Patient education: In vitro fertilization (The Basics)

Written by the doctors and editors at UpToDate

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What is in vitro fertilization? —

In vitro fertilization, or "IVF," is a treatment for infertility. Infertility is when a person has trouble getting pregnant or getting a partner pregnant.

When a person gets pregnant through sex, the ovary releases an egg (figure 1). The partner's sperm swim up the vagina to meet the egg. When a sperm gets into the egg, this is called "fertilization."

With IVF, fertilization happens outside of the body, in a lab. After an egg is fertilized, it can start to grow into an embryo. Doctors then place the embryo into the uterus. The goal is for it to attach to the wall of the uterus, where it can develop into a pregnancy.

The IVF process takes a few weeks and involves several procedures. Because of this, it is called a "cycle."

When is IVF used? —

IVF might be an option if you cannot get pregnant through sex. Your doctor or nurse might suggest trying other treatments first. They might suggest IVF if:

●Your fallopian tubes are missing or blocked.

●Tests show your partner has too few sperm.

●You plan to try to get pregnant using donor eggs.

●You have not gotten pregnant using other treatments.

IVF can also be used for same-sex couples who want to have a baby.

If you are considering IVF, the right treatment plan depends on many different things. These include your age, your health, the cost of treatment, and availability.

How do I prepare for IVF? —

Your doctor or nurse will make sure you understand how IVF works, the risks, and your other options.

When planning an IVF cycle, your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take or bring a bag with all of your medicines with you.

●Any allergies you have.

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

What happens during IVF? —

The exact process, and the medicines used, depend on your situation and your doctor or IVF center. Below are the general steps involved. These happen over a few weeks.

First, you will take medicines to get your body ready to produce eggs:

●Your doctor might prescribe a birth control pill for you to take for a few weeks. This helps keep your hormones at the right levels.

●On the first day of your period, your doctor will schedule tests for a few days later. These usually include blood tests and an ultrasound to look at your ovaries. The results can help your doctor plan your IVF cycle.

●You will get medicine to prepare your ovaries to produce multiple eggs:

•Most people need to give themselves daily shots for about 2 weeks. (A partner, family member, or friend can also help give the shots.) The shots go under the skin, not deep into the muscle.

•Your doctor will do more tests during this time. This is to check your ovaries and hormone levels. Sometimes, they will add new medicines or adjust your dose.

●When your ovaries are ready, you will get a shot of another medicine. This is often called a "trigger shot." It causes the eggs to become fully mature.

Around this same time, sperm is collected:

●The sperm can come from your partner or another person (a sperm "donor").

●Sperm collection is usually done through masturbation. The person giving sperm will ejaculate into a cup in the office or clinic. There are other ways to collect sperm if this is not possible.

A few days later, your doctor will schedule an egg retrieval:

●You will get medicines through an IV (a thin tube that goes into a vein). These usually include medicines to help you relax and medicines to reduce pain.

●The doctor will use a thin needle to remove some eggs from your ovaries. They do this through your vagina.

●If your body does not have enough healthy eggs, you might be able to do IVF using eggs from another person. These are called "donor" eggs.

●Egg retrieval usually takes between 5 and 30 minutes. This depends on how many eggs are retrieved.

Then, the egg or eggs are fertilized:

●The eggs are put into a laboratory dish with the sperm.

•The goal is for sperm to fertilize 1 or more of the eggs.

•In some cases, the doctor might use a special needle to inject sperm directly into the egg. This is called "intracytoplasmic sperm injection," or "ICSI." It can help improve the chances of fertilization.

●The doctor will watch the eggs over a few days. They will check to see how many have been fertilized and are growing into embryos.

•If there is more than 1 embryo, the doctor will decide which they will use. Sometimes, genetic testing is done on the embryos. This can help the doctor learn more about their health.

•The embryos are stored or frozen until it is time to use them. Often, if there are multiple healthy embryos, people choose to have some of them frozen. This way, they can try to use them to get pregnant in the future.

●Your doctor will prescribe a hormone called progesterone. You might put this in your vagina, or take it as a shot each day. It can help prepare your uterus for the embryo.

Finally, you will return to the office or clinic for the embryo transfer:

●The doctor will put the embryo into your uterus. To do this, they will place a tube into your vagina and through your cervix. They will use ultrasound to help guide them.

•A "fresh" embryo is usually transferred a few days after egg retrieval.

•If you are using an embryo that you froze at an earlier time, you can skip straight to the transfer step. Your doctor might recommend taking hormones to prepare your uterus for the embryo.

•Usually, 1 embryo is transferred. In some cases, the doctor will transfer more than 1. They will discuss this with you before the transfer.

●The procedure should not be painful, but it might cause some cramping. It usually only takes a few minutes.

●Hopefully, 1 of the fertilized eggs will attach to your uterus and grow into a pregnancy.

What happens after IVF?

●You can go back to most of your regular activities after the embryo transfer. Your doctor will probably tell you to avoid sex or heavy exercise for a few weeks. Take care of yourself, and rest when you can. It's normal to feel anxious during this time.

●In the days after an embryo transfer, it's common to have symptoms like cramping and bloating. You might also have some vaginal discharge or light spotting. The hormones used in IVF can also cause breast tenderness.

●Your doctor will schedule a blood test to check if you are pregnant. This is called a "beta hCG test." It is usually done about 12 days after egg retrieval, or 9 to 11 days after a frozen embryo transfer. If the test is positive, your doctor will repeat it after a few days to see if your hCG level is rising. If the test is negative, this most likely means the IVF cycle did not work. But your doctor might want to do another test to confirm this.

•If blood tests confirm you are pregnant, your doctor will schedule an ultrasound. This is to make sure the pregnancy is growing as expected. After this, you can get regular prenatal care.

•If you are not pregnant, your doctor will talk to you about your options. For example, you might be able to try another IVF cycle with different medicine doses or using a frozen embryo. Or your doctor might suggest trying something else, like using donor eggs.

●Call your doctor if you have severe belly pain or vaginal bleeding during or after an IVF cycle.

What are the risks of IVF? —

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●The embryo not growing into a pregnancy

●Getting pregnant with more than 1 baby (like twins or triplets)

●Pregnancy loss (miscarriage)

●Problems related to the hormone medicines – These can include cramping, nausea, or swollen and painful ovaries.

●Problems related to the procedure – Examples include bleeding or infection.

●Ectopic pregnancy – This is when an embryo starts to grow outside the uterus, usually in the fallopian tube. If this happens, it needs to be treated immediately.

What else should I know? —

It can be hard to predict the chances that IVF will work. Overall, about 45 percent of IVF cycles lead to the birth of a baby, but this varies by age. The Society for Assisted Reproductive Technology has an online calculator you can use to learn more: www.sart.org.

Going through IVF can be stressful and emotional. It might help to talk to others who are going through something similar. You can find support groups in person or online. If you are having trouble coping, talk to your doctor or nurse.

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Patient education: In vitro fertilization (The Basics)