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In vitro fertilization (IVF) was first successfully performed in 1978 in the United Kingdom. The most advanced reproductive technology, IVF is performed all over the world and is responsible for the live birth of more than 8 million babies.
“In vitro” is derived from Latin that literally means “in glass,” as the first fertilization of eggs to result in embryos occurred in laboratory glass dishes.
The first human IVF cycle used ovarian stimulating medications, i.e., “natural.” Since that time, most IVF cycles use injectable drugs to “superovulate” a woman’s ovaries to produce multiple mature eggs that will potentially increase the number of embryos and the opportunity for pregnancy.
During stimulation, eggs grow in ovarian cysts called follicles that are monitored using vaginal ultrasound through measurements, usually over 10 days.
Once the eggs have grown inside ovarian follicle cysts (follicles) to near 20 mm, a different hormone injection or “trigger” is necessary to mature the eggs for fertilization.
Depending upon the woman’s stimulation protocol and response to medication, she will receive one of two types of trigger shots:
- hCG (human chorionic gonadotropin)
- leuprolide acetate (Lupron®)
Today, the majority of IVF stimulation cycles use GnRH antagonists due to fewer days of injections and a lower risk of the serious complication of ovarian hyperstimulation syndrome (OHSS). OHSS is a known risk of using the hCG trigger.
The “trigger” shot matures the egg. Then, a strictly timed procedure (usually 36 hours following the trigger) is done to obtain the eggs from the follicles, called egg retrieval.
During this outpatient procedure usually performed under intravenous conscious sedation, your physician uses a vaginal ultrasound-guided needle to pierce the ovary and aspirate the eggs from within each of the follicles.
On average, the procedure lasts for 15 to 20 minutes. Fortunately, patients tolerate the egg retrieval very well and usually can go home within an hour of its completion with mild discomfort.
While complications are uncommon, a patient may experience intra-abdominal bleeding or an injury to an internal organ that may require surgery. She can also develop an infection of her ovary.
After the eggs are collected, they are mixed with the partner’s (or donor’s) sperm in the laboratory and incubated for 5-6 days to produce embryos.
During this entire time, the patient has to take certain medications to promote the growth of the uterine lining in preparation for receiving an embryo.
After the 5 days, an embryo is selected and transferred into the uterus under ultrasound guidance. This is also a simple outpatient procedure that requires no anesthesia or sedation.
If there were any additional embryos formed, they could be frozen and used in future cycles. Some patients choose to freeze all the embryos created and perform the embryo transfer at a later time.
In what cases is in-vitro fertilization needed?
The original purpose of IVF was to assist a woman with fallopian tube damage. Since IVF fertilizes an egg with a sperm in the laboratory, the procedure bypasses the fallopian tubes, where natural fertilization occurs.
Today, IVF has expanded its indication to treat any infertility problem. It is also done for genetic testing of embryos from couples who have a high chance of transmitting abnormal genes, thereby placing a child at risk of genetic disease.
What are the side effects of IVF?
In vitro fertilization (IVF) involves two processes with separate risks. One is ovarian stimulation, and the other is the egg retrieval.
Let’s start with stimulation using fertility medications. Typically, the side effects of the medications involve nausea, breast tenderness, mood swings, and abdominal bloating.
Unique to ovarian stimulation, are the risks of ovarian hyperstimulation syndrome (OHSS) and ovarian torsion. Both of these risks are fortunately very infrequent but serious.
OHSS is a rare complication that occurs when the woman hyperresponds to the medications, resulting in an excessive number of ovarian follicles (cysts growing eggs). It usually happens after receiving the hormone trigger of hCG.
If OHSS occurs, the woman experiences abdominal pain, fluid collection in the abdomen, lightheadedness, and nausea/vomiting. If OHSS is very serious, blood clotting and mortality may occur.
Ovarian torsion occurs when the enlarged stimulated ovary twists on its blood supply, reducing ovarian blood flow and, consequently, pain. Surgery may be required to usually untwist or remove the ovary.
The risk of complications from an egg retrieval is very low and involves infection, bleeding, and injury to internal organs, which may require surgery.
What is the success rate of IVF?
The outcome of IVF embryo transfer has dramatically improved from its beginnings. Success rates are usually based on the woman’s age, with the highest percentage of likelihood for pregnancy in women less than age 35.
In the United States, all clinics are required to report their IVF statistics to the Centers for Disease Control and Prevention (CDC). Also, many clinics provide their statistics to the Society for Assisted Reproductive Technology. (1)
In the CDC’s 2017 Fertility Clinic Success Rates Report, the 284,385 assisted reproductive technology (ART) cycles conducted at 448 reporting clinics all over the United States in 2017 led to 68,908 live births of one or more infants at a time. The figure means these many pregnancies reached their successful fruition, and these live births accounted for the delivery of 78,052 live-born infants in total. (1)
The popularity and effectiveness of ART can be gauged from the fact that nearly 1.7% of all infants born in the United States every year are conceived through this procedure. (1)
What are the chances of an IVF-born baby having birth defects?
In the United States, the risk of birth defects is estimated at 3%-5% of all deliveries. (2)
Medical studies demonstrate a slightly higher risk of birth defects in a child conceived from any infertility patient/couple irrespective of the method of conception, whether IVF, intrauterine insemination (IUI), or a natural cycle without fertility treatment. (3)(4)
So, it appears that the risk of birth defects in the infertility population may be due to the condition of infertility rather than any treatment.
Does going through the IVF procedure make you gain weight?
Female hormone fertility treatment usually comes with a mild risk of increasing weight. This is usually seen during treatment and is typically temporary.
What diseases and medical conditions are not favorable for or may increase the risk of complications with IVF?
Prior to any infertility treatment, a woman’s health must be optimized to avoid harming her health and a pregnancy. Although not meant to be a complete list, the following health conditions contraindicate a pregnancy:
- Severe pulmonary hypertension or Eisenmenger’s syndrome
- Unrepaired cyanotic congenital heart disease
- History of peripartum cardiomyopathy
- Severe uncorrected valvular stenosis
- Cardiomyopathy with NYHA class III or IV symptoms
- Marfan syndrome with an abnormal aorta
Certain medications can cause harm in pregnancy. All women should consult their obstetrician regarding the use of medications and their safety in pregnancy.
Medications are assigned categories, with the safest classified as “A” and the most risk to the baby classified as “X.”
Can women suffering from endometriosis or PCOS use IVF to get pregnant?
Virtually all women diagnosed with infertility are candidates for IVF (which involves using their own eggs), except for primary ovarian insufficiency (previously called premature ovarian failure).
What points should be kept in mind when going through an IVF procedure?
Here are six ways to deal with your upcoming IVF cycle:
- Realistic expectations: Infertility can give rise to a lot of emotional turmoil, which can take a toll on the patient’s mental health. Patients who opt for IVF, place a lot of hope in the treatment and naturally worry about its results.Stress is counterproductive to fertility, but it is hard not to let it get to you when there is so much riding on the success of the treatment. If the treatment fails to deliver the desired results, the disappointment can be hard to overcome.To avoid any such major setbacks, you must prepare yourself for all possible outcomes. It is imperative to consult your fertility doctor about what to expect from the treatment and just how likely is it to be successful.
Starting your journey with realistic expectations is the best way to avoid any drastic emotional highs or lows.
- Consider physical, emotional, and financial factors: Infertility decisions are based on three important factors: the invasiveness of the treatment, its impact on the quality of your life, and the cost of the procedure.Once a patient considers all three of these factors, the burden of choosing a direction to pursue can be lessened.
- If you are a couple, be on the same page: The decision to proceed with IVF must be mutual between the couple, and the support for each other must be constant. Whether you are a single woman or couple undergoing IVF, a strong support system can facilitate a less stressful journey.
- Ensure you have options if IVF is unsuccessful: When preparing for IVF, your emotions can range from excitement to fear and from anxious to panic, all with the expectation for success.Having a well-thought-out plan B before your cycle can help maintain your pursuit of a family if IVF does not result in a pregnancy.
- Vet your physician and clinic: Most infertility practices have websites that introduce you to their practice and express their expertise. However, not all clinics have the same success, disclosure, or compassionate care.By doing your homework before deciding on IVF, you will determine the correct center that matches your needs.
- Be your own advocate and avoid procedures that are not supported by medical evidence: The field of infertility has become a perfect storm of desperate patients and poorly covered expensive treatment, all circling in a multibillion-dollar industry.Physicians must only provide evidence-based medicine to optimize outcomes and reduce unnecessary patient expenses. This is vital to avoid the risk of patient exploitation.
Should any dietary changes be made while on IVF cycles?
No diet has been definitively proven to increase fertility through IVF. However, patients are advised to have a normal BMI and an appropriate level of exercise.
What lifestyle changes should be made to increase the success rate of IVF?
In addition to a proper BMI and exercise, women should limit their alcohol intake while trying to conceive (and avoid it completely throughout the pregnancy). Both women and men should avoid tobacco/vaping/marijuana or any recreational drug use.
Are IVF injections necessary for every individual?
While there is no “one-size fits all,” there are several different ovarian stimulation protocols in which IVF-ET (embryo transfer) can be performed.
In these protocols, the patient is generally administered a relatively low-cost oral fertility drug, like clomiphene citrate or letrozole, early in the cycle, followed by a low dose of injectable drugs called gonadotropins.
During stimulation, another injectable medication is used to prevent premature ovulation and the release of the eggs – a GnRH agonist or GnRH antagonists.
Full stimulation protocols are generally more successful than minimal stimulation protocols, but the latter can work better for certain populations, including:
- Women who are not very responsive to fertility medication and do not produce many follicles even with the highest dose stimulation.
- Women who are highly responsive to fertility medication, which puts them at an increased risk of developing ovarian hyperstimulation syndrome (OHSS)
- Women who do not wish to freeze their embryo or want to limit the number of eggs to be fertilized, for ethical or religious reasons
Natural cycle IVF refers to protocols that do not use any ovarian stimulating medications, except usually the hCG trigger shot to prepare the egg(s) for retrieval.
This procedure is not very different from the standard in vitro fertilization and embryo transfer (IVF-ET), as it involves the same or almost identical basic techniques.
These techniques include oocyte retrieval, insemination, embryo culture, embryo transfer, progesterone supplementation after the embryo transfer, and pregnancy testing after the embryo transfer.
Since women undergoing minimal stimulation or natural cycle IVF-ET have only one follicle (a few at most), it may be possible to perform the oocyte retrieval procedure without putting the patient under anesthesia.
The decision to use or forego anesthesia depends on the woman’s tolerance for the procedure.
Why is the failure rate of in vitro fertilization (IVF) so high?
To understand the reason for in vitro fertilization (IVF) success rates, natural fertility must first be understood.
The monthly chance of conception for women less than age 30 is approximately 25%. Due to ovarian aging, the rate of success continues to decline thereafter: 10%-15% monthly fertility at age 35, declining to approximately 5% at age 40.
So, IVF is greatly affected by a woman’s age, among other prognostic factors. Nevertheless, the monthly success rates with IVF are typically higher than natural pregnancy rates.
Why are women who undergo IVF treatment more prone to depression?
Studies have shown the psychological impact of infertility is very intense. One should never underestimate the devastation of infertility despite the outward expression of a person. (5)
Two moments are profound in a woman’s life – the time to discontinue contraception and the realization she may have infertility.
This desire to procreate is often one of life’s major goals, and many women (and men) consider it a defining process of their lives.
As a result, the inability or difficulty in building a family can result in significant mental health challenges that may require the involvement of a reproductive health counselor.