What is in vitro fertilization (IVF)?

If you are having trouble conceiving, you may be considering in vitro fertilization (IVF). This is when eggs and sperm are combined outside the body to create embryos.

 

In vitro fertilization (IVF) is the process of stimulating the ovaries to produce eggs, those eggs are then removed from the ovaries and fertilized in the lab with either sperm or your selected donor sperm. Your embryos will grow in the lab and then be transferred into the uterus. All remaining embryos will be frozen for future use.

 

Your Fertility Physician will decide on a treatment protocol that is best suited for you. The IVF treatment cycle can take between 6-10 weeks from Priming to Pregnancy Test.

In Vitro Fertilization

When to consider IVF

There are numerous reasons why the person might consider IVF. Here are some of the most common:

 

  • If the person providing the eggs is in their late thirties or older
  • If the person has endometriosis
  • If the person has damage to one or both of their Fallopian tubes, if the person have had a tubal ligation or surgery to remove their Fallopian tubes.
  • If the person or partner have a genetic condition or are a carrier of a genetic condition that you do not want to pass onto your children (please see our PGT page for more information)
  • If the person has unexplained infertility or recurrent pregnancy loss
  • If the partner has issues with sperm including low sperm count and / or motility
  • If the person or partner are undergoing reciprocal IVF, which is when one partner supplies the eggs and the other partner carries the pregnancy in their uterus
  • If other forms of fertility treatment, such as IUI, were not successful

What are the steps involved?

If you are interested in IVF, first talk about it with your primary care provider. They can refer you to Mount Sinai Fertility. For more information on our referral process please visit our How to Get Referred page

The IVF procedure includes the following:

Preliminary Testing: 4 - 8 weeks

All patients will have baseline testing prior to starting a treatment to determine the best fertility care plan.

Priming

Most IVF cycles start with a preparation month called “priming.” Before you start any fertility medications, you will take either estrogen tablets or the birth control pill for 1 – 3 weeks to calm the ovaries. This helps to ensure the follicles develop at the same rate.

Controlled Ovarian Stimulation & Cycle Monitoring

After your priming month, you will take injectable fertility medications to stimulate your ovaries to produce and grow more mature eggs. Most people need to take injectable fertility medications every day for 9 to 12 days. During this time, we will do blood tests and internal (transvaginal) ultrasounds to track the development of the follicles in your ovaries. While taking the fertility medications, you will need to see us about 2 to 4 times. These appointments are scheduled in the early morning. You may be asked to return every one to two days until you are ready for the egg retrieval procedure.

Trigger

Once your follicles have developed to an appropriate size and number, you will be prescribed a medication that helps the developing eggs complete their maturation process. The timing of this medication is very important. Your fertility care team will give you specific instructions on the time to perform this injection.

Egg Retrieval

The egg retrieval procedure is when eggs are removed from your ovaries using a needle and an internal ultrasound. The needle travels through a special cover attached to the internal ultrasound probe. It passes through the vagina and into each ovary. The follicles are drained and all the fluid sent to the lab. The embryologists working the in the lab carefully examine the fluid under the microscope to find the eggs. The doctor will give you sedative medications through an IV before the procedure begins, to help relax you and provide pain relief. While you will not be asleep, you should be comfortable. The procedure takes about 15 to 20 minutes. Afterwards, you will stay in our recovery area for about 1 hour before going home.

Fertilization

After your eggs are retrieved, the lab will inseminate them in the hopes that they will fertilize. Fertilization is where the egg and sperm come together to form an embryo. There are two ways fertilization can occur; with conventional IVF, sperm and eggs are mixed together and the sperm must get into the egg on its own. With intracytoplasmic sperm injection (ICSI), one sperm is injected into each mature egg. You can expect about 70% to 80% of mature eggs to become fertilized unless your fertility doctor has told you otherwise. The Embryology team will monitor the development of your embryos over the next week. You will receive updates in your portal regarding your embryo development.

Embryo Transfer

Embryo transfer is when an embryo is transferred into the uterus in the hopes of achieving a pregnancy. Embryo transfer can occur within the week following your egg retrieval procedure; this is called a fresh embryo transfer. Alternatively, an embryo transfer can occur in another month; this is called a frozen embryo transfer. All embryo transfers after genetic testing are frozen embryo transfers. Prior to your IVF cycle, you and your fertility doctor will have decided how many embryos to transfer at a time. This decision is based on a number of factors, including your age, medical history, and the number and quality of your embryos. During the embryo transfer procedure, we will insert a speculum so we can see your cervix. We will use an ultrasound placed on your abdomen to see the uterus. We will place a thin catheter through your cervix into the uterus. The embryo(s) will be placed into your uterus using an even thinner catheter that fits through the first one. The procedure takes about 5 - 15 minutes. It is not painful and does not require pain medication.

Embryo Freezing

You could produce more embryos than are required for transfer. Any embryos that develop to a certain stage can be frozen for long periods of time without reducing their ability to implant later on.

Risks associated with IVF

IVF is a safe procedure, however there are a few risks to be aware of. These include medication risks, ovarian hyperstimulation syndrome (OHSS), procedure risks, cycle cancellation and multiple pregnancy.

Medication risks

You might feel some bloating and fullness in your lower abdomen, which are normal reactions to the injectable medications. Other side effects include bruising and soreness at the injection site, allergic reaction, gastrointestinal symptoms, headaches, or mood changes. If you experience any reactions, please make sure to discuss these with your doctor.

 

Ovarian hyperstimulation syndrome (OHSS)

Some individuals develop a large number of follicles and very high hormone levels in response to their fertility medications. This over-response to medication is called ovarian hyperstimulation syndrome (OHSS). If the response is severe, fluid (water) can build up in the abdomen and lungs, and blood clots can occur. Severe OHSS occurs in 1% to 3% of those undergoing IVF. The fluid may need to be removed with a needle, and hospital admission may be required.

 

Another rare side effect of ovarian stimulation is ovarian torsion, where the ovary twists. This may require emergency surgery. If there is a risk of OHSS, the embryo transfer will be delayed and the embryos will be frozen to allow your body to recover fro the stimulation.

 

Procedure risks

Risks of the egg retrieval procedure include discomfort during the procedure, bleeding, infection, or injury to the surrounding  bowel/bladder/blood vessels. Infections are rare but may require antibiotics or surgery. Sedation is another risk, as some people can become too sedated and have breathing or heart rate complications.

 

Cycle cancellation

In some situations, your IVF cycle might need to be cancelled before the egg retrieval. If this happens, we will book an appointment with your primary doctor and a portion of your fees will be refunded depending on the treatments that have already occurred.

 

Multiple pregnancy

The goal of IVF is to have one healthy baby. However, there is a risk of multiple pregnancies with IVF.  Multiple pregnancies are a risk whenever more than one embryo is transferred.  Risks with multiple pregnancies include miscarriage, premature birth, or long-term health issues such as cerebral palsy. Risks to the person carrying the pregnancy include high blood pressure, diabetes, bleeding, and delivery problems. You may require bed rest or time off work earlier than planned. Please see our Multiple Pregnancy Fact Sheet for more information.

 

Pregnancy Risks

Miscarriages occur in about 15% to 30% of IVF pregnancies. Unless you are doing genetic testing on your embryos, the risk of early pregnancy loss (aka miscarriage) with IVF is the same as the risk with conceiving naturally. This risk is strongly related to the age of the person whose eggs are being used. Ectopic pregnancies (where the embryo implants in the Fallopian tube) occur in about 2% of IVF pregnancies. There are higher risks of high blood pressure, premature birth, caesarean birth, and low birth weight babies with IVF as compared to spontaneous pregnancies. All pregnancies have a small risk for birth defects. The general risk for all pregnancies is approximately 3% – 5%. The risk of birth defects including cerebral palsy appear to be higher in those with infertility, even if they conceive without fertility treatment.