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.

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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,In vitro fertilization 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. 
• Ovulation disorders. 
• Endometriosis.
• Uterine fibroids. 
• Previous tubal sterilization or removal. 
• Impaired sperm production or function. 
• Unexplained infertility. 
• A genetic disorder. 
• Fertility preservation for cancer or other health conditions. 

  Risks

Risks of IVF include:

• Multiple births. 
• Premature delivery and low birth weight.
• Ovarian hyperstimulation syndrome. 
• Miscarriage. 
• Egg-retrieval procedure complications.
• Ectopic pregnancy. 
• Birth defects. 
• Cancer.
• Stress. 

How you prepare

Before beginning a cycle of In vitro fertilization 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.
• 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 In vitro fertilization 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.

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..

• 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.

• 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.

Embryo transfer

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.

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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.

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

• Maternal age. 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.
• 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.
• Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF.
• 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.

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