In vitro fertilization (IVF)

In vitro fertilization, also called IVF, is a complex series of procedures that can lead to a pregnancy. It's a treatment for infertility, a condition in which you can't get pregnant after at least a year of trying for most couples. IVF also can be used to prevent passing on genetic problems to a child.

In vitro fertilization is a treatment for infertility or genetic problems. Before you have IVF to treat infertility, you and your partner might be able to try other treatment options that involve fewer or no procedures that enter the body. For example, fertility drugs can help the ovaries make more eggs. And a procedure called intrauterine insemination places sperm directly in the uterus near the time when an ovary releases an egg, called ovulation. Sometimes, IVF is offered as a main treatment for infertility in people over the age of 40. It also can be done if you have certain health conditions. For example, IVF may be an option if you or your partner has: Fallopian tube damage or blockage. Eggs move from the ovaries to the uterus through the fallopian tubes. If both tubes get damaged or blocked, that makes it hard for an egg to be fertilized or for an embryo to travel to the uterus. Ovulation disorders. If ovulation doesn't happen or doesn't occur often, fewer eggs are available to be fertilized by sperm. Endometriosis. This condition happens when tissue that's like the lining of the uterus grows outside of the uterus. Endometriosis often affects the ovaries, uterus and fallopian tubes. Uterine fibroids. Fibroids are tumors in the uterus. Most often, they're not cancer. They're common in people in their 30s and 40s. Fibroids can cause a fertilized egg to have trouble attaching to the lining of the uterus. Previous surgery to prevent pregnancy. An operation called tubal ligation involves having the fallopian tubes cut or blocked to prevent pregnancy for good. If you wish to conceive after tubal ligation, IVF may help. It might be an option if you don't want or can't get surgery to reverse tubal ligation. Issues with sperm. A low number of sperm or unusual changes in their movement, size or shape can make it hard for sperm to fertilize an egg. If medical tests find issues with sperm, a visit to an infertility specialist might be needed to see if there are treatable problems or other health concerns. Unexplained infertility. This is when tests can't find the reason for someone's infertility. A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, your health care team might recommend getting a procedure that involves IVF . It's called preimplantation genetic testing. After the eggs are harvested and fertilized, they're checked for certain genetic problems. Still, not all of these disorders can be found. Embryos that don't appear to contain a genetic problem can be placed in the uterus. A desire to preserve fertility due to cancer or other health conditions. Cancer treatments such as radiation or chemotherapy can harm fertility. If you're about to start treatment for cancer, IVF could be a way to still have a baby in the future. Eggs can be harvested from their ovaries and frozen for later use. Or the eggs can be fertilized and frozen as embryos for future use. People who don't have a working uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy. The person is called a gestational carrier. In this case, your eggs are fertilized with sperm, but the embryos that result are placed in the gestational carrier's uterus.

IVF raises the chances of certain health problems. From short term to longer term, these risks include: Stress. IVF can be draining for the body, mind and finances. Support from counselors, family and friends can help you and your partner through the ups and downs of infertility treatment. Complications from the procedure to retrieve eggs. After you take medicines to spur the growth of sacs in the ovaries that each contain an egg, a procedure is done to collect the eggs. This is called egg retrieval. Ultrasound images are used to guide a long, thin needle through the vagina and into the sacs, also called follicles, to harvest the eggs. The needle could cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also linked with medicines that can help you sleep and prevent pain during the procedure, called anesthesia. Ovarian hyperstimulation syndrome. This is a condition in which the ovaries become swollen and painful. It can be caused by receiving shots of fertility medicines, such as human chorionic gonadotropin (HCG), to trigger ovulation. Symptoms often last up to a week. They include mild belly pain, bloating, upset stomach, vomiting and diarrhea. If you become pregnant, your symptoms might last a few weeks. Rarely, some people get a worse form of ovarian hyperstimulation syndrome that also can cause rapid weight gain and shortness of breath. Miscarriage. The rate of miscarriage for people who conceive using IVF with fresh embryos is similar to that of people who conceive naturally — about 15% for pregnant people in their 20s to over 50% for those in their 40s. The rate rises with the pregnant person's age. Ectopic pregnancy. This is a condition in which a fertilized egg attaches to tissue outside the uterus, often in a fallopian tube. The embryo can't survive outside the uterus, and there's no way to continue the pregnancy. A small percentage of people who use IVF will have an ectopic pregnancy. Multiple pregnancy. IVF raises the risk of having more than one baby. Becoming pregnant with multiple babies carries higher risks of pregnancy-related high blood pressure and diabetes, early labor and delivery, low birth weight, and birth defects than does pregnancy with a single baby. Birth defects. The age of the mother is the main risk factor for birth defects, no matter how the child is conceived. But assisted reproductive technologies such as IVF are linked with a slightly higher risk of a baby being born with heart issues, digestive problems or other conditions. More research is needed to find out if it's IVF that causes this raised risk or something else. Premature delivery and low birth weight. Research suggests that IVF slightly raises the risk that the baby will be born early or with a low birth weight. Cancer. Some early studies suggested that certain medicines used to stimulate egg growth might be linked with getting a specific type of ovarian tumor. But more-recent studies do not support these findings. There doesn't seem to be a significantly higher risk of breast, endometrial, cervical or ovarian cancer after IVF .

To get started, you'll want to find a reputable fertility clinic. If you live in the United States, the Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology provide information online about clinics' individual pregnancy and live birth rates. A fertility clinic's success rate depends on many things. These include the ages and medical issues of people they treat, as well as the clinic's treatment approaches. When you talk with a representative at a clinic, also ask for detailed information about the costs of each step of the procedure. Before you start a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screening tests. These include: Ovarian reserve testing. This involves getting blood tests to find out how many eggs are available in the body. This is also called egg supply. The results of the blood tests, often used together with an ultrasound of the ovaries, can help predict how your ovaries will respond to fertility medicines. Semen analysis. Semen is the fluid that contains sperm. An analysis of it can check the amount of sperm, their shape and how they move. This testing may be part of an initial fertility evaluation. Or it might be done shortly before the start of an IVF treatment cycle. Infectious disease screening. You and your partner will both be screened for diseases such as HIV . Practice embryo transfer. This test doesn't place a real embryo in the uterus. It may be done to figure out the depth of your uterus. It also helps determine the technique that's most likely to work well when one or more actual embryos are inserted. Uterine exam. The inside lining of the uterus is checked before you start IVF . This might involve getting a test called sonohysterography. Fluid is sent through the cervix into the uterus using a thin plastic tube. The fluid helps make more-detailed ultrasound images of the uterine lining. Or the uterine exam might include a test called hysteroscopy. A thin, flexible, lighted telescope is inserted through the vagina and cervix into the uterus to see inside it. Before you begin a cycle of IVF , think about some key questions, including: How many embryos will be transferred? The number of embryos placed in the uterus often is based on age and the number of eggs collected. Since the rate of fertilized eggs attaching to the lining of uterus is lower for older people, usually more embryos are transferred — except for people who use donor eggs from a young person, genetically tested embryos or in certain other cases. Most health care professionals follow specific guidelines to prevent a multiple pregnancy with triplets or more. In some countries, legislation limits the number of embryos that can be transferred. Make sure you and your care team agree on the number of embryos that will be placed in the uterus before the transfer procedure. What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for many years. Not all embryos will survive the freezing and thawing process, but most will. Having frozen embryos can make future cycles of IVF less expensive and less invasive. Or you might be able to donate unused frozen embryos to another couple or a research facility. You also might choose to discard unused embryos. Make sure you feel comfortable making decisions about extra embryos before they are created. How will you handle a multiple pregnancy? If more than one embryo is placed in your uterus, IVF can cause you to have a multiple pregnancy. This poses health risks for you and your babies. In some cases, a surgery called fetal reduction can be used to help a person deliver fewer babies with lower health risks. Getting fetal reduction is a major decision with ethical, emotional and mental risks. Have you thought through the risks linked with using donor eggs, sperm or embryos, or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You also may need an attorney to file court papers to help you become legal parents of an embryo that's developing in the uterus.

After the preparations are completed, one cycle of IVF can take about 2 to 3 weeks. More than one cycle may be needed. The steps in a cycle go as follows: