In-Vitro Fertilization (IVF)

What is IVF?

IVF is the common acronym for In-Vitro Fertilization, a frequently used conception practice when there are certain issues with the reproductive health of the mother, father, or both. IVF is simply the uniting of egg and sperm in vitro (in the lab). Subsequently the embryos are transferred into the uterus through the cervix and pregnancy is allowed to begin. The process is done in conjunction with ovulation induction through drugs, monitoring of hormone levels and follicle scans with ultrasound.

How common is infertility and IVF?

More than six million people in the United States are affected by infertility. While there are a number of assisted reproductive technologies (ART) available to infertile couples, in vitro fertilization (IVF) is by far the most utilized of these methods. In fact, IVF accounts for more than 99 percent of all ART procedures and is the oldest ART procedure with the first baby born in 1978. IVF was introduced in the United States in 1981 and from 1985 through 2000 and more than 139,000 births of babies conceived through IVF. Through the end of 2002, almost 300,000 babies have been born in the US as a result of reported ART procedures.

Is IVF usually successful?

The average live delivery rate for IVF in 2000 was 29.9 per cent per retrieval, similar to the 20 percent chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term. In 2002, approximately one in every hundred babies born in the United States was conceived using ART. The average couple will need three attempts before obtaining a pregnancy through IVF, all depending on their diagnosis. Some couples will have more than one cause of infertility making IVF the only realistic option for achieving pregnancy.

When should I consider IVF?

If you are under 35 and have been trying to conceive for a year, or if you are over 35 and have been trying for 6 months, you may want to explore the possibility of IVF. IVF is taxing and expensive, so you will want to do tests with your doctor to determine that this is the best route for you. Some good candidates for IVF include those who have:

• Tubal problems can mean a woman’s fallopian tubes are blocked or damaged, which can make it difficult for the egg to be fertilized or for an embryo to travel to the uterus.
• Male factor can include a low sperm count, problems with sperm function or motility which can inhibit sperm from fertilizing an egg on its own.
• Severe Endometriosis affecting both fertilization of the egg and implantation of the embryo in the uterus.
• Ovarian issues which prevent the release or production of eggs.
• Abnormal uterus shape, fibroid tumors, or exposure to diethylstilbestrol (DES) as a fetus.
• Unexplained infertility

What is the process for conceiving through IVF?

IVF consists of numerous steps, they are:

• Ovulation Induction: Injectable medication is used to stimulate development of multiple mature follicles. The eggs develop in structures in the ovaries called follicles. Some women do not develop mature follicles without help from medication. Each follicle contains one egg and can be seen through ultrasound.
• Retrieval: When the woman’s follicles are mature, the egg aspiration procedure is performed to remove the eggs. With the woman under powerful drugs to prevent pain, a needle is passed through the top of the vagina under ultrasound guidance to retrieve the ovary and follicles.
• Fertilization: Sperm is mixed with the eggs about four hours after the egg aspiration, and can be checked the following day to see if fertilization has occurred.
• Embryo Culture: The fertilized eggs, now embryos, are cultured in the laboratory for up to five days and then an appropriate number are selected for transfer to the woman’s uterus.
• Transferring Embryos to the Uterus: Typically 2-4 embryos are transferred in a procedure similar to a Pap smear. Success for this part of the procedure depends on the delicate placement of the embryos near the top of the endometrial cavity. The embryo transfer catheter is loaded with the embryos and it is put through the cervical opening up through to the top of the uterine cavity. This is not painful and no drugs are necessary. The embryos are then squirted out of the catheter to the endometrial lining of the uterine cavity and the transfer is complete. The woman usually stays on her back for 1-2 hours and then relaxes completely for the next day or two.
• Test for Pregnancy: About 11 days after the transfer, a blood test is done on the woman to find out if she is pregnant.

If I conceive with IVF will my baby have the same odds of being healthy as if I had conceived naturally?

Yes, recent research has shown no increased risk of prematurity, pregnancy hypertension, extended delivery, need for C-section, or other delivery complications, and children resulting from IVF have the same incidence of birth defects as children who are conceived naturally. There are slightly elevated numbers of miscarriages among IVF mothers, but this may be due to the close monitoring of these woman, versus woman in the general population that may not have been aware of their pregnancy prior to (or following) their miscarriage.

However, this assumes all critical factors are the same such as age, number of births, exposure to carcinogens, condition of the mother’s body and uterus. This does not take into account if the mother has twins or triplets with IVF, which elevates many risks including increased miscarriage rate, low birth weight, prematurity, abnormal presentations, prolapse of umbilical cord, placental abruption, fetal distress and bleeding after delivery.

Does IVF increase my chance of having twins or triplets?

Of the 78 percent of pregnancies as a result of IVF that result in a live birth, about 50 percent are singletons, 24 percent are twins and 5 percent are triplets or more. The natural rate of multiple births is around one percent, however where a pregnancy results from assisted reproduction, the rate rises to 20-40 percent. In IVF procedures, the step where the sperm penetrates the ovum is achieved in the lab to increase the odds of success of pregnancy. Because many couples have multiple successful embryos implanted, the chance of more than one of them thriving is higher. Also, the percentage of male fetuses decreases as the number of fetuses per pregnancy increases, resulting in more females being born in multiple pregnancies.

What are the costs of IVF?

The average cost of a single IVF procedure in the U.S. is $12,500 on average (it can vary significantly, depending on where and what doctor) and many insurers provide zero or minimal coverage. If you are using an egg donor, compensation for the donor and the egg-donation agency can double the costs. Because success is not assured, remember that you may need to pay for multiple attempts. When you are quoted a price, remember to ask what the costs cover, including pre and post care, the actual procedure, drugs, and any associated lab and ultrasound fees.

Does insurance cover the IVF procedures?

The high cost of infertility treatment, especially IVF, has resulted in reluctance on the part of most insurance companies to provide benefits for infertility and therefore, has rendered such medical intervention financially inaccessible to the general infertile population.

Fourteen states currently have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. However, the laws vary greatly in their scope of what is required and such coverage is often limited, or absent altogether due to regulatory loopholes. For more information about the specific laws for each of those states, please call your state's Insurance Commissioner's office or your State Representatives to learn about pending insurance legislation in your state.

The majority of employer groups as well as health insurance providers continue to avoid voluntarily including infertility benefits. Whether or not you live in a state with an infertility insurance law, you should consult with your employer’s director of human resources to determine the exact coverage your plan provides.

How does natural conception occur?

Conception, or fertilization, occurs when the male’s sperm meets with the woman’s ovum (egg) and successfully penetrates it. This typically takes place in one of the woman’s fallopian tubes and the fertilized egg then travels to the uterus and implants in the uterine lining. For pregnancy to take place, fertilization of the egg must be followed by a successful implantation. Only one egg is released for fertilization in each menstrual cycle. If this egg is not fertilized, conception will not be possible again until the next cycle. See Pregnancy Conception - Overview FAQ for more information.

What are some of the more popular methods of natural conception?

Many couples use the tried and true method of having sex every other day. It is true that sperm can live for 24 to 48 hours in the woman after sex. If you’re consistently having sex on that frequent basis, ovulation will eventually occur and conception should happen in that window of time. Obviously, this works only if the woman is ovulating properly and the man and the woman have no reproductive health issues.

While this method may work for some couples, other couple’s lifestyle or desires may prevent this from being an effective method. For those couples, using ovulation predictor kits may help considerably. These easy to use kits tell the woman when she is ovulating so the couple’s sex activities can be more targeted to the appropriate time-frame. See Ovulation Kits for more information.

Another popular natural method is the Fertility Awareness Method (FAM). It promotes the understanding and tracking of a woman’s ovulation cycles to give the couple a better chance of conceiving. See Fertility Awareness Method for more information.