It is a type of fertility treatment where eggs are combined with sperm outside the body in a lab. It’s a method used by people who need help achieving pregnancy. IVF involves many complex steps and is an effective form of assisted reproductive technology (ART).

People choose IVF for many reasons, including infertility issues or when one partner has an existing health condition. Some people will try IVF after other fertility methods have failed or if they’re at an advanced maternal age. IVF is also a reproductive option for same-sex couples or people who wish to have a baby without a partner.

• Blocked or damaged fallopian tubes
• Low sperm count or other sperm impairments
• Polycystic ovary syndrome (PCOS) or other ovarian conditions
• Uterine fibroids
• Problems with your uterus
• Risk of passing on a genetic disease or disorder
• Unexplained infertility
• Or if you are using an egg donor or a gestational surrogate

IVF is a complicated process with many steps. On average, you can expect the process to last four to six weeks. This includes the time before egg retrieval when a person takes fertility medication until they’re tested for pregnancy.

On average, you can expect the process to last 2-3 months. This includes time before egg donor selection, screening, medical stimulation, and egg retrieval.

Approximately 5% of couples with infertility will try IVF. More than 8 million babies have been born from IVF since 1978. It’s one of the most effective assisted reproductive technologies (ARTs) available.

IVF can be broken down into the following steps:

Birth control pills or estrogen: Before you or your donor start IVF treatment, your healthcare provider may prescribe birth control pills or estrogen. This is used to stop the development of ovarian cysts and control the timing of your /egg donor’s menstrual cycle. It allows your healthcare provider to control your treatment and maximize the number of mature eggs during the egg retrieval procedure. Some people have been prescribed combination birth control pills (estrogen and progesterone), while others are given just estrogen.

Ovarian stimulation: During each natural cycle in a healthy person of reproductive age, a group of eggs begins to mature each month. Typically, only one egg becomes mature enough to ovulate. The remaining immature eggs in that group disintegrate. During your IVF cycle, you’ll take injectable hormone medications to encourage the entire group of that cycle’s eggs to mature simultaneously and fully. This means, that instead of having just one egg (like in a natural cycle), you may have many eggs. The type, dosage, and frequency of medications prescribed will be tailored to you as an individual based on your medical history, age, AMH (anti-mullerian hormone) level, and your response to ovarian stimulation during previous IVF cycles.

Monitoring: Your ovaries’ response to the medications is monitored by ultrasounds and blood hormone levels. Monitoring can occur daily or every few days over two weeks. Most stimulations last between eight and 14 days. At monitoring appointments, healthcare providers use ultrasound to look at your uterus and ovaries. The eggs themselves are too small to be visible with ultrasound. But, your healthcare providers will measure the size and number of growing ovarian follicles. Follicles are little sacks within the ovaries that should each contain a single egg. The size of each follicle indicates the maturity of the egg it contains. Most follicles greater than 14 millimeters (mm) contain a mature egg. The eggs contained within follicles less than 14 mm are more likely be immature and won’t fertilize.

Trigger shot: When your eggs are ready for final maturation (determined by your ultrasound and hormone levels), a “trigger shot” is given to finalize the maturation of your eggs in preparation for egg retrieval. You’ll be instructed to administer the trigger shot exactly 36 hours before your scheduled egg retrieval time.

Egg retrieval: Your healthcare provider uses an ultrasound to guide a thin needle into each of your ovaries through your vagina. The needle is connected to a suction device used to pull your eggs out of each follicle.  Your or donor eggs are placed in a dish containing a special solution. The dish is then put in an incubator (controlled environment).  Medication and mild sedation are used to reduce discomfort during this procedure.  Egg retrieval is done 36 hours after your last hormone injection, the “trigger shot.”

Fertilization:  The afternoon after your or egg donor’s egg retrieval procedure, the embryologist will try to fertilize all mature eggs using intracytoplasmic sperm injection, or ICSI. This means that sperm will be injected into each mature egg. Immature eggs cannot have ICSI performed on them. The immature eggs will be placed in a dish with sperm and nutrients. Immature eggs rarely finish their maturation process in the dish. If an immature egg does mature, the sperm in the dish can then attempt to fertilize the egg. On average, 70% of mature eggs will fertilize. For example, if 10 mature eggs are retrieved, about seven will fertilize. If successful, the fertilized egg will become an embryo. If there are an exceedingly large number of eggs or you don’t want all eggs fertilized, some eggs may be frozen before fertilization for future use.

Embryo development: Over the next five to six days, the development of your embryos will be carefully monitored. Your embryo must overcome significant hurdles to become an embryo suitable for transfer to your uterus. On average, 50% of fertilized embryos progress to the blastocyst stage. This is the stage most suitable for transfer to your uterus. For example, if seven eggs were fertilized, three or four of them might develop to the blastocyst stage. The remaining 50% typically fail to progress and are discarded.  All embryos suitable for transfer will be frozen on day five or six of fertilization to be used for future embryo transfers.

Embryo transfer:  There are two kinds of embryo transfers: fresh embryo transfer and frozen embryo transfer. Your healthcare provider can discuss using fresh or frozen embryos with you and decide what’s best based on your unique situation. Both frozen and fresh embryo transfers follow the same transfer process. The main difference is implied by the name.

• A fresh embryo transfer means your embryo is inserted into your or surrogate’s uterus between three and seven days after the egg retrieval procedure. This embryo hasn’t been frozen and is “fresh.”
• A frozen embryo transfer means that frozen embryos (from a previous IVF cycle or donor eggs) are thawed and inserted into your or surrogate’s uterus. This is a more common practice for logistical reasons and because this method is more likely to result in a live birth. Frozen embryo transfers can occur years after egg retrieval and fertilization.

As part of the first step in a frozen embryo transfer, you or your surrogate will take oral, injectable, vaginal, or transdermal hormones to prepare the uterus for accepting an embryo. Usually, this is 14 to 21 days of oral medication followed by six days of injections. Typically, you’ll have two or three appointments during this time to monitor the readiness of your uterus with ultrasound and to measure your hormone levels with a blood test. When your uterus is ready, you’ll be scheduled for the embryo transfer procedure.  The process is similar if you’re using fresh embryos, except embryo transfer happens within three to five days of being retrieved.

The embryo transfer is a simple procedure that doesn’t require anesthesia. It feels similar to a pelvic exam or Pap smear. A speculum is placed within the vagina, and a thin catheter is inserted through the cervix into the uterus. A syringe attached to the other end of the catheter contains one or more embryos. The embryos are injected it the uterus through the catheter. The procedure typically takes less than 10 minutes.

Pregnancy: Pregnancy occurs when the embryo implants itself into the lining of your uterus. Your healthcare provider will use a blood test to determine if you or your surrogate is pregnant approximately nine to 14 days after embryo transfer.

Before starting IVF treatment, you’ll need a thorough medical exam and fertility tests. Your partner will be examined and tested as well. Some of the preparation you’ll go through include:

• IVF consultation (meet with healthcare providers to discuss the details of the IVF process).
• A uterine exam, up-to-date Pap test, and mammogram (if over 40).
• A semen analysis.
• Screening for sexually transmitted infections (STIs) and other infectious diseases.
• Ovarian reserve testing, and blood and urine tests.
• Instructions on how to administer fertility medications.
• Genetic carrier screening.
• Sign consent forms.
• Uterine cavity evaluation (hysteroscopy or saline-infused sonography (SIS)).
• Your healthcare provider will have you start supplementing with folic acid at least three months before embryo transfer.

There are some mild symptoms that you can experience after embryo transfer:

• Mild bloating and cramping.
• Breast tenderness from high estrogen levels.
• Spotting
• Constipation

Many people will return to normal activities right after their egg retrieval procedure. However, you shouldn’t drive for 24 hours after having anesthesia. Around nine to 14 days after the embryos are transferred, you’ll return to the clinic for a pregnancy test using a blood sample.

During your IVF cycle, you’ll take injectable hormone medications to encourage the entire group of that cycle’s eggs to mature simultaneously and fully. Your healthcare provider will determine the type of drug, frequency, and dosages you need for your treatment. This is based on your age, medical history, hormone levels, and your response to previous IVF cycles if applicable. You can expect to inject fertility medicine for around eight to 14 days.

Several medications can be used during a cycle of IVF. Some are taken orally, while others are injected, absorbed through your skin or placed in your vagina. Your healthcare provider will outline the exact dosage and timing depending on your treatment plan. During the ovarian stimulation phase, you can expect to be given injectable hormones:

• Follicle stimulating hormone (FSH): These hormones work to stimulate your ovaries to produce eggs. You may be given one or a combination of both during your treatment. This is done for approximately eight to 14 days.
• Human chorionic gonadotropin (hCG): Usually given as one final shot to trigger your eggs to mature and set ovulation in motion.
• Leuprolide acetate: A type of gonadotropin-releasing hormone (GnRH) agonist (initiates a response) that’s given as an injection. It can help control the stimulation process or be used as a trigger shot.

You may be prescribed birth control pills or injections before starting IVF. This provides a level of control over your cycle and allows all of your eggs to start simultaneously. Most people are given estrogen supplements to take before and after embryo transfer. This hormone helps thicken the lining of the uterus. Progesterone is also added to improve the chances of an embryo implanting and growing into a successful pregnancy. Most continue this throughout their first trimester. These medications are either oral, injectable, transdermal, or vaginal.

Assisted hatching is a technique used in IVF treatment. It involves making a hole in your embryo’s outer shell before the embryo transfer into your uterus. This hole helps your embryo “hatch” from its outer shell more easily. To get pregnant, your embryo must hatch and attach to the lining of your uterus. Think of assisted hatching as giving your embryo a head start and increasing its chances of hatching and implanting in your uterus. Assisted hatching is used primarily for those who’ve had several failed IVF cycles.

There are several risks associated with IVF treatment:

• Multiple births: A pregnancy with multiple babies carries a higher risk of premature labor.
• Premature delivery: You may have a slightly higher risk of your baby being born early or at lower birth weight.
• Miscarriage: The rate of miscarriage is about the same as pregnancies from natural conception.
• Ectopic pregnancy: This is a condition where your fertilized egg implants outside of your uterus.
• Complications during egg retrieval: Bleeding, infection, and damage to your bladder, bowel, or reproductive organs during the egg retrieval process.
• Ovarian hyperstimulation syndrome (OHSS): A rare condition that causes abdominal pain, nausea, vomiting, diarrhea, rapid weight gain, bloating, shortness of breath, and inability to urinate.

Some experience side effects from the fertility medications used during the ovulation stimulation phase of IVF. These include:

• Nausea and vomiting.
• Hot flashes.
• Headaches
• Enlargement of their ovaries.
• Abdominal pain.
• Bruising from IVF injections.
• After the transfer of your embryo, you should be able to resume normal activities. Your ovaries will be enlarged, and some discomfort may occur. Common side effects after embryo transfer are:
• Constipation
• Bloating
• Cramping
• Breast tenderness (from high estrogen).
• Spotting

IVF can be difficult — both physically and emotionally. Many people doing IVF treatment struggle with depression and anxiety. Infertility struggles and IVF can leave people feeling disappointed or overwhelmed. Talk with your healthcare provider about how you’re feeling so they can offer support through the process.

An IVF pregnancy isn’t automatically considered high risk. An IVF pregnancy will be considered high-risk if there’s a medical condition that makes the birthing parent high risk. For example, advanced maternal age, expecting multiples or high blood pressure.

Yes, it’s possible to select the sex of your baby during IVF. Before your embryo is implanted into your uterus, your embryo’s cells can be studied (embryonic testing) for either male or female chromosomes. Couples can choose to only implant the desired sex and discard the other embryos. This service is illegal in many countries.

Yes, some reasons an IVF cycle fails are

• Premature ovulation.
• No eggs are developing.
• Too many eggs are developing.
• Egg isn’t fertilized by sperm.
• Sperm quality.
• Embryo stops growing or will not implant.
• Problems with egg retrieval or embryo transfer.

Your healthcare provider will be able to examine each step of the process with you and determine how to best move forward with future treatments.

Embryo cryopreservation is done as part of most IVF programs. Some people choose to freeze and store embryos so they can have another chance at getting pregnant. Extra embryos can be frozen and stored for several years, although not all will survive the freezing and thawing process.

Source: https://my.clevelandclinic.org/health/treatments/22457-ivf