What is IVF?
Keri Tomechko
Purpose
In-vitro fertilization (IVF) is a common procedure utilized by women who want to become pregnant but need assistance for a variety of reasons. It is the most effective and well-studied form of assisted reproductive technology (ART) that we have right now. IVF involves diagnostic lab work, medications, and surgical procedures. The procedure offers flexibility in that it can be conducted using either a couple’s egg and sperm or a donor egg and/or sperm. Additionally, the embryo can be carried by the mother/egg provider or by a surrogate.
Process
The process of IVF begins with ovulation induction. During this step, the individual supplying the eggs takes synthetic hormones, such as human chorionic gonadotropin (HCG), which stimulate the ovaries to produce multiple eggs. These medications may be taken for several months prior to the procedure.
Next, mature eggs are collected from ovaries during a sedated minor surgical procedure. In a lab, these eggs are then fertilized by sperm cells. One or more fertilized eggs–called embryos–are collected. Lastly, one to three embryos are transferred back to the uterus of the woman who will carry the baby. If the embryo implants in the uterine lining, pregnancy occurs. From retrieval to implantation, this process—referred to as a cycle or round— typically takes two to three weeks. Although some women see success in the first cycle, many require more than one round.
Depending on the circumstances, a couple struggling with conception may try simpler methods before turning to IVF. Couples may first try fertility drugs, which increase egg production. They may try intrauterine insemination (IUI), which is a procedure that implants sperm directly into the uterus near ovulation.
Motives
Some of the most common reasons that women may turn to IVF include:
advanced maternal age
fallopian tube damage or blockage
oligo-ovulation (infrequent ovulation)
anovulation (no ovulation)
endometriosis (uterine tissue grows outside the uterus
uterine fibroids (benign uterine tumors that increase in prevalence with maternal age)
Additionally, women who have previously undergone tubal ligation or removal may use IVF to conceive.
Reasons for IVF may also include issues with sperm viability. This may include impaired sperm production or function, low sperm concentration, poor mobility, or abnormalities in size and shape, any of which can make it difficult for sperm to fertilize an egg.
The risk of genetic disorders is a common reason that a couple may turn to IVF. The embryos of couples who are at high risk of passing on a genetic disorder will undergo preimplantation genetic testing, during which the fertilized eggs are screened for certain genetic disorders.
Lastly, IVF may be used in combination with egg freezing for fertility preservation. Women with cancer or other health conditions may have to undergo treatments such as radiation or chemotherapy, which can harm fertility. In these scenarios, women may choose to freeze their eggs in a fertilized or unfertilized state for later use.
Downsides of IVF
While IVF is life-changing for many women, there are several notable downsides. IVF can be time-consuming. Many women must undergo several cycles before achieving success, which can be a stressful and discouraging process that may be psychologically and emotionally burdensome. IVF is an invasive procedure, so it naturally includes all of the accompanying risks of surgery. Because multiple embryos are often implanted in order to increase chances of success, IVF results in higher rates of multiple births (more than one child/pregnancy). Multiple births tend to have higher rates of low birth weight and premature delivery, each of which is associated with its own risks. Another risk is ovarian hyperstimulation syndrome, a condition in which the injectable fertility drugs that are used to induce ovulation, such as HCG, can cause ovaries to become swollen and painful.
IVF can be very expensive, and it is often not covered by insurance. Some states have laws that say health insurance companies must cover some portion of the costs of infertility treatment. However, the majority of women receive no IVF coverage or not enough coverage. One cycle of IVF (including medication, procedures, anesthesia, ultrasounds, blood tests, lab work, and/or embryo storage) can cost over $15,000, making it incredibly cost-prohibitive for the vast majority of women. However, in the past several years, coverage trends have been progressing promisingly. Many trending-setting industry leaders have been expanding their coverage of infertility services in their insurance plans.
You can find more information about insurance coverage of IVF and other fertility treatments at The National Infertility Association. (Insurance Coverage by State | RESOLVE: The National Infertility Association).
References
Gaede, Stephen. In Vitro Fertilization (IVF). The Johns Hopkins Fertility Center. hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/fertility-center/infertility-services/ivf.html
Mayo Foundation for Medical Education and Research (MFMER). In vitro fertilization (IVF). Mayo Clinic. mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716
Planned Parenthood Federation of America Inc. What is in-vitro-fertilization (IVF)? Planned Parenthood. plannedparenthood.org/learn/pregnancy/fertility-treatments/what-ivf