The Ins and Outs of In Vitro Fertilization (IVF)

It's helpful to know the ins and outs of in vitro fertilization (IVF) before undergoing such a complex procedure. In vitro fertilization starts with testing to make sure you're a good candidate. After this preliminary step, the procedure involves stimulating the ovaries, retrieving the eggs, preparing the sperm, joining the eggs and sperm, incubating the embryo(s), and transferring them to the uterus.

Considering In Vitro Fertilization

If you are at the point where you are considering in vitro fertilization (IVF), then you have probably spent many months, and maybe even years, of anguish in trying to become pregnant. No doubt the emotional and physical roller coaster that you have been on already has left you frustrated and asking more questions. If your healthcare provider has mentioned that it may be time to start looking at more complex procedures to increase your chances of becoming pregnant, IVF may be your next step.
If you have taken some time to even just briefly research the procedure, you may feel overwhelmed by its complexity. Many factors come into play with this particular form of assisted reproductive technology (ART). Although it can be quite effective for many couples who battle infertility issues, IVF is not for everyone. Taking a closer look at what's involved can help you know what to expect and help you and your partner determine if this is a route you want to pursue.

The Preliminary Testing

Before beginning the IVF process, each woman and her partner should be evaluated to help maximize the chances for a healthy, safe, and successful pregnancy. If you have any medical conditions, such as diabetes, high blood pressure (hypertension), or asthma, they should be well controlled before trying to become pregnant. Also, women who are undergoing an IVF procedure should try to aim for a healthy weight. Studies have shown that there is a reduced chance of success with IVF for women who are obese, along with an increased risk of miscarriage and preterm birth.
Women and their partners will also need to have some blood work done, including screening for anything that might affect a healthy pregnancy. These tests will check for hepatitis B and C, HIV, and other communicable disease, as well as cystic fibrosis, sickle cell trait, or other genetic diseases that may be inherited.
Women may also need to have ovarian reserve testing done to measure their egg quality, quantity, and reproductive potential. These tests will be done on certain days of your cycle and will test certain levels of hormones, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels. Women who have elevated levels of FSH and/or estradiol may have reduced success rates with IVF or may require more medications during the process.
Another test done to check ovarian reserve is called a clomiphene citrate challenge test. This test involves women taking 100 mg of clomiphene citrate (a tablet taken by mouth) on days 5 through 9 of their cycle. Blood tests are done on days 3 and 10 to measure FSH blood levels. Elevated FSH levels on these days are associated with reduced success rates for pregnancy with IVF.
The final test for ovarian reserve is called an antimullerian hormone level test, which is believed to reflect the remaining number of eggs. It can be done on any day in a woman's cycle.
Your healthcare provider will also evaluate your uterus prior to IVF. This may include using the following procedures:
  • Hysterosalpingogram
  • A saline infusion sonohysterography
  • Hysteroscopy.
In some cases, you may need to go through a trial IVF procedure, also called a "mock" transfer, which is used to determine the length and direction of the uterus. A mock transfer can also help your healthcare provider identify any problems that may occur with the embryo transfer.
For men who will be going through the IVF process, a semen analysis should be done. This checks for sperm quality problems that might affect IVF success.
Last reviewed by: Arthur Schoenstadt, MD
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