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During in vitro fertilization (IVF), eggs
and sperm are brought together in a laboratory glass dish to allow the sperm to
fertilize an egg. With IVF, you can use any combination of your own eggs and
sperm and donor eggs and sperm.
After IVF, one or more fertilized eggs are placed in the uterus.
Ovulation and egg retrieval. To prepare for an assisted reproductive procedure using your
own eggs, you will require hormone treatment to control your egg production
(ovulation). This is done to prevent unpredictable ovulation, which would make
it necessary to cancel that in vitro attempt. This is typically done using one
of two similar types of
gonadotropin-releasing hormone analogue (GnRH agonist or GnRH antagonist). The following are two examples of how ovulation can be
After the first week, your doctor checks your blood
estrogen levels and uses
ultrasound to see whether eggs are maturing in the
follicles. During the second week, your dosage may
change based on test results. And you are monitored frequently with
transvaginal ultrasound and blood tests. If follicles fully develop, you are
given a human chorionic gonadotropin (hCG) injection to stimulate the follicles
to mature. The mature eggs are collected 34 to 36 hours later by needle
aspiration guided by ultrasound. You will usually have pain medicine and
sedation for this procedure.
Sperm collection. Sperm are collected by means of masturbation
or by taking sperm from a
testicle through a small incision. This procedure is
done when a blockage prevents sperm from being ejaculated or when there is
a problem with sperm development. Sperm may have been collected and frozen at an earlier time. Then the sperm are thawed on the day the eggs are collected.
Fertilization and embryo transfer. The eggs and sperm are placed in a glass dish and
incubated with careful temperature, atmospheric, and infection control for 48
to 120 hours. About 2 to 5 days after fertilization, the best fertilized eggs
are selected. One to three are placed in the uterus using a thin flexible tube
(catheter) that is inserted through the cervix. Those remaining may be frozen
(cryopreserved) for future attempts.
Pregnancy and birth. Any
embryos that implant in the uterus may then result in
pregnancy and birth of one or more infants.
Overall, in vitro fertilization
(IVF)-related injections, monitoring, and procedures are emotionally and
physically demanding of the female partner. Superovulation with hormones
requires regular blood tests, daily injections (some of which are quite
painful), frequent monitoring by your doctor, and harvesting of eggs.
These procedures are done on an outpatient basis and require only a short
recovery time. You may have cramping during the procedure. You may be advised
to avoid strenuous activities for the remainder of the day or to be on bed rest
for a few days, depending on your condition and your doctor's
In vitro fertilization may be a
treatment option if:
IVF can be done even if a:
IVF can be done using donor eggs for women who cannot
produce their own eggs due to advanced age or other causes.
The number of women who have babies
after in vitro fertilization varies, depending on many different things. Almost
assisted reproductive technology (ART) procedures are done using IVF.
Birth rates resulting from a single cycle of IVF using women's own eggs are
about 30% to 40% for women age 34 and younger, then rates decrease steadily after age
aging of the egg supply has a powerful effect on the chances that an assisted
reproductive technology (ART) procedure will result in pregnancy and a healthy
Cause of infertility. Infertility can be caused
by problems with the woman's or the man's reproductive system. Some of these
causes can include problems with the fallopian tubes, with
or with the sperm.
Pregnancy history. A
woman who has already had a live birth is more likely to have a successful ART
procedure than a woman who hasn't given birth before. This "previous birth
advantage" gradually narrows as women age from their early 30s to their
Own eggs versus donor eggs. Birth rates are affected by whether ART procedures use a
woman's own eggs or donor eggs. Many women over age 40 choose to use donor
eggs, which greatly improves their chances of giving birth to healthy babies.
For each cycle of in vitro fertilization:1
Frozen embryos versus fresh embryos. Donor-frozen IVF embryos from a previous IVF cycle that are thawed and transferred to
the uterus are less likely to result in a live birth than are donor-fresh
(newly fertilized) IVF embryos.1 But frozen embryos
are less expensive and less invasive for a woman, because superovulation and
egg retrieval aren't needed.
In vitro fertilization (IVF) increases the risks
of ovarian hyperstimulation
syndrome and multiple pregnancy.
There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques, such as IVF. Talk with your doctor about these possible risks.
For a woman over age 35 to maximize her chances of
conceiving with her own eggs and carrying a healthy pregnancy, she may choose
to have more embryos transferred than a younger woman would. But this increases
her risk of multiple pregnancy.
Because of the risks to the babies of multiple
pregnancy, experts recommend limiting the number of embryos transferred. Your doctor will recommend a certain number of embryos to be transferred based on your age and specific situation.
Women over 40
have a high rate of embryo loss when using their own eggs. As an alternative,
older women can choose to use more viable donor eggs. When a woman uses donor
eggs, experts recommend using the donor's age to help figure out how many
embryos to transfer.2
a damaging effect on fertility and pregnancy. Smoking reduces the chance that IVF will work.
Smoking can also affect the health of the fetus.
fertilization provides diagnostic information about fertilization and embryo
development (which is not the case with a
GIFT or ZIFT procedure).
to help collect eggs from the woman's ovaries is less expensive, less risky,
and less invasive than egg collection by
In the United
States, a cycle of in vitro fertilization costs approximately $10,000 to
If you and your doctor are concerned about passing on a
genetic disorder to your child, preimplantation genetic diagnosis might be
available. Some genetic disorders can be identified with specialized testing
before an embryo is transferred, increasing the chances of conceiving a healthy
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
Centers for Disease Control and Prevention, American Society for Reproductive Medicine, and Society for Assisted Reproductive Technology (2010). 2010 Assisted Reproductive Technology National Summary Report. Available online: http://www.cdc.gov/art/ART2010/PDFs/ART_2010_National_Summary_Report.pdf.
Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology (2013). Criteria for number of embryos to transfer: A committee opinion. Fertility and Sterility, 99(1): 44–46.
Current as of:
June 4, 2014
Kathleen Romito, MD - Family Medicine & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
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