In Vitro Fertilization
One of the better-known fertility treatments, in vitro fertilization (IVF) essentially involves fertilizing an ovum in a laboratory dish and then transferring the embryo to a woman's uterus. IVF treatment is an assisted reproductive technology (ART) method suitable for couples with any one of various causes of infertility, including tubal factor infertility, endometriosis, and certain types of male factor infertility.
In vitro fertilization statistics suggest that couples under the age of 35 who have been trying to conceive for more than a year without results are ideal candidates for in vitro fertilization. Couples over the age of 35 who have been trying to conceive for six months may also be good candidates for IVF treatment, but it is important to consult a qualified fertility specialist to determine if it is appropriate for you.
The following are a few causes of infertility that may be treated with in vitro fertilization:
- Ovulation disorders
- Blocked or damaged fallopian tubes
- Low sperm count
- Sperm problems such as poor sperm motility
Although there is no established age limit on in vitro fertilization, many infertility clinics and hospitals consider your age as part of the candidate screening process.
The IVF Process
The in vitro fertilization, or IVF, procedure requires highly skilled medical professionals and sophisticated laboratory equipment. The full IVF process is composed of a number of steps, including egg harvesting, fertilization, and embryo transfer. The steps are completed over a period of about a month.
Step One: Ovulation Induction
During the first stage of the IVF process, women are given fertility medication to stimulate simultaneous development of multiple ovarian follicles, which contain the eggs that are released during ovulation. Some of the drugs used for this purpose are clomiphene citrate (Clomid®, Serophene®), human chorionic gonadotropin (hCG), and gonadotropin releasing hormone (GnRH) analog. These fertility drugs are typically administered via injection over a period of seven to ten days and may be used alone or in combination with each other. The goal of the fertility drugs is to produce the simultaneous maturation of multiple eggs, which must be harvested prior to ovulation.
Step Two: Egg Harvesting
In this stage of the in vitro fertilization process, the ova must be harvested before ovulation occurs, or else they will be released in the female reproductive tract. Ultrasound scanning can be used to monitor follicle development. Blood samples can also be taken to measure estrogen levels, which should rise as the follicles mature. About a day and a half before ovulation, an hCG injection is administered. This should cause ovulation to occur approximately 36 hours later. In some cases, a spontaneously occurring luteinizing hormone (LH) surge can trigger premature ovulation.
The most common technique used for egg harvesting is called ultrasound-guided aspiration. This method involves inserting an ultrasound probe into the vagina. The probe emits sound waves, which are used to form an image of the reproductive organs. The fertility specialist guides a tiny needle through the vagina and into a follicle, where gentle suction draws the ovum into the needle. The aspiration procedure can also be performed through the abdominal wall or bladder. In some cases, a laparoscopy may be needed for successful egg harvesting.
Step Three: Insemination and Fertilization
The level of egg development determines when sperm may be added (insemination). The semen is provided by the husband, partner, or sperm donor. For the in vitro fertilization procedure, the male can provide the sperm on the day of the egg harvesting or the sperm can be collected in advance and frozen until it is needed. Motile sperm are separated from the rest of the semen using a process known as "sperm washing." A specific number of sperm are placed with each of the eggs in a separate laboratory dish.
After the eggs have been inseminated by the sperm, the lab dishes are left in an incubator for approximately 18 hours. After fertilization is complete, it takes about 12 hours for the fertilized cell to divide in two. After 48 hours, the pre-embryos consist of two to four cells each and are ready for embryo transfer into the uterus.
Step Four: Embryo Transfer
Embryo transfer is typically performed as an outpatient procedure. The physician uses a transfer catheter to carefully deposit the embryo or embryos into the uterine cavity. While the embryo transfer procedure takes only 10 to 20 minutes, some IVF clinics recommend that patients rest for a period of time immediately afterward.
After undergoing IVF, patients are given daily progesterone injections to increase the chance of successful embryo implantation. The success rate of the IVF procedure is approximately 20 percent per treatment cycle.
How Many Embryos Should You Transfer?
Patients who undergo the in vitro fertilization procedure should first consult with their doctor to determine the number of embryos that will be transferred. It is possible for more than one embryo to implant in the uterus lining (endometrium) after transfer. The more embryos transferred, the greater the chance of multiple pregnancies. An embryo or embryos that are not selected for immediate transfer may be frozen for use at a later date through a process known as cryopreservation.
On average, the cost of in vitro fertilization is about $12,000 per cycle; this price should include the cost of fertility drugs, ultrasounds, blood tests, and all other medical expenses that are directly related to the in vitro fertilization procedure. The high cost of IVF reflects the fact that the procedure is complex and can be performed only by highly trained medical professionals.
The number of IVF cycles needed will vary by patient. Several factors play a role in the success of IVF treatments, including the age of the patient, the degree of infertility, and the quality of the embryo and semen. Some women will only undergo one treatment before successfully conceiving, other women may need to undergo as many as six IVF cycles. Unfortunately, some women are unable to conceive even after undergoing multiple IVF cycles.
Financing plans are offered by health care financing companies such as CareCredit. Consumers can pay off the cost of treatment (the loan) over a period of 12 months, 18 months, 24 months, or another period of time that is convenient to them. In the majority of cases, the consumer will have to pay interest on the loan; the applied interest rates typically depends on the amount of time it takes the consumer to pay off the loan and the consumer's credit score.
IVF and Health Insurance
Depending on the type of plan you have and the state in which you live, your insurance coverage may be applied toward the cost of in vitro fertilization. Some states have laws requiring insurance carriers to offer coverage for infertility diagnosis, treatment, or both. While it is unlikely that your health insurance company will pay for the cost of IVF cycles, as IVF is considered an elective procedure, most health insurance companies will cover all or a portion of the cost of infertility testing and diagnosis fees.
Currently, IVF is the most common form of assisted reproductive therapy performed; In fact, 99 percent of ART pregnancies are the result of IVF treatment. In the United States, IVF success rates have been relatively high. By the end of 2002, nearly 300,000 babies conceived through assisted reproductive technology had been born.
However, there are many factors that play a role in the success of IVF treatment, including the viability of the embryos, the age of the mother, and the quality of the sperm.
Age and IVF Success Rates
The age of the woman undergoing in vitro fertilization does affect the pregnancy success rate; as a woman ages, her chances of getting pregnant via IVF decrease:
- Approximately 37 percent of women under the age of 36 who undergo IVF experience a successful pregnancy.
- The success rate of IVF treatment for women aged 36 to 39 is 28 percent.
- In women over the age of 40, IVF treatment is successful approximately 13 percent of the time.
Natural Pregnancies versus In Vitro Pregnancies
Women who conceive via IVF generally have normal pregnancies:
- The success rates of IVF, as presented by these statistics, are similar to the success rates of natural means (copulation).
- The rate of miscarriage following IVF is also comparable to the rate of miscarriage after natural conception.
- Ectopic pregnancies occur in roughly 3 to 5 percent of in vitro fertilization cases, the same rate as in pregnancies achieved naturally.
Consult a Fertility Specialist
Though there are many benefits of IVF treatment, the procedure is not without certain risks. During a consultation about in vitro fertilization, a fertility specialist will be able to go into greater detail about the various risks and benefits of in vitro fertilization. Find a fertility doctor near you to schedule an appointment.