the cervix, uterus, fallopian tubes, and ovaries. During a transvaginal/pelvic ultrasound, a provider will gently insert a wand-like instrument called a transducer into the vagina to record images of the pelvic organs. This can help identify any abnormal structures or growths and during IVF, this same procedure is used to monitor the development of the follicles inside the ovaries.

Antral follicle count (AFC)

AFC is a key tool used to assess the ovarian reserve (number of remaining eggs) and potential fertility. AFC is typically measured during transvaginal ultrasound during the early phase of the menstrual cycle.

Anti-müllerian hormone (AMH) test

AMH is produced by the ovaries and is considered a potentially important indicator of reproductive health. An AMH test measures the amount of AMH in a blood sample and correlates with the number of eggs in the ovaries; higher levels of AMH typically means the ovaries have a larger supply of eggs. With age, the number of eggs decreases, causing AMH to also decrease; at menopause, AMH levels drop to zero when there are no eggs remaining in the ovaries.

Fertility hormones

In addition to an AMH test, other common blood tests can help provide insight into a woman’s ovarian reserve (i.e., the number of eggs available for potential fertilization).

The cost of IVF

The cost of IVF can vary significantly depending on several factors, including geographic location, the prescribed treatment plan, the specific clinic, and any additional procedures or tests required.

Chapter 4

The average cost of one cycle of IVF in the U.S. can range from $12,000 to $15,000, but these prices do not include the cost of necessary medications or other services such as genetic testing and embryo freezing.

The cost breakdown of IVF

While IVF costs vary widely, the total expense of a single cycle can typically be broken down to reflect the following components:

  1. Initial consultation and diagnostic tests: This usually includes the first appointment with the fertility specialist, medical history review, physical exams, blood tests, ultrasounds, and semen analysis.
  2. Medications: The IVF process requires a variety of medications to stimulate the ovaries, control the menstrual cycle, and prepare the body for embryo transfer. Costs of these medications vary widely depending on a number of factors but medication expenses can often comprise a significant percentage of the total cost of IVF.
  3. Egg retrieval: Retrieving the mature eggs from the ovaries requires a surgical procedure, often including an additional cost for anesthesia.
  4. Sperm collection: If necessary, a medical provider may order sperm tests in order to analyze the sperm and prepare for fertilization.
  5. Insemination or intracytoplasmic sperm injection (ICSI): In some cases, fertility specialists may recommend using specific laboratory methods to fertilize the eggs with sperm.
  6. Embryo culture: Once the eggs are fertilized with sperm, the resulting embryos require several days of monitoring and culturing in a laboratory.
  7. Embryo transfer: If the embryos are being transferred immediately following the retrieval and culturing, there will be a cost to cover the procedure to implant the embryo into the uterus.
  8. Optional cryopreservation: If the embryos are not being transferred immediately, there will be a cost for freezing and storing the embryos for future use.
  9. Optional genetic testing: In some cases, a provider may recommend preimplantation genetic testing (PGT) to screen embryos for genetic abnormalities.
  10. Additional procedures: If necessary, an IVF cycle may require additional procedures like assisted hatching or embryo biopsy at extra costs.

Insurance coverage for IVF

Insurance coverage of IVF varies significantly depending on the country, state, and specific insurance plan. But in many countries, including the U.S., most insurance plans do not offer comprehensive coverage for IVF. Some insurance plans may offer partial coverage for specific parts of the IVF process, like diagnostic testing or medications.

Financing options for IVF

For individuals or couples seeking financial assistance, there are several financing options available for IVF.

  1. Fertility clinic financing: Some fertility clinics offer financing programs or partnerships with financial institutions, providing loans or payment plans tailored to cover IVF expenses.
  2. Medical credit cards: Some credit card companies offer medical credit cards that can be used to pay for medical procedures, including fertility treatments like IVF. These cards often come with promotional financing options, such as interest-free periods.
  3. Grants and scholarships: There are several non-profit organizations and foundations dedicated to providing fertility grants and scholarships to individuals and couples with financial need who are pursuing fertility treatments.
  4. Insurance coverage or flexible spending accounts (FSAs): Some insurance plans offer partial coverage or FSAs (pre-tax dollars) that can be used for fertility treatments like IVF.
  5. Comprehensive fertility benefits: Employers that offer comprehensive fertility benefits such as Carrot can help employees save money with reimbursement options and provide a simplified payment method for fertility and family-forming care.

The IVF process step-by-step

Chapter 5

The IVF journey is individualized for a variety of reasons, but in general, the process includes several steps to stimulate egg production and maturation, and fertilize eggs and sperm outside the body in a laboratory setting to create embryos. If the IVF process results in one or more healthy embryos, those embryos can then be frozen for future use or transferred into the uterus for potential implantation.

Step 1: Ovarian stimulation

The medications used in IVF are part of a process called “controlled ovarian hyperstimulation.” Administering IVF medications every day for a period of time causes the ovaries to produce multiple follicles (fluid-filled sacs in the ovaries) that each contain an egg. In most cases, the process starts in the early stage of the menstrual cycle. After doing initial lab tests and a baseline ultrasound, the patient begins self-administering IVF medications once or twice a day for an average of 7–14 days.

Step 2: Egg retrieval

The egg retrieval involves a minor surgical procedure performed under sedation or light anesthesia (lasting about 20-30 minutes) to remove the mature eggs from the ovaries for fertilization in the laboratory. The procedure is performed 36 hours after the final dose of IVF medication known as the “trigger shot.” Egg retrieval is performed by transvaginal ultrasound-guided needle aspiration.

Step 3: Sperm collection and preparation

Before starting IVF, male partners are often asked to do sperm testing, otherwise known as a semen analysis. This test analyzes the volume and quality of a man’s sperm and is considered an important first step in identifying male factor infertility.

Step 4: Fertilization

There are two common types of fertilization in the IVF process: natural insemination and intracytoplasmic sperm injection (ICSI).

Step 5: Embryo development and selection

Once eggs are retrieved and fertilized, the embryologist will monitor the development of the embryos and provide an embryo grading report. Embryo grading refers to the process of assessing and classifying the quality of the embryos at various stages of development.

Step 6: Embryo transfer

Embryos can either be transferred a few days after fertilization occurs (fresh transfer) or frozen and stored for later use (frozen embryo transfer or FET). A fresh embryo transfer typically takes place between three and five days after the egg retrieval.

Step 7: Pregnancy test and follow up

Patients can normally resume normal activities following a frozen embryo transfer. It will take about 12-14 days for a pregnancy test to confirm whether the embryo transfer resulted in a pregnancy.

Success rates of IVF

According to the Society for Assisted Reproductive Technology, age is the most important factor when determining success rates of all ART methods.

Success rates decline as women age and this decline becomes more drastic after a woman reaches her mid-30s. This decline in success is influenced by the high rate of miscarriage with age, particularly over age 40.

Success rates by age:

The risks and side effects of IVF

Like all medical interventions and procedures, there can be some risks and side effects associated with the IVF process.

Side effects of IVF include:

Alternatives to IVF

Because of the significant emotional, physical, and financial stress associated with IVF, many people may choose to explore alternative routes to pregnancy.

Chapter 8

Fertility treatment alternatives to IVF include:

Coping with the emotional rollercoaster of IVF

Chapter 9

The IVF process can be incredibly challenging for individuals and couples on a psychological and emotional level. Research shows that the depression levels in patients with infertility are comparable to patients who have been diagnosed with cancer. It's important to be prepared for the emotional challenges of IVF.

Conclusion

IVF is a complex process that has helped many individuals and couples achieve pregnancy. For many people dealing with fertility issues including advanced maternal age, ovulation problems, male factor infertility, or unexplained infertility, IVF may be a life-changing opportunity. Before beginning an IVF journey, it’s important to check an employer’s fertility benefit offerings.