Why do people get ivf

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.

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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6 arguments “FOR” in vitro fertilization (IVF)

IVF is not a “last resort”, but the best way to deal with infertility

method is still a lot of misunderstanding in the form of myths and fears. People who think about IVF are afraid of the consequences: from the procedure itself to the high cost of treatment and the birth of unhealthy children. As a result, IVF is resorted to only when all other methods of getting pregnant have not worked, the time has been irretrievably lost.

In unsuccessful attempts to conceive a child, women and men spend years, a lot of money and nerves - and after all, they could become parents long ago with the help of IVF, because this is the most reliable way to cure infertility. “Zdorovye Mail.Ru” dispels prejudice associated with IVF, together with the chief physician of the REMEDI Institute of Reproductive Medicine, obstetrician-gynecologist Elena Mladova.

IVF is a method for people with severe infertility

In fact, the IVF procedure is a standard method for treating infertility. For women over 35 years of age, the reason to turn to IVF is unsuccessful attempts to get pregnant within a year.

What about patients under 35? If pregnancy has not occurred after a year of unprotected sex, you can devote another 6-12 months to examinations and treatment of both partners by other methods - and in the absence of pregnancy, still turn to IVF.

“I had a patient who devoted seven years to alternative ways to get rid of infertility - even leeches were used! Then she turned to reproductive specialists, as a result, she became pregnant almost immediately. And then I wondered for a very long time why she wasted so much time when she could just do IVF, ”says the doctor.

Successful IVF takes many attempts

Many people have a “friend who has done IVF three, five, seven times, and all to no avail.” Such patients tell everyone how long and costly it is - so people save IVF as a last resort.

In reality, the success of in vitro fertilization depends on many factors, the main one being, of course, the age of the patient.

“Up to 35 years, the probability of getting pregnant after the transfer of two embryos is 50%, at 36-38 years old - 38%, at 39-40 years old - 30%, at 40-42 years old - 22%, at 43-44 years old - 11%. The preparation for the implantation process also affects: how well the woman was examined, how the eggs were selected for fertilization, whether the embryos were tested for chromosomal defects, ”explains Elena Mladova.

Of course, different patients will need a different number of attempts. But often you can get pregnant by IVF the first time, and on average you will need to do three “approaches”.

According to the doctor, there is a take home baby indicator - it means what percentage of IVF cycles ends with the birth of a child. So, this figure is approximately equal to 34-36%: it means that a third of women will become pregnant and give birth the first time, another third - from the second IVF attempt, the rest - after the third cycle.
If it was not possible to give birth to a child after three IVFs, you need to carefully look at what goes wrong during the procedure itself. Perhaps there are too many mutations in the embryos, and they need to be carefully selected. Or, for example, a woman is already well over 40, and she is still trying to get her own eggs for IVF - and in this case, you should think about donor cells.

Hormonal stimulation during IVF is dangerous

During the preparation for IVF, the woman’s ovaries are stimulated with the help of analogues of natural hormones – this is necessary so that not one (much less often two) eggs mature, (as in the natural menstrual cycle) , but a few. With the help of stimulation, you can get 12, and 15, and even 20 eggs at a time - this significantly increases the chances of IVF success and reduces the procedure time.

“Of course, we can take one egg for IVF in the natural cycle – but then our chances of reaching only the stage of embryo transfer are only 30%. If the patient is very afraid of hormonal stimulation, this is the way out, but then she takes on high risks that the procedure will not succeed.

But I recommend stimulation to everyone - this is the most reliable way to get pregnant sooner,” explains Elena Mladova.

The most common possible side effect that occurs infrequently in the process of preparing for IVF is ovarian hyperstimulation syndrome: due to not always correctly selected doses of hormones, the ovaries can increase in size, the abdominal cavity fills with fluid, blood thickens.

The most common side effect that occurs when preparing for IVF is ovarian hyperstimulation syndrome: due to the loading dose of estrogen and progesterone, the ovaries literally “swell” up to five times in size, the abdominal cavity fills with fluid, blood thickens. This syndrome can be life-threatening - due to the density of the blood, the risk of thrombosis increases, and hence myocardial infarction, stroke and other serious consequences.

“It's not that bad - since the 1980s, when the technology of ovarian stimulation was invented, science has advanced, and the risk of complications has been significantly reduced.

Hyperstimulation occurs mainly not from the stimulation itself, but from subsequent pregnancy in the same cycle, which also provokes a large release of estrogen and progesterone. As a result, the body receives a double dose of hormones - this causes a failure.

There are several solutions to the problem, the doctor explains. “We can freeze embryos after successful stimulation and fertilization, and then transfer them to the next cycle. Or use the latest drugs in an individually selected dose, which minimize the risk of side effects and do not cause hyperstimulation at all - after them, the level of hormones returns to normal on the third day.

In general, today I can almost 100% guarantee a woman that she will not have any ovarian hyperstimulation syndrome.”

Women are often afraid that after IVF, the likelihood of cancer will increase - for example, of the breast or uterine body, that is, organs that are sensitive to sex hormones. But studies show that there is no increase in cancer cases or cancer deaths after in vitro fertilization. The detection rate of oncological diseases is slightly increased - only because a woman is more often and thoroughly examined before and during IVF.

The doctor explains that the patients' fears, again, are usually related to hormonal stimulation. However, in fact, it is possible to stimulate even patients who are genetically predisposed to breast cancer or have already contracted it - and want, for example, to freeze their eggs for the future. For safety reasons, they are additionally prescribed special drugs that neutralize the effect of "excess" estrogen.

IVF is full of twins (or even triplets!)

Indeed, with in vitro fertilization, the likelihood of multiple pregnancy increases. This happens for several reasons.

Firstly, reproductive specialists sometimes deliberately transfer two or three embryos to a woman in order to increase the chances that at least one will take root. Secondly, due to the technology of cultivating embryos, the possibility of “bifurcation” increases, after which identical twins are obtained - compared to a normal pregnancy, it grows from two to 12 times.

As a result, for example, two embryos were implanted in the patient, and one of them also split in two - here you have triplets.

“I am in favor of transplanting one embryo into a woman, if possible,” the doctor is sure. “And to increase the survival rate, do pre-implantation genetic diagnosis and exclude non-viable embryos with chromosomal mutations.

If it so happens that there are three or more fetuses, I always suggest making a reduction - reducing the number of embryos to two. This will significantly reduce the risk of preterm birth and other consequences of multiple pregnancies. ”

With twins, reduction is not done, because the risk of miscarriage is too great. But with three or more embryos, the probability of losing the entire pregnancy due to reduction is only 5%, so this procedure is justified.

IVF babies are all sick

Since the invention of IVF technology , more than 8 million "test-tube babies" have been born . And doctors say with confidence that the method itself does not harm the health of babies.

Another thing is that IVF, as we have already found out, increases the likelihood of having twins or triplets - and they are often premature. And because of premature birth, complications arise - up to cerebral palsy. But you can minimize this risk by transplanting one embryo at a time.

“In Sweden, for example, six IVF attempts are paid for by the state – but only one embryo at a time. Medical officials believe that this is more profitable than nursing premature twins and triplets later, or even treating sick children for life, ”says Mladova.

Also, the health characteristics of children born through IVF are related to the fact that older people turn to this procedure - and over the years, as you know, the risk of mutations in germ cells increases.

This is solved by the fact that the embryos are examined more carefully - they carry out pre-implantation diagnostics. But, unfortunately, it will not be possible to identify all mutations - it is not known exactly what we are looking for, and it is too expensive to check all the genes of each embryo.

Therefore, the frequency of developmental anomalies in "IVF children" is indeed growing a little - 4% versus 2.5% during normal pregnancy. But usually these are some cosmetic defects that are easy to correct surgically. The frequency of severe neurological disorders, such as autism, does not increase due to IVF.

IVF is expensive and accessible to few

IVF is really not cheap. But there is good news - the state allocates quotas for in vitro fertilization under compulsory medical insurance.

“Over the past 10 years, IVF funding by the state has increased 10 times,” says Elena Mladova.

And almost everyone can get a quota for IVF - just go to the antenatal clinic, register and collect the necessary documents. According to the federal quota, there are no upper restrictions on the age of parents, even a single woman can receive funding, you can choose any accredited clinic in the country (including private) for the procedure. For regional quotas, each entity sets its own rules, but usually the upper age limit for the patient is 45 years old, and only married couples can participate.

There is a common misconception that the state gives only one attempt for “free IVF”. This is not so: the federal quota is indeed issued for one IVF cycle, but you can participate in the program several times. And the regional quota immediately allows two attempts, but you can apply for it only once.

“For various reasons, about two thirds of patients still do IVF at their own expense. You will also have to pay for the preservation of eggs or embryos “for the future” - today young women who want to extend their fertile age do this. Patients also pay for (if necessary) egg and sperm donation, surrogate mother services.

Still, we have quite enough children born under compulsory health insurance. And, I hope, there will be even more soon,” says Elena Mladova.

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There are many conflicting rumors around IVF: some consider it a panacea, while others, on the contrary, are sure that this procedure is deadly for mother and baby. Let's look at what IVF is, who really needs it, and how high the risks associated with this method of infertility treatment are.

In vitro fertilization (IVF) is a complex and high-tech method of infertility treatment, which includes several stages:

Consultation and examination. An obstetrician-gynecologist (reproductologist) tells a couple about the technique, explains its benefits and risks. If the future parents agree, they are invited to undergo an examination and pass the necessary tests. If there are no contraindications to the procedure, the couple is offered to enter the IVF protocol - that is, to begin treatment.

Ovarian stimulation. During the monthly cycle, one mature egg is released from the ovaries. To increase the chances of conception, a woman can be prescribed drugs that "force" to mature several eggs - this increases the chances of successful fertilization.

Sometimes it is possible to do without drug stimulation of the ovaries - this technique is called "IVF in a natural cycle". Unfortunately, "natural" IVF is not suitable for everyone, so the choice of technique should be entrusted to the doctor. The doctor will take into account the results of examinations and analyzes and select the IVF method that is right for you.

Egg collection. When the eggs are mature, the doctor will remove them from the ovary with a special needle. This is a small but complete operation, which is carried out in a small operating room under anesthesia.

Oocyte fertilization and embryo culture. Both of these steps take place in the laboratory.

A lab worker will take a sperm sample from the future father and add it to the eggs for fertilization to occur. If the spermatozoa are not active enough or have an irregular shape, they can be “helped” by introducing them into the egg with a special needle. The procedure is called intracytoplasmic sperm injection, or ICSI.

If fertilization is successful, the cell will divide and grow. 3-4 days after fertilization, expectant parents may be offered pre-implantation genetic diagnosis (PGD). This will make sure that everything is fine, and the embryo can be transferred to the mother.

Embryo transfer to the uterus. 3-5 days after fertilization, the embryo is placed in the mother's uterus. This procedure is also performed in a small operating room, anesthesia is usually not needed.

Now all we have to do is wait. Two weeks after the embryo transfer, you will need to take a blood test for human chorionic gonadotropin (hCG). This hormone is produced by the shell of the embryo (chorion), and appears in the blood only after the successful implantation of the embryo into the uterine cavity. If the hCG level is high, the procedure was successful!

After successful implantation of the embryo, pregnancy and childbirth proceed in the same way as after conception "naturally". The baby born into the world, as a rule, is almost no different from other babies.

IVF is a last resort, which is resorted to if other methods of infertility treatment have not helped. At the same time, a woman must be healthy enough to undergo IVF without serious complications.

In our country, the procedure for selecting patients for IVF is described in the order of the Ministry of Health of the Russian Federation dated August 30, 2012 No. 107n. According to the order, IVF is recommended for couples who have not been helped:

laparoscopic and hysteroscopic correction;

ovulation stimulation;

treatment of male factor infertility.

Treatment is considered ineffective if pregnancy has not occurred within 9-12 months. True, this does not apply to women over 35 years old - in this case, the doctor can refer you to IVF earlier. If there are no obstacles to IVF, the procedure can be done free of charge under the CHI policy.

The list of IVF contraindications is quite large. Among them are infectious and non-infectious diseases, diseases of the nervous system and circulatory system, diseases of the endocrine system and metabolic disorders, oncological diseases and many other diseases. The full list is in order No. 107n.

If the disease is curable, then IVF can be done after recovery. That is why before the procedure it is very important to undergo an examination and pass all the tests that the doctor will prescribe. If cured in time, the probability of conception as a result of IVF will be much higher, and the risk for mother and child is much lower.

Risks for the mother. According to international studies, the maternal morbidity and mortality rate directly associated with IVF is low - but still somewhat higher than in women who conceived a child "naturally".

Researchers believe that this is because IVF is more often used by older people who may have other medical conditions other than infertility. In addition, the statistics are "spoiled" by women with multiple pregnancies - IVF often results in twins, which are more difficult to endure than one child.

In addition, some risk is associated with hormonal stimulation of the ovaries and the stage of egg retrieval. Stimulation can cause ovarian hyperstimulation syndrome, and the egg retrieval phase increases the risk of thrombosis, abdominal bleeding, infection, and anesthesia complications, just like any other surgical procedure.

However, according to available data, IVF does not cause cancer. There was no significant association between IVF, breast and cervical cancer.

Baby risk. The most well-known health risk associated with IVF is Angelman syndrome. This is a very rare genetic defect - the estimated risk with IVF is 2-5 cases per 15,000 people, while with a "natural" conception, the risk will be 1 case per 15,000 people.

A large national study in Norway found that children conceived through assisted reproductive technology have a higher risk of developing leukemia and Hodgkin's lymphoma compared to "normal" children. However, these diseases are also rare - so the real chance that a particular child will get sick is very small.

In general, the risks of birth defects with IVF are associated with the underlying cause of infertility, and smaller size and frailty with multiple pregnancies, so that the risks from IVF are only marginally higher than the risks from "natural" conception.

But what is known for sure is that IVF does not affect the mental abilities of children. The researchers studied the school performance of such children and found that they study even better than peers conceived "naturally". True, IVF has nothing to do with it: it’s just that people who could afford an expensive procedure were usually richer and had a higher level of education, so they tried to put their children in the best school and paid a lot of attention to their development.

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