In Vitro Fertilization

What is in vitro fertilization?

In vitro fertilization (IVF) is a way to help couples who are having trouble getting pregnant. In vitro actually means "in glass." A woman's eggs are removed, fertilized by sperm and nutrients in a glass dish in a lab, and then put into her uterus.

IVF is a form of assisted reproductive technology (ART). ART uses special methods to help couples get pregnant and involves handling both the woman's eggs and the man's sperm. These methods have made it possible for many couples to have children.

When is it used?

IVF is a treatment for infertility. A couple is considered to be infertile if they have not been able to get pregnant after at least one year of trying. IVF may be tried after a number of tests to try to find the cause of infertility. IVF may be done when other simpler fertility treatments have been tried and it is found that:

• A woman's fallopian tubes are blocked, which means the sperm cannot reach the egg. (Fertilization normally takes place in the fallopian tubes.)
• The woman has endometriosis, which means tissue from the uterus has grown outside the uterus.
• The male partner has no sperm or low sperm counts.
• There are problems with the cervix, such as an infection.
• The woman produces antibodies which kill the sperm.
• The cause of infertility is not known.

Depending on the cause of infertility, examples of other possible treatments are:

• Fertility drugs taken by the woman for ovulation problems.
• Medical or surgical treatment for endometriosis.
• Surgery to repair damage to a woman's ovaries, fallopian tubes, uterus, or vagina.
• Surgery or medicine to fix the male partner's infertility problem.
• Gamete intrafallopian transfer (GIFT), which is used when the woman has at least one normal fallopian tube. Three to five eggs are placed in the fallopian tube, along with the man's sperm, for fertilization inside the woman's body.
• Zygote intrafallopian transfer (ZIFT), also called tubal embryo transfer, which combines IVF and GIFT. The eggs retrieved from the woman's ovaries are fertilized in the lab and placed in the fallopian tubes rather than the uterus.
• Use of donor eggs (eggs from another woman), donor sperm (sperm from another man), or previously frozen embryos.

How do I prepare for in vitro fertilization?

Make sure that you check the credibility and reputation of a fertility clinic before starting any treatment. The Centers for Disease Control and Prevention maintain a national database of clinics and their success rates. You can get this information by calling the Division of Reproductive Health at 770-488-5200 or visiting their Web site at http://www.cdc.gov/art/.

How is IVF done?

The male partner gives a sperm sample so it can be tested before the procedure. Then the woman is given medicine that makes the ovaries produce more eggs. The woman will have follow-up visits with her provider, who will use vaginal ultrasound to see how the eggs are developing. The eggs should mature within a couple days. When the eggs are mature, they will be collected at the clinic. The man will also give another sperm sample.

To collect the eggs, the woman will first be given a sedative to relax her and possibly put her to sleep. The eggs will be removed from the ovaries with a needle inserted through the vaginal wall and into the ovaries. The provider will use ultrasound scanning to see the ovaries and guide the needle. The eggs will then be placed in a culture dish with the sperm for fertilization.

After the eggs are collected, the woman will be given an antibiotic to prevent infection.

After about 40 hours, the eggs will be examined to see if they have been fertilized by the sperm and are dividing into cells. Two or three of the fertilized eggs, called embryos, will then be placed in the woman's uterus--about 2 days after they were removed from her ovaries. Putting the embryos into the uterus is a simple procedure that takes 10 to 15 minutes. The embryos are transferred with a thin, soft tube that is put into the vagina, through the cervix, and into the uterus. The embryos are gently flushed out of the tube and into the uterus. Your provider may use ultrasound to help place them in the uterus. Because several embryos are put into the uterus, there is a chance of becoming pregnant with more than 1 baby.

What happens after the procedure?

The woman may be able to leave the clinic several hours after the procedure. She will take hormones and have blood tests for the next 2 weeks to make sure the lining of the uterus is ready to accept the egg. She will return in 2 weeks for a pregnancy test. If she is not pregnant, another procedure can be done after she goes through a normal monthly menstrual cycle.

Embryos not used in the first procedure can be frozen for later use.

What are the benefits of the procedure?

• With IVF, some couples with infertility problems are able to have their own children.
• If a couple has a high risk of having a baby with genetic problems, they may use IVF to become pregnant using the eggs or sperm of healthy donors.
• IVF results in pregnancy and the birth of a baby in 30 to 40% of the women who have the procedure between the ages of 25 and 37. The success rate becomes much lower after the age of 37.

What are the risks or disadvantages?

The success of IVF depends on many factors, such as age, the cause of infertility, the woman's response to fertility medicines, the sperm's ability to fertilize the egg, the couple's willingness to undergo multiple procedures, and the expertise of the provider or clinic performing the procedure.

IVF is expensive, time consuming, emotionally draining, and may need to be tried again if it is not successful. Depending on state laws, insurance companies may not cover the procedure. It is important for couples to decide early in the process what they can afford, both emotionally and financially. This includes understanding the procedure, drug therapy, tests, egg retrieval and fertilization processes, and how many times they are willing to try the procedure. Open, sensitive communications are important at all times between the woman, her partner, and the fertility specialist.

Some of the risks of the procedure are:

• pelvic infection
• bleeding
• becoming pregnant with more than 1 baby, for example, twins, triplets, or more
• reaction to anesthesia
• injury to pelvic organs

When should I call my healthcare provider?

If you are a woman who has just had IVF, you should call your provider right away if:

• You have a fever over 100.5 degrees F (38 degrees C).
• You have pelvic pain.
• You have heavy vaginal bleeding.
• You have blood in your urine.