In 2012, an estimated five million children around the world were born using assisted reproduction techniques (ART), including in vitro fertilization (IVF). The procedure has definitely come a long way since the birth of Louise Brown in 1978 when it was still largely experimental.
Today, IVF and other ARTs are seen as solutions to those who want to conceive a child but are hindered by fertility issues and genetic problems.
IVF involves taking mature eggs from the ovaries of a woman where they will stay in a lab to be fertilized by sperm. After successful fertilization, the eggs are implanted into a woman’s uterus in hopes it will result in a successful pregnancy. More than one fertilized egg can be implanted and may result in more than one child.
Couples can use their own eggs and sperm for an IVF procedure. Or, it may take the form of a gestational surrogacy where a fertilized egg is implanted in the uterus of a surrogate who can be genetically not related to the child they are carrying. IVF can also involve eggs, sperm and embryos (fertilized eggs) from anonymous donors.
A number of factors will determine whether or not a baby can be born through IVF, including age and the reason behind the infertility. Given the complex nature of the procedure, it comes as no surprise that IVF costs a lot of money and can also be time consuming and invasive. Not only that, but there are also risks involved.
Why do it given the risks and high cost? Truth be told, IVF isn’t the only solution for issues with infertility and genetic problems. There are less invasive options, like using fertility drugs to increase egg production. That said, there are occasions when the use of IVF may become necessary:
Health conditions. Diseases like cancer require treatment that may interfere with fertility. As such, those who want to have children can turn to IVF to preserve their eggs for later use.
Genetic disorders. Couples who don’t want to pass a genetic issue to their child can go for a process called pre-implantation genetic diagnosis where harvested eggs are screened for genetic problems and only those that are issue-free will be implanted.
Undetermined cause of infertility. There are times when a reason can’t be found for a couple’s infertility. IVF can be recommended as a solution in this case.
Below average sperm production or impaired function. Fertilization is difficult when issues such as poor mobility, abnormalities in sperm size and shape and below average sperm concentration are present. IVF can be a solution if there are no underlying health concerns or the problem can’t be corrected.
Tubal ligation. Some women undergo this procedure to prevent pregnancy. In case they want to get pregnant, they need to undergo tubal ligation reversal, but IVF can be an alternative to that.
Endometriosis. This affects the functions of the fallopian tubes, ovaries and uterus. Since it might be difficult to conceive, IVF can be seen as a solution for conception.
Early ovarian failure or ovulation disorders. Women who lose normal ovarian function before the age of 40 can’t produce enough estrogen. IVF can be considered if pregnancy is wanted.
Risk of pregnancy. Pregnancy can pose a serious health risk to some women and IVF is seen as a solution if they really want to have a child.
Procedure
There are five steps involved in IVF:
#1: Super ovulation
A woman produces one egg per month, but during this stage, fertility drugs are given in order to increase the production of eggs. Regular transvaginal ultrasounds are also required during this stage to check on the ovaries. Blood tests will also be done to examine hormone levels.
#2: Retrieval of the egg
A procedure called follicular aspiration is performed in order to retrieve the eggs from a woman’s body. It’s an outpatient procedure that can be performed in the doctor’s office. With the aid of ultrasound images, a needle is inserted through the vagina and into the ovary and sacs where the eggs are contained.
A suction device connected to the needle is the one responsible for pulling the eggs out of the follicles. This is done once for every follicle.
Sperm is also collected by asking a male to produce a semen sample. The semen sample will be needed the morning the eggs are retrieved.
While masturbation is the main method for retrieving sperm from a partner, there are occasions where procedures like testicular aspiration – a process involving the use of a needle to get sperm from the testicle – is required. In some cases, donor sperm is used.
#3: Insemination and fertilization
Insemination is when the sperm is introduced to the eggs. The combined result is put in an environmentally controlled chamber. Fertilization occurs within a few hours after insemination.
There are cases when direct injection of the sperm into the egg is performed. It’s a process called intracyctoplasmic sperm injection (ICSI) and it’s done when fertilization chances are low.
However, there are cases when everything seems normal but an ICSI is still performed.
#4: Embryo culture
An embryo is formed when an egg divides. The status of the embryo will be checked on a regular basis to ensure proper growth. A normal embryo will have several actively dividing cells within five days.
At about three to four days after fertilization, a procedure called pre-implantation genetic diagnosis can be performed on the embryo. This is for couples who fear they might be passing a genetic issue onto their offspring.
The procedure involves screening a single cell from each of the embryos to check for genetic disorders. This method allows parents to choose to implant embryos free from any genetic issue.
Given the nature of the procedure, it’s not surprising many find it controversial. Not all centers offer to do this procedure.
Another procedure, called assisted hatching, can also be suggested, particularly for older women or women who have tried IVF several times but with failed results.
This method involves making a hole in the zona pellucida, the surrounding membrane of an embryo and where it hatches from, before the transfer of embryos to assist in the hatching of the embryo, as well as boosting the chances of implantation.
#5: Transfer of the embryo
An embryo can be implanted into the uterus three to five days after retrieval and fertilization. Just like the removal of eggs, a thin tube is inserted into the vagina, through the cervix and into the uterus.
A syringe attached to the other end of the catheter is used to transfer the fertilized eggs into the uterus. The procedure is successful when the embryo sticks to the womb, resulting in pregnancy.
Multiple embryos can be placed into the uterus. As such, it can lead to the formation of more than one child. There are factors like a woman’s age that determine the number of embryos that can be implanted into the uterus.
There are cases when embryos are fertilized, but not used straight away. In other words, they are frozen and can be implanted later on.
Risks
IVF involves time and money, and those who go through it expend a great amount of physical and emotional energy. That’s not even counting the many risks, such as:
Miscarriage. Just like natural conception, there is a 15 to 25 percent chance a woman will miscarry a child conceived through IVF. However, the rate of miscarriage increases depending on the woman’s age. There’s even a risk of miscarriage when frozen embryos are used.
Stress. IVF can drain someone emotionally, physically and financially. This is why seeking help from friends and family is recommended when going through the process. Having a support system can make it much easier.
Ectopic pregnancy. This happens when a fertilized egg sticks outside the uterus. In most occasions, it implants in the fallopian tube. This is a particularly draining situation, as the pregnancy cannot continue given that an embryo cannot live when it’s outside the uterus. About two to five percent of women experience this.
Complications with egg retrieval. Using an aspirating needle to remove eggs can cause bleeding, infection or damage to the bladder, blood vessel or bowel.
Side Effects
Women may experience several side effects after IVF. They are required to rest after going through the process. Most, however, can get back to their normal routines the next day. Here are some of the side effects that can be experienced after IVF:
- Constipation
- Mild bloating
- Mild cramping
- Passing of fluid after the procedure – the amount is small and can be clear or tinged with blood
That said, there are side effects that require the attention of a doctor and these include:
- Blood in the urine
- Fever that’s more than 100.5F
- Pain in the pelvis
- Heavy vaginal bleeding
There are also side effects involved with taking fertility drugs in the beginning of the IVF procedure. These include abdominal pain, bloating, headaches, hot flashes, and mood swings, among others. Some women may even experience more severe side effects, such as faintness, shortness of breath, nausea or vomiting, reduced urinary frequency, severe stomach pains and rapid weight gain.
Success Factors
The success of an IVF procedure depends on many factors, including:
- the age of the mother
- the reason for infertility
- lifestyle
- reproductive history
The Society of Assisted Reproductive Technologies gave the following approximates for live birth after IVF:
- for women aged 35 and under: 41 to 43%
- for women between 35 to 37 years of age: 33 to 36%
- for women between 38 to 40 years of age: 23 to 27%
- for women aged 41 and over: 13 to 18%
Costs
The actual cost of an IVF procedure depends on a number of factors. For instance, the amount of medication needed to be taken affects IVF costs. The place of residence also determines the final cost of IVF. The amount of money an insurance company is going to spend on the procedure also figures in the final cost. The number of IVF cycles needed also determines the total bill.
All that said, the American Society of Reproductive Medicine (ASRM) puts the average cost of an IVF procedure at $12,400.
Those who want to go through an IVF cycle should check the coverage offered by their insurance company. Even better, they should ask for their benefits to be put in a written statement.
Keep in mind that there are laws requiring insurance companies to partially cover the costs for infertility treatments, but not every state enacts them. Also be aware that some companies don’t pay for ART procedures but cover the cost of infertility drugs and monitoring.
