In Vitro Fertilization (IVF)
In vitro fertilization is a multi-step procedure used to join an egg and sperm outside a woman’s body. The fertilized egg then divides and is called an embryo. The embryo or multiple embryos are then implanted directly into the woman’s uterus. This form of assisted reproductive technology (ART) can be performed with eggs and sperm from the patient and her partner or from donor(s).
IVF requires five steps:
Ovarian stimulation: Medications will be prescribed that cause the ovaries to produce multiple eggs. Medications may also be prescribed in order to promote maturation of the eggs, prevent early ovulation and prepare the uterine lining for implantation. During this time, vaginal ultrasounds and blood tests will be used to monitor egg development and the body’s response to the medications. This process takes one to two weeks.
Egg retrieval: Eggs are removed from structures called follicles in the ovaries. The follicles are located via ultrasounds and a thin needle is then inserted into a follicle and eggs are suctioned through the needle. Mature eggs are incubated in media that contain nutrients to help maintain their viability.
Sperm retrieval: If a partner’s sperm are to be used for IVF, a semen sample will be collected on the same day as egg retrieval. Sperm are then isolated from the sample. Alternatively, a procedure can be performed to remove sperm directly from the testicles with a needle.
Fertilization: There are two methods for fertilizing the eggs. The sperm and eggs may be incubated together and the sperm will eventually enter the eggs. Alternatively, a technique called intracytoplasmic sperm injection (ICSI) may be performed that entails direct injection of sperm into the eggs.
- Embryo development and transfer: Once eggs are fertilized, they begin to divide and are called embryos. A few days after fertilization, embryos are transferred via a catheter to the woman’s uterus. Pregnancy results when an embryo implants in the lining of the uterus. The transfer of more than one embryo can potentially result in multiple births.
Reasons for Pursuing IVF
IVF may be considered when a woman has been unable to become pregnant with the aid of other less costly methods or when the following medical conditions are apparent:
- Blocked, damaged or missing fallopian tubes
- Scar tissue that causes pelvic organs to adhere to each other
- Malformed uterus
- Reduced capacity of ovaries to provide viable eggs
- Premature ovarian failure
- Male infertility
Risks and Side Effects
IVF increases the likelihood of becoming pregnant with multiples. IVF increases the chances of premature delivery and low birth weight even when multiples are not present.
Side effects of fertility medications include headaches, mood swings, abdominal pain, and bloating.
During ovarian stimulation, ovaries may become swollen causing pain although this is rare. This condition is called ovarian hyperstimulation, and it may cause nausea, bloating, vomiting, rapid weight gain due to the accumulation of fluids, shortness of breath, and decreased urine output. Rest may be all that is required to resolve symptoms of hyperstimulation, but drainage of excess fluid may be necessary for more severe cases.
Risks associated with the egg retrieval procedure include anesthesia-related risks, bleeding, infection, and injury to organs in close proximity to ovaries.
After the embryo transfer, the following side effects are common: bloating, cramping, tender breasts, constipation, and secretion of a small amount of fluid from the vagina.
The Society for Assisted Reproductive Technology reports that in 2012, the percentage of IVF cycles resulting in live births for different age groups of women were the following:
- Age <35: 40.7%
- Ages 35-37: 31.3%
- Ages 38-40: 22.2%
- Ages 41-42: 11.8%
- Age >42: 3.9%
Undergoing the steps involved in IVF can be very stressful for couples. IVF is a long process that involves many steps separated by periods of waiting for critical results. Additionally, IVF is very expensive and there is no guarantee of success. Despite the anxiety induced by the IVF process, people usually cope well and do not report any negative impact on their relationships. It is critical to become aware of the decisions that may need to be made during IVF and discuss how they will be addressed with your partner.
- American Society for Reproductive Medicine
- Resolve: The National Infertility Association
- The American Fertility Association
- Society for Assisted Reproductive Technology (SART): A Patient's Guide
- Medline Plus:In Vitro Fertilization
Diagnosis and Treatment Available at Texas Children’s:
References & Sources
American Pregnancy Association (2007, May). In Vitro Fertilization. Retrieved from http://americanpregnancy.org.
Fast Facts About Infertility from RESOLVE.org (2015, April). http://www.resolve.org/about/fast-facts-about-fertility.html
Society for Assisted Reproductive Technology. Clinic Summary Report: All SART member clinics (2012)
Storck, S. (2012, Feb 26). In Vitro Fertilization. Retrieved from http://www.nlm.nih.gov/medlineplus/.
Other Contributors: Brittany L. Coughlin, M.A.
Date Reviewed: 7/7/2016