In vitro fertilization (IVF), is the most common and effective type of assisted reproductive technology to help people become pregnant. IVF can help achieve pregnancy when other treatments have not worked.

This procedure involves fertilizing an egg outside the body, in a laboratory dish, and then implanting it in a person’s uterus.

IVF is the most common and effective type of assisted reproductive technology (ART). According to the Centers for Disease Control and Prevention (CDC), ART is the conception method for around 2.1% of babies born in the United States each year. There is also a higher chance of a multiple births with IVF.

This article covers the IVF procedure. It explains success rates, costs, screenings, and more.

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In 1978, Louise Brown became the first baby born via IVF conception. Robert Edwards and Patrick Steptoe, who collaborated on the procedure, are considered the pioneers of IVF.

In a natural pregnancy, an egg develops and matures in the ovary. Ovulation is when the ovary releases that egg.

The sperm travel through the uterus and into the fallopian tube to find the egg and penetrate it, which leads to fertilization. The fertilized egg, or embryo, then attaches itself to the uterus wall and begins developing into a baby.

However, IVF may be an option for the following reasons:

  • a person is unable to get pregnant naturally
  • a person or couple is diagnosed with unexplained infertility
  • male factor infertititly or abnormal sperm parameters
  • a person’s fallopian tubes are blocked

According to the Human Fertilization and Embryology Authority in the U.K., one IVF treatment cycle can take between 3–6 weeks. However, a person may require more than one cycle depending on their risk factors and the success rate of the treatment.

Techniques may differ depending on the clinic. However, IVF usually involves the following steps:

1. Superovulation

Superovulation is also known as controlled ovarian hyperstimulation. Fertility medications contain either luteinizing hormone or follicle-stimulating hormone. These hormones make the ovaries produce more eggs than usual. Transvaginal ultrasound scans can monitor the growth and progress in the ovaries.

As an alternative, a person may use donated or frozen eggs.

2. Retrieving the eggs

Doctors use a minor surgical procedure known as “follicular aspiration” or “egg retrieval” to collect eggs.

Under ultrasound guidance, a thin needle is inserted through the vagina and into an ovary. The needle is attached to a suction device that removes the follicular fluids and the eggs. Doctors perform this process for each ovary.

3. Insemination, fertilization, and embryo culture

The collected eggs are placed together with sperm and kept in an environmentally controlled chamber. After a few hours, the sperm should enter the egg.

Sometimes the sperm is directly injected into the egg. This process is known as an intracytoplasmic sperm injection (ICSI). Frozen sperm, retrieved through testicular biopsy, may be used.

The fertilized egg divides and becomes an embryo. Once the embryos reach the blastocyst stage, many fertility centers offer preimplantation genetic testing (PGT). This technique screens an embryo for chromosomal abnormalities or aneuploidies.

The transfer uses one or two of the best embryos. A person then receives hormones and other medications to prepare the uterine lining for the embryo’s implantation.

4. Embryo transfer

Sometimes, the womb receives more than one embryo. It is important to discuss the number of transferred embryos with a doctor.

Most commonly, the doctor will only transfer a single embryo. The decision to transfer more than one embryo must consider several risk factors, and a person should discuss them with a doctor.

Around 3–5 days after fertilization, the transfer of the embryo begins by using a thin tube or catheter. It enters the uterus through the vagina. When the embryo sticks to the uterus lining, also known as implantation, a pregnancy has started, and embryo growth continues.

For 2019, the CDC estimated that the percentage of intended egg retrievals that resulted in live birth deliveries was:

  • 52.7% among people aged under 35 years
  • 38% among people aged between 35–37 years
  • 24.4% among people aged between 38–40 years
  • 7.9% among people over the age of 40

These statistics vary depending on where the procedure takes place.

Other factors

Age is the most important risk factor that affects the success rate with IVF.

However, the likelihood of success can depend on other factors, including:

  • the cause of infertility
  • ovarian reserve test results
  • whether or not pregnancy or a live birth has occurred before
  • the strategy that will be used

The average cost of one IVF cycle in the U.S. varies between $10,000–15,000. However, some insurance providers cover infertility treatments such as IVF. Therefore, a person with health insurance may obtain IVF treatment at a lower cost.

Coverage will be dependent on the health insurance provider and the state that the person lives. Currently, 17 states in the U.S. require insurance providers to either cover or offer coverage for infertility treatment by law.

A person can calculate an estimate of their due date by using a due date calculator.

Many websites, such as Flo Health, provide a calculator to estimate a person’s due date using information such as the embryo transfer date and the type of transfer they underwent. The calculators include:

  • Day 3 embryo transfer
  • Day 5 embryo transfer
  • IVF with own eggs
  • IVF with fresh donor eggs cycle
  • Fresh donor embryos cycle

Screening and testing are available to determine the sex of the embryo and to identify if there any genetic abnormalities.

Primarily, preimplantation genetic testing (PGT) was a procedure used by doctors to detect genetic disorders in the embryo’s DNA. These could result in a birth abnormality or developmental issue.

In addition, doctors now also conduct this method to identify the sex of the embryo before implantation during IVF. Doctors can analyze which chromosomal make up the embryo processes to determine if the embryo will be male or female.

A 2018 study notes that over 72% of contacted ART clinics offer preimplantation testing.

Intrauterine insemination (IUI), also called artificial insemination, is a technique where the uterine cavity receives sperm directly from a catheter. This technique reduces the time and distance required for the sperm to travel to the egg and fertilize it.

This process is different from IVF, where the eggs and sperm are placed together outside of the body in a controlled environment.

IUI is normally used to treat mild male factor infertility and couples with unexplained infertility. A person undergoing IUI may also receive medication to stimulate ovulation. A doctor will inject the sperm into the uterus during the ovulation period.

IUI is a simple procedure that normally takes between 5–10 minutes compared to IVF. IUI is also cheaper than IVF. IUI, on average, costs between $300–1,000 without insurance.

However, IUI is also less successful than IVF.

Once the sperm is injected by doctors into the uterine, the body’s natural processes will take over. In IVF, doctors can monitor whether an egg has been fertilized and select the best embryo(s).

Success rates for IUI are generally around a third of that for IVF.

Additionally, IUI may not be a suitable fertility treatment in the following circumstances where a person:

  • has blocked fallopian tubes
  • has severe endometriosis
  • is in their late 30s or over 40
  • has low-quality eggs
  • has a low number of eggs

This treatment is also not suitable if the reason for infertility treatment is severe male factor infertility.

ICSI is a technique that injects a single sperm into an egg for fertilization.

ICSI is a common treatment for couples experiencing male factor infertility. It may also improve the chance of fertilization in people with a previously unsuccessful IVF cycle. It is also for cycles that plan to use preimplantation genetic testing.

The American College of Obstetricians and Gynecologists associate ICSI with a slightly higher risk of birth defects, including:

Many people will experience little to no side effects during IVF. However, some people may experience side effects. These may include:

  • fatigue
  • abdominal pain
  • sore breasts
  • irritability
  • nausea
  • headaches

These symptoms tend to occur during the ovarian stimulation phase of IVF. A small percentage of people may also experience the following side effects:

  • shortness of breath
  • dehydration
  • vomiting or abdominal pain that requires hospital admission

Some people may also experience mood fluctuations.

The IVF process is usually not painful, although a person may experience mild discomfort at some stages.

As IVF involves the injection of fertility medication, there may be mild bruising and pain at the injection site. A person may also experience abdominal cramping that may be painful.

The egg retrieval process is normally not painful because pain medication is given before the procedure.

Embryo transfer is also not usually painful.

Some risks are associated with IVF, including the following:

Side effects of medication

Some people may have reactions to the medications given during treatment.

The possible side effects of IVF drugs include:

  • nausea and vomiting
  • difficulty breathing
  • irritability
  • hot flashes
  • enlargement of the ovaries
  • difficulty sleeping
  • abdominal pain

Ovarian hyperstimulation syndrome (OHSS)

Rarely, the medications used to stimulate ovaries to produce eggs can cause OHSS. This happens when there is an overresponse to the medications being used and the hormone levels become very elevated.

People with OHSS have a large number of growing follicles and high estrogen levels. This leads to fluid leaking into the abdomen, which may cause bloating, nausea, and swelling of the abdomen.

With severe OHSS, the following symptoms are possible:

  • blood clots
  • shortness of breath
  • dehydration
  • vomiting

Pregnancy loss

The leading cause of pregnancy loss, whether in IVF or natural conception, is an abnormal number of chromosomes, known as chromosomal aneuploidy.

An embryo is tested with PGT to look for aneuploidy.

Multiple births

When the uterus recieves more than one embryo in the transfer, there is a higher chance of having twins, triplets, or more babies.

Pregnancies with more than one fetus can result in:

  • preterm birth or low birth weight
  • double the mother’s risk of developing diabetes
  • significant increase in the mother’s blood pressure

The doctor may recommend that there should only be a single embryo transfer in people who have a heightened chance of having twins.