In Vitro Fertilization, IVF - information about the process and procedures

Advanced Fertility Center of Chicago
Gurnee & Crystal Lake, Illinois

What is in vitro fertilization or IVF?

IVF involves stimulating multiple follicles and eggs to develop in the ovaries, then taking eggs out of the woman, fertilizing them in the laboratory with her partner's sperm and transferring embryos back to her uterus.

The first IVF baby in the world (Louise Brown) was born in July of 1978 in England. Louise Brown was 28 when she delivered her own baby in 2006. Her own baby was conceived without in vitro fertilization. Hundreds of thousands of children are now born every year as a result of the in vitro fertilization technique.

Who should be treated with in vitro fertilization?

IVF can be used as an effective treatment for infertility of all causes except for women with infertility caused by an anatomic problem with the uterus, such as severe intrauterine adhesions.

It is generally used in couples who have failed to conceive after at least one year of trying who also have one or more of the following:

1. Blocked fallopian tubes or pelvic adhesions with distorted pelvic anatomy. Women that have had tubal ligation and are considering tubal reversal surgery as well as men that are considering vasectomy reversal surgery might also consider IVF.
   
   
2. Male factor infertility (low sperm count or low motility). ICSI is an IVF procedure that can fertilize eggs even with poor sperm quality.
   
   
3. Failed 2-4 cycles of ovarian stimulation with intrauterine insemination
   
   
4. Advanced female age - over about 38 years of age. In vitro fertilization and advanced maternal age is discussed in detail on the female age page.
   
   
5. Reduced ovarian reserve, which means lower quantity (and sometimes quantity) of eggs. A day 3 FSH and estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Reduced egg quantity and quality is usually treated with either IVF, or with IVF with egg donation.
   
   
6. Severe endometriosis
   
   
7. Unexplained infertility when inseminations have failed. Unexplained infertility means standard fertility tests have not found the cause of the fertility issue.
   

How does IVF improve fertility?

In vitro fertilization increases the efficiency of human reproduction, which is often not very efficient naturally.

• Essentially, we are involved in a numbers game that worsens as the female partner ages
• With IVF we remove multiple eggs - and after careful culture for 3-5 days of the eggs that fertilize, we transfer one or more of the "prettiest" embryos back to the uterus.
• Any remaining embryos (if there are any) can be frozen for future use by the couple

In a sense, we are compressing many months of "natural" attempts into one menstrual cycle. By transferring the fertilized embryo(s) directly to the uterine cavity, fertility is improved for many couples that have sperm issues (fertilization defects), or issues on the female side related to egg pickup from the ovary, or tubal transport of the embryo to the uterus.

Therefore, with IVF:

1. We force the body to produce multiple follicles and eggs (only one follicle with one egg inside develops in a natural menstrual cycle)
   
   
2. We take the eggs out of the ovaries when they're ready (release and tubal pickup of the egg can be inefficient naturally)
   
   
3. We coerce fertilization in the lab (sperm or egg issues can cause fertilization problems in a natural situation)
   
   
4. We culture the embryos for several days and then pick the best one (or more) for transfer to the woman (selection of the best one(s) increases chances of success)
   
   
5. We transfer the embryo(s) to the best location in the middle of the uterine cavity (tubal transport of the embryo to the uterus is bypassed)

As shown in the graph above, as women age we get less eggs with in vitro fertilization. More importantly, we see lower rates of implantation per embryo transferred (compare "Embryos Transferred" to "Fetal Heartbeats"). The rate of miscarriage also increases with the age of the female partner (compare "Fetal Heartbeats" to "Babies Born"). The numbers above the columns show the actual values (averages for each age group).

"Day 5 Blasts" are estimated because we do both day 3 and day 5 transfers. For those couples that had a day 3 embryo transfer procedure we estimated the number of day 5 blastocysts that (probably) would have been available if we had cultured all embryos until day 5.

From the data above, we can calculate a useful statistic called the implantation rate. The implantation rate is usually defined as the percentage of embryos transferred that implant and develop to the stage of ultrasound documented fetal heartbeat.

For example, if we transfer 2 embryos to the uterus and the female becomes pregnant - if there is one fetal heartbeat seen on early ultrasound (single pregnancy) the implantation rate is 50% (1 of the 2 implanted). If there are two fetal heartbeats seen on early ultrasound (twin pregnancy) the implantation rate is 100% (both embryos implanted).

Implantation rates are used by fertility doctors when talking with couples about their chances for IVF success rates and multiple births. Implantation rates are also used by in vitro fertilization laboratories as a measure of internal quality control. If there is a weakness somewhere in the system (in the lab, or elsewhere) then implantation rates drop as embryos become "weaker" - with a decreased ability to implant and continue normal development.

By tracking implantation rates the clinic can have an "early warning system" that should trigger a thorough investigation of the entire IVF system.

Our implantation rates for 2003-2005 were 47% for women under 35 years old, 33% for age 35-39, and 18% for women 40-42.

IVF clinical pregnancy and live birth information from the same data shown above

Before you choose an in vitro fertilization clinic for your fertility treatment, make sure you know the IVF success rates of fertility clinics you are considering.

Both SART and the CDC (US government agency) make this easy by posting success rates for all reputable IVF clinics on their websites. Our IVF success rates page has links to these reports.

IVF procedures

In vitro fertilization stimulation protocols and follicle development

Egg retrieval procedure

Embryo transfer procedure

What to do if the first IVF cycle fails?

Advanced Fertility Center of Chicago | Gurnee, IL (847) 662-1818 | Crystal Lake, IL (815) 356-1818

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