There are many conditions that render males and/or females infertile. There are also some conditions that simply make it more difficult for a couple to become pregnant naturally. In addition to fertility problems, there are couples who would like to have biological children and need a surrogate mother, for one reason or another. This is where in vitro fertilization comes in handy. This process makes it possible for couples who are having trouble getting pregnant to have a child. It also allows women to carry fertilized eggs from another woman or carry the child of a man with whom she has not had intercourse.
What is in vitro fertilization?
The words "in vitro" literally mean "in the glass." What this means in regard to in vitro fertilization is that a woman's eggs are fertilized outside of the body, as opposed to in utero. This fertilization ideally takes place in a clean, professional environment.
Several steps are often taken to prepare for fertilization. The woman involved will need to make eggs before ovulation in order for a viable egg or eggs to be collected. This is a natural process that produces one egg per monthly cycle. It is ideal to have several eggs for the procedure. Therefore, patients will be given a fertility drug, such as clomiphene citrate, in order to stimulate the ovaries into producing more eggs than usual.
Unfortunately, not all women can produce eggs even with fertilization drugs. In cases such as these where a women still wishes to carry a baby herself, there may be the option to use donor eggs for fertilization. The donor will go through the same collection process as a patient who is having eggs removed for their own pregnancy. Of course, this assumes that the hopeful mother who cannot produce eggs will be able to carry a child. If that is not possible, in vitro fertilization can be used with a surrogate mother. Other situations may call for donor eggs, donor sperm and/or surrogate mothers, as well.
Collecting the egg and sperm
Collecting a male's sperm for in vitro fertilization is the easy part. The only thing complicated about it is proper storage so the sperm remains viable. The male simply needs to produce sperm through ejaculation for collection. If the fertility issue is with the male, then donor sperm can be collected in the same manner. If ejaculation is impossible and sperm is present, doctors may retrieve sperm through a small incision in the scrotum.
The collection step is more complicated for women. Their eggs are harvested through a process known as follicular aspiration. When the eggs are present, the woman will have a needle passed through her vagina into her ovary where the follicles house the eggs. The fertility professional will suck the eggs out through the needle in both ovaries. This is done before ovulation. If ovulation takes place, it becomes necessary to wait until the next cycle. The procedure should be relatively painless and done with medications that help with comfort. There may be some discomfort after the surgery. However, it tends to be short-lived, as very little trauma is placed on the reproductive organs when done properly.
The collected eggs are inspected for viability before the fertilization process begins. The best of the batch are chosen for the sperm. The eggs may be fertilized in two ways. The eggs can be simply stored together with the sperm so the sperm will fertilize the eggs naturally, though this might not work in cases where the eggs or the sperm are not functioning properly. The other method is to inject the sperm into the egg, essentially forcing fertilization.
After there is successful fertilization, an embryo should form. This occurs when the cells begin dividing. It should start growing and dividing at a regular rate past this point. During this time, the embryo should be under observation to ensure that it is growing as it is supposed to grow. This takes only a few days.
Pre-implantation genetic diagnosis
Before an embryo is inserted, it is possible to have it checked for predisposition to genetic disorders. The test for this is known as pre-implantation genetic diagnosis. It is not always available and is not thought necessary for parents with no known history of genetic disorders. However, if it is available and there is a history, it could ensure that the embryos chosen are not susceptible to genetic disease. This test can be conducted just a few days after the sperm fertilizes the egg.
Insertion of the embryo into the womb occurs between three and five days after the fertilization. It is done using a catheter that places the eggs in the uterus via the vaginal opening and cervix. This is an outpatient procedure. The hope is that the embryo will implant inside the uterus and thus the woman will become pregnant. Sometimes more than one embryo is placed in the uterus if it is thought that implantation will be difficult. This can result in multiple implantations and should be considered carefully if the couple does not want more than one child.
After the procedure, it is simply a matter of waiting to find out of it worked. This can be a difficult and exciting time for expecting parents. Luckily, it is possible to find out within a couple of weeks. While signs of pregnancy may take a little longer to appear with in vitro fertilization, traditional methods of testing work the same. Therefore, women can take pregnancy tests and watch out for missed periods.
Who might benefit from in vitro fertilization?
Several hopeful parent types may benefit from in vitro fertilization. Instances that may warrant the procedure are:
- Women who are past their natural child-bearing years
- Women whose eggs do not pass through the fallopian tubes due to a medical condition or past medical procedure
- Decreased sperm count in the male
- Problems with sperm production or ejaculation in the male
- Women with endometriosis
- Couples requiring a surrogate due to any number of issues carrying children from health to sexual orientation
How long does it take to have in vitro fertilization?
Numerous factors will dictate how long the in vitro fertilization takes:
- The viability of the eggs harvested
- Whether fertilization takes place on the first try
- Whether healthy embryos result from fertilization
- Whether the embryo or embryos implant
If any of these steps go wrong, the process may have to be started again. Furthermore, the process may have to change due to unforeseen issues. It may turn out that a donor egg, sperm or embryo is necessary.
So, how long does the process take if all goes well?
The female will need to begin fertility drug therapy and be observed for roughly two weeks before egg retrieval. At that time, the egg will be fertilized. If the process goes according to plan, insertion of the embryo will take place in less than a week from that time. Technically, the process ends there. However, the woman must then wait to see if the embryo has implanted. Not counting that waiting period, the entire process will take roughly three weeks and will include multiple doctor's visits. There will likely be some visits before treatment begins as well, but that time will vary from patient to patient and doctor to doctor, if that time is taken at all.
The success rates of in vitro fertilization depend on many things. Furthermore, the statistics are not perfect due to the fact that not all successes and failures are reported as such. There is also the chance of implantation occurring but not resulting in a live birth. Nonetheless, documented success is on the rise and in vitro fertilization is considered a viable treatment for certain types of infertility.
The overall reported success rates for in vitro fertilization vary from country to country. However, they tend to hover at just a few percent to 15 percent less than half. Plainly put, more than half of women who undergo in vitro fertilization will not have a successful pregnancy. It should be noted that women who opt for in vitro fertilization are often suffering from some form of infertility, be it an issue with their partner or with themselves. Nearing half is far better than the statistics for infertile women who try to get pregnant naturally.
By age group
There is no doubt that the success of in vitro fertilization goes down as age goes up. There is a disparity of 20 percent or more between women 34 and younger and women older than 40.
The statistics by age are:
- 34 and younger: 30 to 35 percent
- 35 to 37: 25 percent
- 38 to 40: 15 to 20 percent
- More than 40: 6 to 10 percent
The factors that affect success rates for in vitro fertilization include:
- How long the individual has been infertile
- Stress, though according to some studies, it does not play a role in success of in vitro fertilization
- Obesity in the implanted female
- High caffeine intake
- High alcohol intake
- Various medical conditions
How to increase chances of in vitro fertilization working
With a procedure like in vitro fertilization, there is a delicate balance of hormones, nature and nurture in place. If anything goes out of balance, it is possible that the procedure will fail. Therefore, it is important for recipients of this treatment to take their doctors' advice and possibly make a few lifestyle changes.
Listen to the professionals
In vitro fertilization is not cheap and it can take some time. Therefore, it should be handled properly to avoid having to do it more than once or having it fail. That means listening to the professionals handling the procedures involved. These professionals specialize in fertility treatments and understand what the body needs to have a successful implantation and pregnancy. Take all medicines as directed and follow the instruction the doctors give to the letter.
Give up bad habits
Some studies show that smoking can decrease the chances of in vitro fertilization working by up to 34 percent. In some age groups, that eliminates the odds of it working. It is a risk not worth taking. Furthermore, it can cause numerous other complications if it continues during pregnancy. Therefore, smoking cessation should take place before fertilization for women undergoing the treatment. Women should also abstain from smoking while pregnant.
Other substances like alcohol and caffeine can cause issues with in vitro fertilization as well. It is best to abstain from these substances throughout the treatment and throughout the pregnancy. Essentially, the body should be treated as if it is already pregnant in regard to consumption of questionable substances. Of course, illegal drugs come with a multitude of problems as well. To maintain a healthy balance, maintain a healthy diet and consume only healthy foods, drinks, prescribed medications and nothing else.
Along with maintaining a healthy diet to encourage success of in vitro fertilization, it may be necessary to drop some weight before attempting the treatment. Obese women have less of a chance of conceiving both naturally and with in vitro fertilization. It is possible to increase the chances with some healthy dieting. Exercise can also be helpful. Be sure to discuss both the diet and the exercise with the fertility specialists doing the treatment before it begins, in case there is something that may interfere with its success.
There is certainly evidence that stress may not affect the outcome of in vitro fertilization, which is certainly a good thing, considering that the process itself can be stressful. However, as with any health or medical concern, it is a good idea to relax and minimize stress when undergoing in vitro fertilization. It is better for the health of the mother for her to be calm and positive throughout the process as much as possible. There is definitely the possibility that a happy and positive hopeful mother will be more likely to continue in the event that the procedure requires several attempts.
The risks of in vitro fertilization
Every medical procedure has side effects and possible risks that patients should weigh first. In vitro fertilization is no exception. There can be undesirable outcomes from individual procedures within the treatment or from the overall treatment.
Potential side effects of fertility drugs
The primary risk of fertility drugs is hyper-stimulation of the ovaries. This happens to about 30 percent of women who take the drugs necessary for their eggs to be harvested. Hyper-stimulated ovaries are essentially swollen ovaries and they can hurt. It can be simply uncomfortable and easily treated or it can be severe and require that the patient be hospitalized. Symptoms of mild to severe hyper-stimulated ovaries are fluid in the abdomen, pain, gas, nausea, bloating, vomiting and heartburn.
Potential side effects of egg harvesting
The egg harvesting step of in vitro fertilization is not a major surgery. However, it is still surgery and has its risks. The medication given for the procedure may cause a reaction, though that risk is patient specific. There is also the chance of bleeding, possible injuries to any tissue in the area of the retrieval tools and infections. Every step of in vitro fertilization requires frequent contact between medical professionals and the patients involved. Therefore, these effects are likely to be spotted if the patients convey any discomfort or symptoms to their doctors or through tools like sonograms.
Potential side effects of embryo insertion
The most common risk of embryo insertion is multiple implantations. That means twins, triplets or more. There are big risks for the mother and the fetuses in cases of multiple implantations. Patients may be given the option to reduce the number of fetuses in the womb to increase the chances of another fetus's survival.
Pregnancy risks that increase with in vitro fertilization
While there are studies that suggest otherwise, numerous studies show that the risk of birth defects, some potentially fatal to the infant, increases with in vitro fertilization. At this time, there is no explanation for this increase. Two possibilities are something to do with fertilization outside of the womb and perhaps an effect of the fertility medication.
Birth defects that could be linked to in vitro fertilization, but are not conclusively linked, include:
- Septal heart defects
- Imperforate anus
- Chromosome abnormalities
- Esophageal atresia
- Cleft lip
- Cleft palate
How much does in vitro fertilization cost?
In vitro fertilization is generally thought to be an expensive process and that is a correct belief. Doctors will often try other, less invasive, procedures before suggesting in vitro. There are other treatments that cost less and will work on specific infertility issues, rendering in vitro fertilization unnecessary in these cases. However, the cause of infertility cannot always be determined and cheaper alternatives do not always work. In the end, opting for in vitro fertilization can run roughly 15,000 U.S. dollars, sometimes more, sometimes less. Of course, there are several factors. These include extra procedures, complications, etc. Injection of the sperm directly into the egg may cost more. Implantation of a donor or already harvested and fertilized embryo from a prior treatment should be cheaper. Each treatment will come with its own price tag and there is no guarantee of fertilization. Therefore, one will likely pay for each round of in vitro fertilization until it works or becomes evident that it will not work.