What’s In Vitro Fertilization?
In vitro fertilization, or IVF, is the most common technique of assisted reproductive therapy. It’s been used and refined for decades. In IVF, eggs are retrieved from a woman’s body (usually the intended mother, although she may be an egg donor) and combined with sperm (from the intended father or a donor) in the laboratory. After fertilization, the resulting embryos are incubated for several days, and then one or more is transferred into the intended mother’s uterus (or, sometimes, the uterus of a gestational surrogate).
If you’re choosing IVF, make sure you’re choosing it because you really want it, not to please someone else or to fit an imagined ideal. No one else can make the choice for you; it’s your body, and you’re in charge of it. After you do your research and understand the procedure, if you believe that IVF is right for you, then proceed. To help you in your decision-making process, we have some information about the risks and benefits of having IVF at In Vitro Fertilization (IVF): Risks and Benefits.
Please note that this page is for informational purposes only, and is not a substitute for qualified, individualized medical advice. You should discuss your potential elective procedure with your own doctor(s), including your primary care physician and the doctor who will perform your procedure if you decide to proceed.
How it’s done
There are several steps to the IVF procedure. The first part of the procedure is the harvesting of the eggs. Usually, the woman takes ovulation induction medications in order to produce eggs. Even if the woman ovulates normally, these medications are often used, because they can stimulate the ovaries to produce multiple eggs (in a natural cycle, only one egg is usually produced). Ultrasounds and blood tests are used to monitor her during this time. It is possible in some cases to perform “natural cycle IVF,” in which no ovulation induction medications are used, but the woman is monitored during her natural cycle and the egg that her body produces on its own can be retrieved. If you would like to consider this option, please discuss it with your doctor to find out whether it would be possible in your case.
When one or several ripe eggs (follicles) are present in the ovaries, it’s time for the egg retrieval procedure. This is done in the doctor’s office. The woman is given some medication to help her stay relaxed and to prevent pain, but she doesn’t need to be under anesthesia as this is a minor procedure. Under the guidance of ultrasound, the doctor inserts a needle through the wall of the vagina to each ovary, and carefully removes each ripe egg. If the couple is using an egg donor for IVF, these first parts of the procedure will be done on the egg donor rather than on the intended mother.
The next step is fertilization. The man’s sperm (or donor sperm) are combined with the highest-quality eggs that were retrieved from the woman’s body. (If intracytoplasmic sperm injection (ICSI) has been selected, that procedure is performed at this time; see its separate page for more details.) The mixture is placed in an environmentally-controlled chamber, where the sperm can fertilize the eggs. If fertilization occurs, it usually does so within a few hours.
The resulting embryos are then incubated for several days. They are regularly monitored to ensure that they’re healthy. (If preimplantation genetic diagnosis (PGD) has been selected, that procedure is performed 3-4 days after fertilization; see its separate page for more details.)
The final step of the IVF procedure is the embryo transfer. The healthiest embryo(s) are selected for transfer. (Assisted hatching may be used on the embryos just before transfer; see its separate page for more details.) How many embryos are used depends on several factors. In order to decrease the chances of multiple births, which can be dangerous for the babies’ health, there may be only one or two embryos transferred; however, the age of the mother and any medical conditions she has may make it desirable to transfer more embryos. The procedure for embryo transfer is similar to the procedure for egg retrieval, but in reverse. Ultrasound guidance is used, and a needle is passed through the vagina and cervix into the uterus. The embryos are then passed through the needle. It is hoped that one embryo will implant into the wall of the uterus, resulting in pregnancy.
If any healthy embryos are remaining that were not transferred, the couple has the option of storing these embryos for use during a later IVF cycle. This would mean that, if the current IVF cycle does not result in pregnancy, one or a few stored embryos can be thawed and transferred (so that the egg retrieval and fertilization steps don’t have to be repeated); if the current cycle does result in pregnancy, the couple may wish to use the stored embryos in the future to attempt to have another baby. If the couple does not choose to store the embryos, they can be discarded, or they can be donated. Donated embryos are used for IVF in couples who are unable to produce healthy embryos using their own eggs and sperm, but still wish to experience pregnancy. Sometimes, donated embryos are used in scientific research.
IVF can help many infertile couples become pregnant, but is not always successful on the first cycle. In many cases, more than one cycle of IVF is needed to achieve pregnancy. If embryos from the first cycle are stored, they may be used for later cycles as described above; if not enough healthy embryos resulted from the first cycle, or if the extra embryos were not stored, then all of the steps of the IVF cycle may need to be repeated.
Preparing for the procedure
Choosing your clinic
When choosing an assisted reproductive technology clinic (sometimes called a fertility clinic), there are several factors you may want to take into consideration. One is the physician(s) and others who will oversee your care. Make sure that your physician is board-certified; you may want to know that a board-certified reproductive endocrinologist (a specialist in the hormones involved in reproduction) is on the staff, as a consultant if necessary. You should also expect that your clinic will be a member of the Society for Assisted Reproductive Technology (SART), and follows the guidelines of the American Society for Reproductive Medicine (ASRM). You might also want to consider the clinic’s success rates, which are collected and published by the Centers for Disease Control (CDC), but you should be aware that interpreting this data is more complicated than you might think.
For more help in your search for a reproductive medicine specialist, visit our How to Find the Best Assisted Reproductive Technology Clinic page. At Doctor Review, you can also search providers for patient reviews to help you find the very best.
Getting ready for the procedure
Before going through IVF, both the man and the woman will have several diagnostic procedures, blood tests, and examinations. In some cases, other types of infertility treatment, such as ovulation induction (stand-alone; this is also part of IVF) or intrauterine insemination, may be done first, and IVF will only be necessary if these are unsuccessful.
The woman should plan to spend the rest of the day after the embryo transfer resting. Complete bed rest is not necessary, but she should not return to any vigorous activities for at least that day. In most cases, the woman will take progesterone (a hormone) for 7-10 days after the transfer; it can be taken orally or given by injection. This will help thicken the lining of the uterus and support the early pregnancy.
For many couples, the hardest part of recovery is waiting to find out whether the woman is pregnant. The pregnancy test can be performed 12-14 days after the embryo transfer. Usually, a blood test is used, which can detect pregnancy earlier than a urine pregnancy test.