What is in vitro fertilization (IVF)?

IVF is the medical abbreviation for in vitro fertilization, an infertility treatment which timeline starts with egg collection via follicle puncture, followed by fertilization at the laboratory with sperm collected from the male. Embryo development is monitored to check whether pregnancy is achieved or not.

The various sections of this article are assembled in the following table of contents.

Types of IVF

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.

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. Its success rates, however, are higher, and this is the reason why it is the treatment of choice in the majority of cases.

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:

Male infertility

Moderate-to-severe cases of male infertility can be treated by means of IVF:

Female infertility

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
  • Endometriosis

IVF referral criteria

For a patient to be eligible for IVF treatment, she should be able to produce eggs, without uterine anomalies or disorders that may hinder embryo implantation or lead to a miscarriage.

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.

On the other hand, in cases where poor ovarian reserve or menopause is the cause of female infertility and therefore the patient does not meet the basic requirements, an alternative could be donor-egg IVF. Should you need more information, please visit the following post: IVF with donor eggs.

It is also possible for couples to undergo IVF with donor sperm or even double-donor IVF, that is, with both donated eggs and donated sperm.

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 to read the following post: IVF vs ICSI.
  • Embryo culture: Once the oocyte has been fertilized, 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, 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.

What to expect from IVF

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

  • 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 derived are not severe.

Disadvantages of IVF

  • 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.

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 potentials 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 you to read this article: Side effects of IVF.

How much does IVF cost?

The approximate cost of in vitro fertilization is €3,000-5,000. Nonetheless, it depends on the particularities of each case, the fertility clinic chosen, required testing, etc.

More often than not, the medications prescribed to patients are not included in the initial cost estimate. On average, fertility drugs to induce ovulation add €1,000-2,000 to the overall cost, and around €300 more derived from the preparation of the endometrium.

It is crucial for patients to review carefully the additional expenses and the fees included in the initial price given by the clinic.

Another important aspect to consider is that pregnancy does not always occur on the first attempt with IVF. In this sense, is may be interesting to ask for the cost of embryo cryopreservation, frozen embryo transfers, etc.

Some fertility clinics offer special plans or discounts from the second or third attempt with IVF onwards.

FAQs from users

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 with gender selection possible?

Gender selection is possible through a procedure known as pre-implantation genetic diagnosis (PGD) or pre-implantation genetic screening (PGS). However, sex selection for social use is allowed in a small number of countries.

PGD/PGS 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 rule out the presence of sex chromosome abnormalities. At that point, the gender of each embryo (XX or XY) can be determined.

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 brings 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.

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 assisted hatching in IVF with ICSI?

Assisted hatching is a method that consists in making a hole in the zona pellucida to help the embryo break out or “hatch” from it. By doing this, we can increase the chances of pregnancy. It is carried out while the embryo is in the laboratory.

You can find more information here: Definition of assisted hatching.

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.

4 comments

  1. usuario
    Amanda Jones

    Hello, my name is Amanda. I’ve endometriosis (grade IV) and did surgery on July. I’ve been trying to conceive ever since with no luck so far. I’d like to know how long should I remain in the waiting list for IVF. Do you know if it will take longer or less?

    • avatar
      Sandra F.Fertility counselor

      Hello Amanda,

      I am afraid fertility clinics do not give any preference to women suffering from endometriosis or any other pathology. You should take into account that every woman who undergoes IVF has been diagnosed with a fertility problem, and there’s no problem more important than the others. As for waiting lists, it depends on each fertility clinic, and may vary from a few days to several months.

      I hope I have been able to help,

      Regards

  2. usuario
    Caitlyn

    Hello! Thank you for this wonderful article.
    Well, I did an ET which finally was negative and after a few months resting, I started a second cycle this time with a frozen embryo I froze after my 1st attempt. This time I’m taking estrogens orally, and also patches and pessaries, but even with all that my endometrium is not growing. Later, provided that the estrogens took me to depression, they tried with my natural cycle, but my endometrium does not grow!
    Is there any medication in the world I can take to make my endometrium grow? Natural estrogens or something like that? What about acupuncture or exercise? Anything?
    Thanks!

    • avatar
      Sandra F.Fertility counselor

      Hello Caitlyn,

      In those cases where there is no endometrial growth, knowing what is causing it is very difficult. Anyhow, it was a good idea to try with a natural cycle, since there are times when administering estrogens and progesterone exogenously leads to failure because the organism does not response to medications and therefore endometrial thickness remains the same.

      Although you can try with different natural remedies, it should be clear that they are not fertility treatments and won’t make your endometrium grow as expected; but any help is good anyway. Exercise may promote blood circulation in that zone, leading thus to endometrial growth.

      And the same applies to acupuncture and some foods that improve blood flow such as oranges and ginger. As for taking natural estrogens, I recommend you to ask your gynecologist firstly.

      Best wishes