Since the first “test tube” baby was born in 1978, in vitro fertilization (IVF) has enjoyed great success in helping couples experiencing fertility problems. The following contains everything you need to know about IVF.
What is IVF?The process of IVF involves joining the egg from a female with sperm from a male in a laboratory setting, then introducing the embryo into the mother’s womb. This is of course a very simple explanation for a complex procedure. IVF actually occurs in four steps:
Step 1- the women is given fertility drugs to stimulate her ovaries to produce eggs. In a normal monthly cycle, the ovaries generally release only one egg. Fertility drugs coax the ovaries to produce multiple eggs, thus increasing the chances of successful IVF. The woman is monitored closely until such a time as her doctor determines that she has produced enough eggs to harvest.
Step 2- the eggs are “harvested”. In this procedure, the doctor inserts a needle through the woman’s vagina and into the ovary to extract the eggs. The procedure may be uncomfortable, and women may be offered sedating medication. The fluid removed from the ovary is examined to determine the number and condition of the eggs. While the eggs are being obtained from the woman, her partner must produce a semen sample (it is important that men do not ejaculate for a couple of days prior to the procedure, so as to optimize the sperm count.
Step 3- the harvested eggs and the sperm are mixed in the laboratory in a dish (hence the term “test tube baby”). After 18 to 20 hours, it is possible to determine if the sperm have fertilized any of the eggs, and if any of these embryos are growing. The embryos are incubated in the lab for the next 2 to 4 days, and then it is time for the final step.
Steps 4- in the last step, one or more embryos are introduced into the woman’s uterus via the cervix, using a long skinny tube (catheter). The woman then rests for a short time. She will need to take hormones for a few weeks, at which time it will be determined whether the embryo implanted as expected in the uterus.
Who is a good candidate for IVF?IVF is the treatment of choice for couples who wish to become pregnant with a biological child but have been unable to do so due to one of the following reasons:
• Blocked, damaged or absent fallopian tubes
• Low sperm count
• Couples who have tried other methods of conceiving but who have been unsuccessful in becoming pregnant
The success rate of IVF mirrors the normal pregnancy rate; that is:
• 37% for women < 35 years of age
• 28% for women aged 35 to 39
• 13% for women older than 40
Remember that for all women, there is only a 25 to 30% chance that pregnancy will occur each month with unprotected sex. Rates of miscarriage for women who have undergone IVF are also similar to rates in the non-IVF population.
If you are considering IVF, you will want to research the doctor and the clinic regarding their success rates with IVF. You should have an initial consultation with the doctor who will be performing the procedure, at which time you will both have an opportunity to ask a lot of questions. Make a list of questions before you go so that you do not forget what you wanted to ask when you go to your consult. The doctor will also want to ask you a lot of questions to determine whether you are a good candidate for IVF. Both partners should attend any meetings with the physician, as IVF will require the participation and commitment of both partners.
What else do I need to consider regarding IVF?There are several factors that you will need to think about before undergoing IVF:
• Age- the younger the woman, the greater the chances of success with IVF, as with normal pregnancies. If you are an older woman, make sure you know the statistics before you undergo the procedure.
• Cost- one cycle of IVF (one attempt) will cost somewhere in the neighborhood of $12,000. Discuss beforehand whether you can afford the procedure and how many cycles you would like to attempt, in case the first attempt is unsuccessful. Check with your insurance company to see if any part of the procedure is covered.
• Multiple births- having the IVF procedure raises the risk of having multiples (twins, triplets or higher). Decide beforehand how you would feel if you were told that 4 embryos implanted. Would you want to have all four babies? It is best to have this conversation beforehand. Your doctor will also discuss this issue with you. Make sure everyone is on the same page!
• Extra embryos- sometimes there are more embryos harvested than implanted, leading to extra embryos. Have a plan in place if this occurs and decide beforehand what you will do with extra embryos. Some people choose to destroy them, while others decide to freeze them for later use if desired. Regardless, ensure that you discuss this as a couple, and also with your doctor.
• Rough cycles- the hormones that women take to stimulate their ovaries can cause many unpleasant side effects, such as headaches, moodiness, vaginal dryness, hot flashes and the development of ovarian cysts. Most women do not experience side effects, but have a plan in place in case you are one of the rare women who experience nasty side effects.
If you and your partner have tried to get pregnant on your own without success, IVF may be right for you, particularly if either partner has been diagnosed with certain conditions such as blocked fallopian tubes, low sperm count or endometriosis. Before you decide whether IVF is right for you, do your homework. Be sure that you understand the procedure fully before you commit. IVF is expensive, so be sure that IVF is necessary before making the investment.