A Beginner’s Guide to In Vitro Fertilization

Experiencing fertility problems isn’t something that anyone expects when they begin trying to conceive. It can be overwhelming, frustrating, and leave you feeling hopeless, but it’s important to keep in mind that there are a number of treatment options that can give you the family you’re hoping for. One option that may come to mind right away is in vitro fertilization (IVF).

In Vitro Fertilization: An Overview

IVF is common enough that it’s often one of the first fertility treatments to come to mind for many, but it’s important to note that it’s far from one of the first treatment options for a patient to implement. Going the route of IVF depends on the causes of your infertility, and not everyone is a good candidate.

Patients in their 20s to mid-30s have the best success rates with IVF. Women with fertility problems like polycystic ovary syndrome (PCOS) and endometriosis often make good candidates for IVF. Couples with male factor infertility, such as low sperm count, also benefit from IVF.

At IVFMD, we focus on 6 main steps in the IVF treatment process.

  1. Ovarian Stimulation. In a normal cycle, 10-20 eggs are produced, but only one is naturally stimulated to maturity. The first step in IVF is to use medication that stimulates the ovaries to allow for more eggs to reach maturity, giving the patient a higher chance of successful fertilization.
  2. Egg Retrieval. Once the follicles have begun to mature, the eggs are retrieved via ultrasound guidance through the vagina. The patient is under IV sedation for 20 minutes during this step.
  3. Fertilization. The mature eggs are isolated and fertilized in the lab. This process involves each eggs being incubated with roughly 70,000 motile sperm. For cases with low sperm count, one sperm is chosen and injected into the egg.
  4. Embryo Culture. The fertilized eggs are allowed to culture for five days under controlled conditions. The patient takes progesterone during this time to prepare the uterine lining if she desires a fresh transfer.
  5. Embryo Transfer. On or around the fifth day of the culture process, a single embryo is transferred into the patient’s uterus via a soft catheter under ultrasound guidance. This step is painless and does not involve sedation. Embryos are transferred either fresh or frozen, with frozen becoming more and more common. In a frozen embryo transfer (FET), the uterine lining isn’t exposed to as many hormones and the endometrium is able to develop more gradually and naturally, making implantation more likely.
  6. Embryo Biopsy for PGT. Instead of fresh transfer, embryos can be biopsied and tested for chromosomal abnormalities (Preimplantation Genetic Testing, or PGT). In the future, a normal (euploid) embryo can be thawed and transferred after the uterine lining has been prepared with hormones. Then comes the hard part: waiting. The patient waits for about 10 days before taking a pregnancy test to determine if the transfer was successful. If the test is positive, the patient is referred to an obstetrician for the remainder of the pregnancy. 

 

IVF Stim- Egg Retrieval

IVF culture- Embryo Transfer

Risks Involved with IVF

While serious complications from IVF are rare, there are still risks involved, as with any medical procedure. The medication involved with ovulation stimulation may have side effects like headaches, mood swings, abdominal pain or bloating, and hot flashes. Risks during the medical procedures include bleeding, infection, damage to the bowel and/or blood vessels surrounding the ovaries, and adverse reactions to sedation. 

Most women have mild pelvic soreness and cramping after egg retrieval but this is self limited, resolving within a couple of hours after the procedure.

For safety reasons our anesthesiologists require patients to be at body mass index (BMI) of 38 or lower. High body mass can allow accumulation of the anesthetics Propofol and Fentanyl that in high dose can suppress respiration.

Following the IVF protocol, the risk of miscarriage stays in line with the chances of miscarriage during a natural conception, but the risk increases with age. There is roughly a 2-5% chance of ectopic pregnancy, which occurs when an embryo implants outside of the uterus. There is also a chance of multiple births if more than one embryo is transferred. 

Other Types of IVF

On top of basic IVF, IVFMD offers a number of different treatments that may work for you. Choosing the correct stimulation protocol is one of the most important decisions in IVF planning. At IVFMD we take great care in assessing every patient’s situation when designing the ovarian stimulation protocol. The reserve of the ovaries, as determined by the AMH level and the antral follicle count, plays a critical role in helping us decide the stimulation protocol. Patients who have normal egg reserve can use the regular IVF protocols, whereas patients with low egg reserve can benefit from one of the aggressive protocols.

Mini IVF is a newer protocol that we offer. This treatment path is a good option for those with low egg reserve, which is when tests determine that you have less than the average number of eggs for your age. Mini IVF uses a lower dosage of ovulation stimulation medication because you have fewer eggs to try to bring to maturity. We also utilize the INVOCELL device with our Mini IVF treatment, which allows the patient to carry the embryos in the vagina while they begin to develop. This action mimics the conditions of the fallopian tubes, where the embryo develops in natural conception.

Aggressive IVF protocols are offered that are more tailored to a patient’s circumstances. Different medications are used at different parts of the cycle, depending on the woman’s egg reserve and how they respond to the medications. These different protocols allow for more focused growth of the follicles, encouraging at least one to mature. 

How Much Does IVF Cost?

At most fertility clinics, the cost of the various fertility medications used while undergoing IVF cost around $1,500 to $8,000 per cycle depending on the woman’s egg reserve. The cost of IVF on top of that can be anywhere from $12,000 to $15,000. With everything combined, many couples spend an average of roughly $20,000 per cycle. With prices that high, many couples become discouraged at the thought of having to undergo more than one cycle.

At IVFMD, we’ve implemented the IVF global fee, which secures your price before you begin ovulation stimulation, so you won’t be hit with any surprise costs. Our cost for IVF is $8,500, with fertility medications still costing around $2,000-3,000. Mini IVF with INVOCELL is another affordable option, costing $5,500 with the same price for medications. To do a transfer of frozen embryos, the cost is $2,000. 

IVF Could Be the Answer

IVF sounds overwhelming when you’re first starting down this path, but our physicians are here to help you every step of the way. If you’ve been struggling to conceive naturally, talk to your doctor about your concerns and ask them if IVF might be right for you. At IVFMD, we’re staffed by professionals who care and want to help you get the family you’re searching for. Contact us today with any questions and to schedule a consultation. 

 

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