IVF is the medical abbreviation for in vitro fertilization, a challenging Assisted Reproductive Technology (ART) from the technical viewpoint that is used to help couples or women who have trouble conceiving.
The success rates of IVF depend on multiple factors, but undoubtedly age is a key factor. Also, the quality of the sperm used plays a major role when it comes to determining the chances of getting pregnant with IVF.
The total cost of in vitro fertilization procedures is considerably high due to two main aspects: on the one hand, the hormonal medications used to induce ovulation, and on the other hand, the varied range of modern technologies and lab equipment used.
Below you have an index with the 12 points we are going to deal with in this article.
Definition of IVF
In vitro fertilization is an Assisted Reproductive Technology (ART) that involves the collection of eggs from the woman's ovaries by means of follicle puncture (ovum pick-up). Then, they are fertilized at the laboratory using the husband's or partner's sperms. The development of the resulting embryos is monitored until the embryo or embryos selected are transferred back to the woman's uterus. The ultimate goal is to achieve a healthy pregnancy.
Depending on how the egg and the sperm cell are fused together, we can distinguish between two types of IVF:
- Conventional IVF: Both reproductive cells are put in contact in a petri dish and are expected to fuse together by themselves.
- ICSI: It stands for Intracytoplasmic Sperm Injection. The sperm is manually inserted inside the egg cell by microinjection.
Choosing between the former or the latter depends on what is causing female and/or male infertility in the couple, as well as the particularities of each fertility clinic. Still, even though the fertilization process varies, the previous steps are the same. Watch the whole process step by step in this video:
Difference between IVF and IUI
Artificial insemination (AI), better known as intrauterine insemination or just IUI, is another infertility treatment, though less technically challenging than IVF. With IUI, the partner's sperm is inserted into the female's uterus, and fertilization occurs inside the female reproductive tract as it would with sexual intercourse, without further medical involvement.
So, as one shall see, IVF involves a higher degree of complexity than artificial insemination (AI)—not only the number of steps to follow is higher, but also the involvement of the specialist. In fact, IVF requires a simple surgical procedure to retrieve the eggs, while with IUI this step is unnecessary.
Its success rates, however, are higher, and this is the reason why it is the treatment of choice in the majority of the cases.
You may hear terms such as in vitro insemination, which actually is incorrect as you may have understood with the definition of each technique given above.
The following post contains further info on this topic: Artificial insemination vs. in vitro fertilization.
When is IVF used?
A couple may need IVF treatment to have a baby due to a wide range of causes. Male infertility, female infertility or both may be the reason why this infertility treatment is recommended.
The following are the most common indications of in vitro fertilization:
Moderate-to-severe cases of male infertility can be treated by means of IVF:
In the case of women, fertility problems are often linked to the following factors:
- Problems with ovulating caused by endocrine disorders
- Tubal factor infertility
- Uterine factor infertility
- Cervical factor infertility
IVF referral criteria
The requirements for male patients depend on the type of IVF that is required. Conventional or standard IVF is the technique of choice when the MSC (motile sperm concentration) is between 1 and 3 million sperm/ml. Should severe motility, morphology or concentration problems be detected, then ICSI would reach higher success rates. Samples not obtained by ejaculation require ICSI as well, as their quality is poor in general.
Either way, some fertility clinics have a preference for ICSI even when the patient is a good candidate for conventional IVF.
What is the timeline for an IVF cycle?
The IVF process can become a tough one for many patients, as they have to go through various steps before achieving success.
- Controlled ovarian stimulation: Patients take fertility drugs to induce ovulation for around 10 days. The purpose is to obtain a higher number of eggs. This way, the moment of ovulation can be monitored, which helps increase the odds for the eggs collected to be mature, with a good fertilization potential.
- Ovum pick-up or follicle puncture: It is a surgical intervention for the collection of mature oocytes. It is done through aspiration, which takes 20-30 minutes and requires anesthesia.
- Semen collection and capacitation: Samples are collected through masturbation, although it can be done through epididymal sperm aspiration or testicular biopsy. Samples go through a sperm washing process to increase their fertilization potential.
- Fertilization: The egg and sperm binding takes place at this point, either for themselves (conventional IVF) or through microinjection (ICSI). For more information about the differences between both ways of fusing gametes, we recommend that you read the following post: IVF vs ICSI.
- Embryo culture: Once the oocyte has been fertilized, the embryo development is monitored to check whether everything is going as expected. Embryo implantation in the mother's uterus will take place within seven days post insemination. Until then, the embryos are cultured in incubators that simulate optimal development conditions at the IVF laboratory.
- Preparing uterus for embryo transfer: Women are given estrogen and progesterone for the pattern and the thickness of the endometrial lining (uterine layer where embryos implant) to be adequate and the odds for embryo implantation to rise.
- Embryo transfer: After being cultured, the best quality embryos are selected. The most viable embryos will be the ones chosen for the transfer. Usually, between 1 or 2 embryos are transferred, although 3 or more can be used depending on what is established by law in the country where the transfer is taking place.
- Embryo freezing: High-quality unused embryos are cryopreserved by vitrification for later use.
- Pregnancy test: Within 10 to 15 days (two-week wait) post embryo transfer, women can take a pregnancy test to detect their hCG levels in case embryo implantation has been successful.
Just like other assisted reproductive technologies, IVF success rates are based on several factors, being the patient's age one of the most influential ones.
Experts have been able to establish a series of patterns to grade the odds for success in each case. Such percentages are:
- 40% in women under 35
- Between 27-36% in women between 35 and 37
- Between 20-26% in women between 38 and 40
- Between 10-13% in women over 40
When talking about and comparing between the success rates of different techniques or fertility clinics, one should pay attention to the meaning of success in each case. Sometimes, statistical data refers to different percentages, e.g. pregnancy rate, birth rate, live birth rate, etc.
Real IVF outcomes should be based on the live birth rates obtained with this method, and not only on the pregnancy success rate. It should be taken into account that not all pregnancies are successful.
If you want to learn more about IVF success rates and outcomes, the following article may be of interest: Success Rates of IVF.
What are the pros and cons?
Like any other infertility treatment (e.g. intrauterine insemination or IUI), in vitro fertilization procedures have a series of advantages and disadvantages. You can find them explained below.
Benefits of IVF
The following are the main pros of in vitro fertilization:
- Consistently high success rates
- Couples with severe infertility problems have the chance to become parents. In particular, ICSI offers the possibility of attaining fertilization even in cases of severe male infertility, such as obstructive azoospermia.
- Using both donor eggs and donor sperm is possible, something that increases the number of infertile patients who can become parents thanks to IVF.
- In general, the potential side effects associated are not severe.
Disadvantages of IVF
On the other side of the coin, IVF carries a series of cons as well. We mention the most relevant ones below:
- Patients have to self-administer fertility drugs, which can lead to the appearance of complications.
- Surgery under anesthesia is necessary. Even though it is a simple procedure that does not take too long, some risks exist.
- The cost of IVF is higher if compared to other techniques such as IUI.
Regardless of whether you go for a classical IVF cycle or an ICSI, the drawbacks associated are similar.
Potential side effects and risks
As seen earlier, ovarian stimulation and follicle puncture can cause a series of adverse reactions. Patients should be informed about all these potential risks before getting started with the treatment.
- Ovarian Hyperstimulation Syndrome (OHSS): It translates into a superstimulation of the ovaries. It causes ovarian enlargement and extravasation of liquids due to an increase in the blood vessel permeability. The function of the liver, hematologic, renal, and respiratory systems may be compromised in the most severe cases.
- Multiple births: The risk for a twin pregnancy with a single embryo transfer (SET) is almost non-existent. However, in those cycles where two embryos are transferred, the probability of having twins is 6%. If three embryos are transferred, the chances rise up to 12%, while triplet pregnancies occur in 3% of the cases. Still, these rates depend also on factors such as maternal age and the quality of the uterine lining.
- Miscarriage: Almost 20% of pregnancies end up in a miscarriage, and it tends to happen during the early stages of pregnancy. It depends on factors such as the patient's age and the particularities of each woman or couple.
- Ectopic pregnancy: It occurs when the embryo implants in a place other than the uterine cavity. Between 2% and 5% of women who undergo an IVF treatment may have an ectopic pregnancy as a result. This figure contrasts with the approximate 1% of this type of pregnancy when it occurs as a result of a natural conception.
If you want more information about the risks of IVF, we recommend that you read this article: Side effects of IVF.
How much does IVF cost?
Before giving you particular sums, it is important to remark that there are many variables specific to your particular medical case that can influence the overall cost of IVF.
In any case, IVF is affordable for anyone who needs it, Dr. Miguel Dolz, OB/GYN specialized in Reproductive Medicine, states. All fertility clinics offer a wide range of financing options for patients that allow everyone to start a cycle.
In countries like Spain or the UK, where IVF and other treatments can be covered by the public health system as long as the patient meets a series of requirements, IVF is available for everyone.
Cost in the USA
Many US clinics offer different in vitro fertilization cost plans, including multiple cycle packages with different pricing options. For example, single cycle IVF packages using own eggs can range from $8,500 to $12,000.
On the other hand, some fertility clinics offer money back guarantee programs, available for a higher fee. For example, while a multiple cycle IVF cost plan without money back guarantee can cost about $16,000, the price with money back guarantee (usually up to 80%) is typically $18,000 or more.
The availability of these plans is subject to the health insurance plan of each patient. In some IVF centers, multiple cycle IVF cost plans are available only in case the patient is not covered by insurance. However, the standard type of IVF arrangement across the country is a single cycle.
The use of additional techniques contributes to increasing the cost. For example, if ICSI and assisted hatching were necessary, the cost can be as high as $33,000 or over, and using ICSI with PGD for a blastocyst embryo transfer using donor eggs and a surrogate can start from $80,000.
If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.
Cost in the UK
The costs of IVF vary on a case-by-case basis, and some women may be eligible to have NHS-funded IVF, provided that they meet the criteria that can be found on the fertility guidelines published by the National Institute for Health and Care Excellence (NICE).
If you decide to have IVF treatment at a private clinic, are not eligible for NHS treatment, or want to skip long waiting lists, the cost of a single IVF cycle can be £5,000 or more.
In the case of women aged under 40 years who have not been able to conceive after 2 years of regular unprotected intercourse or 12 artificial insemination cycles (with 6 or more being by IUI), the NHS will offer them 3 full cycles with or without ICSI.
As for women aged 40-42 years who have not been able to conceive after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (with 6 or more being by IUI), the NHS will offer them 1 full cycle, with or without ICSI, as long as they meet these requirements:
- They have never had IVF treatment before
- There is no evidence of low ovarian reserve
- They have talked with their doctor about the risks of IVF and pregnancy at this age
Also, in cases of unexplained infertility, that is, where evidence shows that there is no chance of pregnancy and IVF is clearly the only effective treatment, your doctor will refer you directly to NHS-funded IVF treatment.
Another possibility for British patients in need of IVF is pursuing this treatment abroad. Often, women who opt for this alternative are in need of egg donation. However, you should keep in mind that the HFEA only licensed clinics in the UK.
Cost in Canada
The general cost of in vitro fertilization (IVF) in Canada usually starts from $7,000 (Canadian dollars). However, the total cost is expected to be higher, especially if you are not covered by insurance. To the basic cost of IVF treatment, you should add:
- Registration fee: from $300
- Administration fee: from $650
- Drug costs: from $3,000
- Embryo cryopreservation: from $1,000
- Ongoing storage of embryos: from $250
- Thawing and replacing frozen embryos (FET): from $1,300
- Additional procedures such as Preimplantation Genetic Diagnosis (PGD), assisted hatching, ICSI, oocyte cryopreservation, etc. would contribute to increase the sum above.
It should be noted that the province of Ontario pays for fertility treatments, provided that you are an Ontario resident and have a valid OHIP card. To qualify for Ontario’s Fertility Program (one-time cycle per lifetime of IVF), the woman must be under the age of 43. You can qualify for an additional cycle if you act as a surrogate.
FAQs from users
What is Assisted Hatching?
Assisted Hatching (AH) is an assisted reproduction technique that can be used in the IVF lab with the resulting embryos. AH involves the penetration of the zona pellucida that recovers the embryos using a laser. It is performed on day 3 of embryo development.
AH allows the blastocyst to leave the zona pellucida, thereby increasing the implantation potential of embryos. Given that it is an invasive technique that carries some risks, it is indicated in the following cases only: patients who are 37 or over, embryos with a thick, dark or abnormal zona pellucida, multinuclear embryos, previous implantation failure, developmentally delayed cleavage-stage embryos, too high FSH levels, poor responders.
How many IVF cycles should you do before using donor eggs?
This is an extremely difficult question to answer because Fertility is a physical, emotional, and financial investment. Unless a woman is in menopause, one can never definitively provide a 0% chance for pregnancy using her eggs. However, as a woman ages, particularly above age 39 along with very poor ovarian age testing (ultra low AMH and/or elevated FSH), the prognosis for success with IVF becomes very poor.
So, there is no absolute number of IVF cycles to recommend undergoing before moving to egg donation. Nevertheless, one should consider egg donation if her IVF cycle was cancelled due to a poor response or a low number of eggs were retrieved despite a high dose of stimulation with poor embryo development.
How many IUI cycles should you do before moving on to IVF?
In couples with a good prognosis, that is, under the age of 37, with a normal sperm sample, we recommend 4 IUI attempts before moving on to IVF. In the case of single women or donor insemination cycles, up to 6 attempts are recommended. It depends on the clinical history of each patient, though.
Is IVF with gender selection possible?
Gender selection is possible through a procedure known as pre-implantation genetic diagnosis (PGD). Sex selection for social use is allowed in a small number of countries, though.
PGD is used for the genetic screening of the embryos before transferring them to ensure they are healthy, without chromosomal abnormalities, genetic disorders or birth defects.
It allows gender selection because the X and Y chromosomes have to be analyzed to dismiss the presence of sex chromosome abnormalities. At that point, the gender of each embryo (XX or XY) can be determined.
How much does IVF with egg donation cost?
The cost of egg donation depends widely on the country where the patient undergoes treatment.
While in European countries such as Spain, Cyprus, the Czech Republic, Portugal, or Greece it ranges from €3,800 to €5,500 approximately, in others such as Ukraine and Russia, it can be as high as €8,500-11,000. In the UK, however, egg donation costs about £9,500.
As for the USA, it is the most expensive destination, but at the same time the one that offers the possibility of choosing between a known, a semi-known, or an anonymous donor, which is an advantage for many egg donor recipients. On average, the price there reaches $20,000-40,000.
Other popular egg donation destinations around the world are Barbados and South Africa, where the price range is €4,500-5,900.
Read more in the following post: Cost of IVF with donor eggs.
Is it possible to undergo IVF from age 40 onwards?
The fertility potential of women starts declining at age 40, and therefore the success rates of IVF with own eggs are substantially lower at this point. In short, the chances for success depend on egg quality, but also on egg quantity.
This is the reason why most clinics around the world have an upper age limit for IVF patients using their own eggs. In general, such limit is set between the ages of 43 and 45.
In this sense, IVF with donor eggs may be a good option, as younger women produce high quality eggs, with a lower rate of chromosomal abnormalities to be present. By age 40, 60% of the eggs produced are abnormal.
Is IVF an option for gay couples as well?
On the one hand, lesbian couples have the chance to have a child through lesbian IVF or intra-partner egg sharing. It is a way for both of them to participate in the process actively, as one becomes the biological mother and the other the birth mother.
Intrauterine insemination (IUI) with donor sperm is another option available for lesbian couples. However, it depends on the chances for conception this treatment may bring to the couple, so fertility tests will be performed prior to choosing between one option or another.
On the other hand, gay men can build their family thanks to surrogacy with donor eggs. In this case, a gestational carrier undergoes IVF with the eggs of another woman, who acts as the egg donor for the intended parents, while one of them delivers the semen sample. Thus, the child will be genetically linked to one of the parents.
How many embryos should be transferred with donor eggs?
Specialists do recommend everyone undergoing IVF, whether it is done using own or donated eggs, to transfer one embryo in order for a multiple pregnancy to be prevented. There exist certain cases where transferring two embryos would be justified, including poor embryo quality and previous failed IVF attempts with a single embryo.
Also, given that the final decision is in the hands of the patient, sometimes younger patients who wish to have twins request a 2-embryo transfer from the beginning. The older the woman is, the higher the number of risks associated with a multiple pregnancy.
Can I get pregnant naturally after IVF?
Many couples achieve a natural pregnancy after having had an "test tube" baby. It happens in cases where the cause of infertility declines or disappears.
Stress is a good example. Some patients see their fertilizing potential reduced because of the stress caused when trying to conceive. Anxiety can affect egg and sperm quality, thereby hindering the odds of conception.
Making lifestyle changes (relaxing, changing dietary habits, diminishing or stopping the consumption of toxic substances, etc.) can help improve the chances of getting pregnant to a large extent.
Also, it may occur in cases of unexplained infertility.
What types of IVF protocols can be found?
Even though the purpose of taking fertility drugs is always the same, different protocols, ways to induce ovulation and prepare the endometrial lining can be found.
Depending on each woman's situation, the medications to take and the dose that best fits her need are determined. This is the reason why fertility testing is necessary prior to IVF treatment. Monitoring the response to medications and changing the type of drug or dose is crucial, too.
What are the symptoms of an IVF pregnancy?
When IVF is successful, there is no reason why pregnancy symptoms should be different to those of a natural pregnancy. Still, drugs to induce ovulation may cause some side effects such as bloating or nuisance, but in principle they are not expected to be different.
Is time off necessary after IVF egg collection?
No, it is not normally needed, either after follicle puncture or after the embryo transfer. Bed rest for IVF recovery is recommended only in exceptional cases.
How many IVF cycles before success?
Depending on what lead to IVF failure on the first round, a second attempt could improve the success rate or not.
For instance, if the first IVF cycle failed because of poor uterine receptivity, the protocol will be changed so that it works better on the second attempt.
Usually, various aspects are modified the second time a couple undergoes IVF, something that helps achieve better outcomes in general. It depends, however, on the particularities of each case.
IVF or ICSI, which one is better?
No treatment is better than the other, as both of them have their pros and cons. Depending on the characteristics of each couple and the origin of their fertility problems, IVF or ICSI would be more advisable.
For example, the most severe cases of asthenozoospermia should be treated with ICSI to guarantee a minimum number of chances for success. On the other hand, when the woman suffers from problems with ovulating or blocked fallopian tubes, conventional IVF can help solve the problem successfully.
Conventional IVF is more similar to natural conception and requires a higher degree of gamete manipulation. However, ICSI helps patients make a step forward toward pregnancy, as the egg-sperm binding is done manually.
What is the difference between conventional IVF and mini IVF?
Mini or micro IVF is an alternative to conventional IVF in which the level of ovarian stimulation with oral medications and injectables is lower.
Suggested for you
Following IVF embryo transfer, the next phase of the treatment is known as two-week wait or 2WW, which is defined as time period between the transfer and the moment when you finally test for pregnancy. If you want to learn more and get some useful tips to survive it, check out this post: What is the Two-Week Wait (2WW)? – Tips to Survive It.
Also, if you are interested in learning more about ICSI, a more challenging type of IVF, we recommend that you visit this post: What Is ICSI or Intracytoplasmic Sperm Injection?
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Reproducción Asistida ORG. Video: El proceso de la fecundación in vitro (The in vitro fertilization process), by Miguel Dolz Arroyo, MD, PhD, Jun 4, 2014. [See original video in Spanish].
FAQs from users: 'What is Assisted Hatching?', 'How many IVF cycles should you do before using donor eggs?', 'How many IUI cycles should you do before moving on to IVF?', 'Is IVF with gender selection possible?', 'How much does IVF with egg donation cost?', 'Is it possible to undergo IVF from age 40 onwards?', 'Is IVF an option for gay couples as well?', 'How many embryos should be transferred with donor eggs?', 'Can I get pregnant naturally after IVF?', 'What types of IVF protocols can be found?', 'What are the symptoms of an IVF pregnancy?', 'Is time off necessary after IVF egg collection?', 'How many IVF cycles before success?', 'IVF or ICSI, which one is better?' and 'What is the difference between conventional IVF and mini IVF?'.