Ivf medical term

In vitro fertilization (IVF) - Mayo Clinic

Overview

In vitro fertilization

During in vitro fertilization, eggs are removed from mature follicles within an ovary (A). An egg is fertilized by injecting a single sperm into the egg or mixing the egg with sperm in a petri dish (B). The fertilized egg (embryo) is transferred into the uterus (C).

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using a couple's own eggs and sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — someone who has an embryo implanted in the uterus — might be used.

Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. In addition, IVF can be time-consuming, expensive and invasive. If more than one embryo is transferred to the uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy).

Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

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Why it's done

In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less-invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in the uterus near the time of ovulation.

Sometimes, IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
Endometriosis. Endometriosis occurs when tissue similar to the lining of the uterus implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
Uterine fibroids. Fibroids are benign tumors in the uterus. They are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
Previous tubal sterilization or removal. Tubal ligation is a type of sterilization in which the fallopian tubes are cut or blocked to permanently prevent pregnancy. If you wish to conceive after tubal ligation, IVF may be an alternative to tubal ligation reversal surgery.
Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, a visit to an infertility specialist might be needed to see if there are correctable problems or underlying health concerns.
Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.
Fertility preservation for cancer or other health conditions. If you're about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.

Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman's eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier's uterus.

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Risks

Risks of IVF include:

Multiple births. IVF increases the risk of multiple births if more than one embryo is transferred to your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does.
Premature delivery and low birth weight. Research suggests that IVF slightly increases the risk that the baby will be born early or with a low birth weight.
Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful.

Symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.
Miscarriage. The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15% to 25% — but the rate increases with maternal age.
Egg-retrieval procedure complications. Use of an aspirating needle to collect eggs could possibly cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also associated with sedation and general anesthesia, if used.
Ectopic pregnancy. About 2% to 5% of women who use IVF will have an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can't survive outside the uterus, and there's no way to continue the pregnancy.
Birth defects. The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived. More research is needed to determine whether babies conceived using IVF might be at increased risk of certain birth defects.
Cancer. Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumor, more-recent studies do not support these findings. There does not appear to be a significantly increased risk of breast, endometrial, cervical or ovarian cancer after IVF.
Stress. Use of IVF can be financially, physically and emotionally draining. Support from counselors, family and friends can help you and your partner through the ups and downs of infertility treatment.

How you prepare

The Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology provide information online about U. S. clinics' individual pregnancy and live birth rates.

A clinic's success rate depends on many factors. These include patients' ages and medical issues, as well as the clinic's treatment population and treatment approaches. Ask for detailed information about the costs associated with each step of the procedure.

Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screenings, including:

Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone in your blood during the first few days of your menstrual cycle. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.
Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.
Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV.
Practice (mock) embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.
Uterine exam. Your doctor will examine the inside lining of the uterus before you start IVF. This might involve a sonohysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.

Before beginning a cycle of IVF, consider important questions, including:

How many embryos will be transferred? The number of embryos transferred is typically based on age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs or genetically tested embryos.

Most doctors follow specific guidelines to prevent a higher order multiple pregnancy, such as triplets or more. In some countries, legislation limits the number of embryos that can be transferred. Make sure you and your doctor agree on the number of embryos that will be transferred before the transfer procedure.
What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will.

Having frozen embryos can make future cycles of IVF less expensive and less invasive. Or, you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.
How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.
Have you considered the potential complications associated with using donor eggs, sperm or embryos, or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You may also need an attorney to file court papers to help you become legal parents of an implanted embryo.

What you can expect

IVF involves several steps — ovarian stimulation, egg retrieval, sperm retrieval, fertilization and embryo transfer. One cycle of IVF can take about two to three weeks. More than one cycle may be needed.

Ovulation induction

The start of an IVF cycle begins by using synthetic hormones to stimulate the ovaries to produce multiple eggs — rather than the single egg that typically develops each month. Multiple eggs are needed because some eggs won't fertilize or develop normally after fertilization.

Several different medications may be used, such as:

Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.
Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally after eight to 14 days — you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.
Medications to prevent premature ovulation. These medications prevent your body from releasing the developing eggs too soon.
Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.

Your doctor will work with you to determine which medications to use and when to use them.

Typically, you'll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, you may have:

Vaginal ultrasound, an imaging exam of your ovaries to monitor the development of follicles — fluid-filled ovarian sacs where eggs mature
Blood tests, to measure your response to ovarian stimulation medications — estrogen levels typically increase as follicles develop, and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled before egg retrieval for one of these reasons:

Inadequate number of follicles developing
Premature ovulation
Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome
Other medical issues

If your cycle is canceled, your doctor might recommend changing medications or their doses to promote a better response during future IVF cycles. Or you may be advised that you need an egg donor.

Egg retrieval

Egg retrieval can be done in your doctor's office or a clinic 34 to 36 hours after the final injection and before ovulation.

During egg retrieval, you'll be sedated and given pain medication.
Transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs.
If your ovaries aren't accessible through transvaginal ultrasound, an abdominal ultrasound may be used to guide the needle.
The eggs are removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 20 minutes.
After egg retrieval, you may experience cramping and feelings of fullness or pressure.
Mature eggs are placed in a nutritive liquid (culture medium) and incubated. Eggs that appear healthy and mature will be mixed with sperm to attempt to create embryos. However, not all eggs may be successfully fertilized.

Sperm retrieval

If you're using your partner's sperm, a semen sample needs to be provided at your doctor's office or clinic the morning of egg retrieval. Typically, the semen sample is collected through masturbation. Other methods, such as testicular aspiration — the use of a needle or surgical procedure to extract sperm directly from the testicle — are sometimes required. Donor sperm also can be used. Sperm are separated from the semen fluid in the lab.

Fertilization

Fertilization can be attempted using two common methods:

Conventional insemination. During conventional insemination, healthy sperm and mature eggs are mixed and incubated overnight.
Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.

In certain situations, your doctor may recommend other procedures before embryo transfer.

Assisted hatching. About five to six days after fertilization, an embryo "hatches" from its surrounding membrane (zona pellucida), allowing it to implant into the lining of the uterus. If you're an older woman, or if you have had multiple failed IVF attempts, your doctor might recommend assisted hatching — a technique in which a hole is made in the zona pellucida just before transfer to help the embryo hatch and implant. Assisted hatching is also useful for eggs or embryos that have been previously frozen as the process can harden the zona pellucida.
Preimplantation genetic testing. Embryos are allowed to develop in the incubator until they reach a stage where a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes, typically after five to six days of development. Embryos that don't contain affected genes or chromosomes can be transferred to your uterus. While preimplantation genetic testing can reduce the likelihood that a parent will pass on a genetic problem, it can't eliminate the risk. Prenatal testing may still be recommended.

Embryo transfer

Egg-retrieval technique

Typically, transvaginal ultrasound aspiration is used to retrieve eggs. During this procedure, an ultrasound probe is inserted into your vagina to identify follicles, and a needle is guided through the vagina and into the follicles. The eggs are removed from the follicles through the needle, which is connected to a suction device.

ICSI

In intracytoplasmic sperm injection (ICSI), a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior in vitro fertilization cycles failed.

Blastocyst

Three days after fertilization, a normally developing embryo will contain about six to 10 cells. By the fifth or sixth day, the fertilized egg is known as a blastocyst — a rapidly dividing ball of cells. The inner group of cells will become the embryo. The outer group will become the cells that nourish and protect it.

Embryo transfer is done at your doctor's office or a clinic and usually takes place two to five days after egg retrieval.

You might be given a mild sedative. The procedure is usually painless, although you might experience mild cramping.
The doctor will insert a long, thin, flexible tube called a catheter into your vagina, through your cervix and into your uterus.
A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter.
Using the syringe, the doctor places the embryo or embryos into your uterus.

If successful, an embryo will implant in the lining of your uterus about six to 10 days after egg retrieval.

After the procedure

After the embryo transfer, you can resume your usual daily activities. However, your ovaries may still be enlarged. Consider avoiding vigorous activity, which could cause discomfort.

Typical side effects include:

Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer
Breast tenderness due to high estrogen levels
Mild bloating
Mild cramping
Constipation

If you develop moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection, twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulation syndrome.

Results

About 12 days to two weeks after egg retrieval, your doctor will test a sample of your blood to detect whether you're pregnant.

If you're pregnant, your doctor will refer you to an obstetrician or other pregnancy specialist for prenatal care.
If you're not pregnant, you'll stop taking progesterone and likely get your period within a week. If you don't get your period or you have unusual bleeding, contact your doctor. If you're interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.
Embryo status. Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less-developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or other care provider about your specific situation.
Reproductive history. Women who've previously given birth are more likely to be able to get pregnant using IVF than are women who've never given birth. Success rates are lower for women who've previously used IVF multiple times but didn't get pregnant.
Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility.
Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman's chance of success using IVF by 50%. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful.

Talk with your doctor about any factors that apply to you and how they may affect your chances of a successful pregnancy.

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In vitro fertilization (IVF): MedlinePlus Medical Encyclopedia

In vitro fertilization (IVF) is the joining of a woman's egg and a man's sperm in a laboratory dish. In vitro means outside the body. Fertilization means the sperm has attached to and entered the egg.

Normally, an egg and sperm are fertilized inside a woman's body. If the fertilized egg attaches to the lining of the womb and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception.

IVF is a form of assisted reproductive technology (ART). This means special medical techniques are used to help a woman become pregnant. It is most often tried when other, less expensive fertility techniques have failed.

There are five basic steps to IVF:

Step 1: Stimulation, also called super ovulation

Medicines, called fertility drugs, are given to the woman to boost egg production.
Normally, a woman produces one egg per month. Fertility drugs tell the ovaries to produce several eggs.
During this step, the woman will have regular transvaginal ultrasounds to examine the ovaries and blood tests to check hormone levels.

Step 2: Egg retrieval

A minor surgery, called follicular aspiration, is done to remove the eggs from the woman's body.
The surgery is done in the doctor's office most of the time. The woman will be given medicines so she does not feel pain during the procedure. Using ultrasound images as a guide, the health care provider inserts a thin needle through the vagina into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time.
The procedure is repeated for the other ovary. There may be some cramping after the procedure, but it will go away within a day.
In rare cases, a pelvic laparoscopy may be needed to remove the eggs. If a woman does not or cannot produce any eggs, donated eggs may be used.

Step 3: Insemination and fertilization

The man's sperm is placed together with the best quality eggs. The mixing of the sperm and egg is called insemination.
Eggs and sperm are then stored in an environmentally controlled chamber. The sperm most often enters (fertilizes) an egg a few hours after insemination.
If the doctor thinks the chance of fertilization is low, the sperm may be directly injected into the egg. This is called intracytoplasmic sperm injection (ICSI).
Many fertility programs routinely do ICSI on some of the eggs, even if things appear normal.

Watch this video about:Intracytoplasmic sperm injection

Step 4: Embryo culture

When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly check the embryo to make sure it is growing properly. Within about 5 days, a normal embryo has several cells that are actively dividing.
Couples who have a high risk of passing a genetic (hereditary) disorder to a child may consider pre-implantation genetic diagnosis (PGD). The procedure is most often done 3 to 5 days after fertilization. Laboratory scientists remove a single cell or cells from each embryo and screen the material for specific genetic disorders.
According to the American Society for Reproductive Medicine, PGD can help parents decide which embryos to implant. This decreases the chance of passing a disorder onto a child. The technique is controversial and not offered at all centers.

Step 5: Embryo transfer

Embryos are placed into the woman's womb 3 to 5 days after egg retrieval and fertilization.
The procedure is done in the doctor's office while the woman is awake. The doctor inserts a thin tube (catheter) containing the embryos into the woman's vagina, through the cervix, and up into the womb. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results.
More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman's age.
Unused embryos may be frozen and implanted or donated at a later date.

IVF is done to help a woman become pregnant. It is used to treat many causes of infertility, including:

Advanced age of the woman (advanced maternal age)
Damaged or blocked fallopian tubes (can be caused by pelvic inflammatory disease or prior reproductive surgery)
Endometriosis
Male factor infertility, including decreased sperm count and blockage
Unexplained infertility

IVF involves large amounts of physical and emotional energy, time, and money. Many couples dealing with infertility suffer stress and depression.

A woman taking fertility medicines may have bloating, abdominal pain, mood swings, headaches, and other side effects. Repeated IVF injections can cause bruising.

In rare cases, fertility drugs may cause ovarian hyperstimulation syndrome (OHSS). This condition causes a buildup of fluid in the abdomen and chest. Symptoms include abdominal pain, bloating, rapid weight gain (10 pounds or 4. 5 kilograms within 3 to 5 days), decreased urination despite drinking plenty of fluids, nausea, vomiting, and shortness of breath. Mild cases can be treated with bed rest. More severe cases require draining of the fluid with a needle and possibly hospitalization.

Medical studies have shown so far that fertility drugs are not linked to ovarian cancer.

Risks of egg retrieval include reactions to anesthesia, bleeding, infection, and damage to structures surrounding the ovaries, such as bowel and bladder.

There is a risk for multiple pregnancies when more than one embryo is placed into the womb. Carrying more than one baby at a time increases the risk for premature birth and low birth weight. (However, even a single baby born after IVF is at higher risk for prematurity and low birth weight.)

It is unclear whether IVF increases the risk for birth defects.

IVF is very costly. Some, but not all, states have laws that say health insurance companies must offer some type of coverage. But, many insurance plans do not cover infertility treatment. Fees for a single IVF cycle include costs for medicines, surgery, anesthesia, ultrasounds, blood tests, processing the eggs and sperm, embryo storage, and embryo transfer. The exact total of a single IVF cycle varies, but may cost from approximately $12,000 to $17,000.

After embryo transfer, the woman may be told to rest for the remainder of the day. Complete bed rest is not necessary, unless there is an increased risk for OHSS. Most women return to normal activities the next day.

Women who undergo IVF must take daily shots or pills of the hormone progesterone for 8 to 10 weeks after the embryo transfer. Progesterone is a hormone produced naturally by the ovaries that prepares the lining of the uterus (womb) so that an embryo can attach. Progesterone also helps an implanted embryo grow and become established in the uterus. A woman may continue to take progesterone for 8 to 12 weeks after becoming pregnant. Too little progesterone during the early weeks of pregnancy may lead to miscarriage.

About 12 to 14 days after the embryo transfer, the woman will return to the clinic so that a pregnancy test can be done.

Contact your provider right away if you had IVF and have:

A fever over 100.5°F (38°C)
Pelvic pain
Heavy bleeding from the vagina
Blood in the urine

Statistics vary from one clinic to another and must be looked at carefully. However, patient populations are different in each clinic, so reported pregnancy rates cannot be used as an accurate indication of one clinic being preferable to another.

Pregnancy rates reflect the number of women who became pregnant after IVF. But not all pregnancies result in a live birth.
Live birth rates reflect the number of women who give birth to a living child.

Outlook of live birth rates depend on certain factors such as mother age, prior live birth, and single embryo transfer during IVF. Success rates have changed over the years in part due to the increasing use of single embryo transfers. IVF clinics have encouraged single embryo transfers to reduce the risk of twin pregnancies, which have higher risk for complications than singleton pregnancies. Embryos not transferred may be frozen and saved. The cycles in which those frozen embryos are thawed and transferred are called frozen embryo transfer cycles (FET).

IVF; Assisted reproductive technology; ART; Test-tube baby procedure; Infertility - in vitro

Catherino WH. Reproductive endocrinology and infertility. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 223.

Forman EJ, Lobo RA. In vitro fertilization. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 41.

Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2021;116(3):651-654. PMID: 34330423 pubmed.ncbi.nlm.nih.gov/34330423/.

Tsen LC. In vitro fertilization and other assisted reproductive technology. In: Chestnut DH, Wong CA, Tsen LC, et al, eds. Chestnut's Obstetrics Anesthesia. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 15.

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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what is this procedure? How is the IVF procedure carried out? – health articles

An increasing number of couples today are diagnosed with infertility. The problem is widespread not only in our country, but also abroad, and specialists in the field of reproduction are actively developing new methods and technologies to combat it. One of these methods is IVF (in vitro fertilization).

How can you become parents with infertility?

A few years ago, the diagnosis sounded like a sentence. Many couples had to just put up with it. Moreover, often marriages broke up precisely because of the impossibility of one or both spouses to have children.

In the 20th century, the IVF method appeared, with which pregnancy became possible even with infertility. Today it is being actively developed and improved, there are more and more new ways of carrying out various manipulations. This increases the effectiveness of programs and increases the chances of having a child.

What is IVF?

The presence of the word "extracorporeal" in the name of the technique implies that fertilization is carried out outside the body of the mother of the unborn baby. This assisted reproductive technology includes a whole range of different procedures, which lasts about two weeks.

The effectiveness of the IVF program is on average 30-40%. Most couples need several procedures to achieve the desired pregnancy. If the first IVF cycle ended in failure, this is not a reason to give up. On the contrary, the reproductologist will take into account all the features of the first cycle, analyze each stage, which will allow taking risks into account in subsequent cycles.

The result of using the methodology depends on a number of factors, including:

Woman's age
Causes of infertility and its duration
Concomitant factors: the presence of various pathologies and diseases of internal organs, the current state of sexual partners, the state of the endometrium, the quality of eggs, genetic factors, lifestyle, the health of a man

How is in vitro fertilization performed? Milestones

Immediately after contacting the clinic, a woman and a man are sent for a comprehensive examination. It is carried out in order to identify diseases and pathological conditions that may be contraindications to the implementation of the IVF program and have a negative impact on the onset and course of pregnancy. If such problems are found, doctors will first perform the necessary therapy. This will increase the chances of a favorable outcome of the IVF program.

Diagnostic complex includes:

Assessment of the state of the pelvic organs, mammary glands, thyroid gland
Hormone profiling
Examination for urogenital infection
Tests for syphilis, hepatitis B and C, HIV
Tests for TORCH
Fluorography
Consultation of a general practitioner regarding the possibility of carrying a pregnancy and a conclusion on the state of health
Clinical, biochemical blood tests, coagulogram, urinalysis, ECG
Cervical cytology
Determination of blood group and Rh factor
Spermogram with evaluation of spermatozoa morphology according to Kruger, MAR-test

Also, patients can be referred for a consultation with an endocrinologist, mammologist, urologist-andrologist and other narrow specialists.

Preparatory phase

Couples who plan to use in vitro fertilization for the birth of a child need a thorough diagnosis of reproductive function and the general condition of the body. Examination before IVF allows you to identify health problems at this stage and solve them. This increases the chances of a successful onset and gestation.

Based on the results of the examination, the reproductologist determines an individual treatment regimen for the spouses before IVF.

First stage. Controlled Ovarian Stimulation

To increase the chance of pregnancy, a woman is prescribed hormonal drugs that contribute to the maturation of several follicles at the same time. One ovum matures in each follicle. The dose of the administered drug is selected individually, taking into account the age of the woman, her weight and the initial state of the ovaries. During stimulation

Second stage. Follicle puncture

Using ultrasound, doctors monitor the growth of follicles. At the right time, when they reach the optimal size, the follicles are punctured. The operation is performed in a gynecological chair under intravenous anesthesia and does not cause severe discomfort. Under the control of ultrasound (which minimizes the risk of damage to the ovaries or fallopian tubes), the reproductologist pierces the follicles with a long thin needle, their contents enter special test tubes. The follicular fluid is immediately transferred to the laboratory, where the embryologist searches for eggs. The procedure takes approximately 10 minutes.

The third stage. Sperm donation and direct insemination

Sperm is donated by a man in a clinic setting. After collection, the ejaculate is transferred to the laboratory for further processing, during which the fraction of the most active spermatozoa is isolated. Then fertilization is carried out - the union of male and female germ cells. In different cases, this can be IVF, in which the eggs for fertilization are placed in a special cup containing a suspension of sperm, or ICSI and its varieties (PIXI, IMSI) - when one sperm is placed inside the egg for fertilization using special micro-instruments.

Important! The doctor will definitely tell you about all the features, differences and possibilities of the procedures. He will also determine whether there is a need for the use of such auxiliary techniques.

Fourth stage. Embryo Transfer

Embryo transfer

Currently, the transfer of embryos of the fifth day of development is most often carried out. This is due to the fact that it is at this stage that one can most accurately assess the potential of embryos, choose the most promising of them for transfer, and therefore increase the likelihood of pregnancy. During the transfer, the embryo is placed in a soft, flexible catheter that passes painlessly through the cervix. The procedure is without anesthesia, but if necessary, local anesthetics can be used. The remaining high-quality embryos can be frozen at the request of the spouses.

Important! No more than 2 embryos are transferred at the same time. As a rule, only one is used, which avoids the risks of a multiple pregnancy that is dangerous for both the mother and the child.

The procedure takes about 5 minutes. For about 50-60 minutes, the woman is in a prone position and after such a rest she can go home.

Important! At this stage, even minor physical activity should be excluded. To do this, doctors advise their working patients to take sick leave.

When is pregnancy confirmed?

You can confirm the fact of conception after 14 days. Pregnancy is determined using a special test that measures the level of the hormone hCG in the blood serum 10-14 days after the transfer. This hormone is synthesized only by the cells of the embryo. The first ultrasound is recommended to be carried out a week after the day of the test for hCG.

Important! In the future, the woman is also observed by specialists. If pregnancy occurs, it is supported by drugs prescribed by a doctor. With a negative pregnancy test, you must stop taking all drugs. Menstruation will come, which may be different from normal menstrual flow.

Advantages of the procedure in MEDSI

Qualified specialists in the field of reproduction. Our doctors have extensive professional experience in Russia and abroad. They have all the necessary knowledge
Expert diagnostics. For its implementation in clinics, advanced equipment is used to ensure high accuracy of all examinations
Own laboratory. All necessary manipulations with biological material are carried out in it (analysis and processing of ejaculate, collection of eggs, fertilization, cultivation, etc.)
Preparation and implementation of IVF programs. We have all the capabilities to solve problems related to in vitro fertilization and provide a comprehensive approach to them
Provision of a full range of services. Our specialists provide not only the processes necessary for the onset of pregnancy, but also the management of pregnancy, as well as recovery after childbirth
Compliance with international standards. Our laboratory provides optimal conditions for successful work with biomaterial (multi-stage air purification, maintenance of pressure, temperature and humidity in the premises, constant automated monitoring of cultivation conditions)
Automated biological material identification system. The FertiProof system is the first in Russia and guarantees the exclusion of the human factor, the "substitution" of biomaterial throughout all stages of the IVF program
Individual approach. We offer an integrated approach and take into account all the factors that can become barriers to the birth of a baby. On the basis of the Center, a reproductive psychologist conducts an appointment, which will help ensure a confident path to the result

If you are planning to participate in the IVF program in Moscow and want to clarify the cost of medical care, call +7 (495) 7-800-500. Our specialist will answer all questions and make an appointment with a doctor.