The IVF Journey | Part One: Introduction to IVF
A primer on in vitro fertilization and important considerations before beginning treatment.
By Lauren Lisle
Medical Experts: Jordan Rush, MD, OB-GYN; Desireé McCarthy-Keith, MD, MPH
If you’re contemplating in vitro fertilization (IVF), either with a partner or solo, you likely have questions about the process. While the amount of information available on the procedure itself is quite vast, there’s plenty to mull over before choosing to explore fertility treatments to arrive at the best decision for you. We’ll help you understand what the process entails and how to best prepare, plus give you expert advice from fertility specialists.
What is IVF and How Does it Work?
IVF stands for in vitro fertilization. It is a common type of assisted reproductive technology (ART) that can aid with fertilization, embryo development, and implantation to increase your chances of getting pregnant.
In IVF, a combination of medications and surgical procedures are used to retrieve mature eggs from ovaries to be fertilized by sperm in a lab. These fertilized eggs (embryos) are then implanted into the uterus. This procedure can be done using a couple’s own eggs and sperm, or eggs, sperm, or embryos from a donor.
Who is a Good Candidate for IVF Treatment?
There are different reasons to consider IVF, such as cases of unexplained infertility, advanced maternal age, becoming a single parent by choice, surrogacy, or the presence of certain health conditions, including endometriosis, uterine fibroids, and fallopian tube damage.
“The best candidates for IVF are patients with tubal factor infertility (blocked tubes),” specifies Jordan Rush, MD, OB-GYN at Northside Women’s Specialists, part of Pediatrix Medical Group in Atlanta, Georgia. “These patients qualify as candidates for initial treatment with IVF/embryo transfer.”
Additionally, a good candidate for IVF success has “healthy egg quality and reserve and normal sperm from a partner or donor,” explains Desireé McCarthy-Keith, MD, MPH, medical director of Shady Grove Fertility Atlanta, specializing in obstetrics and gynecology, reproductive endocrinology, and infertility. To do this, “egg reserve is assessed by ultrasound of the ovaries and blood testing for [certain hormone] levels. Sperm function is measured by microscopic semen analysis,” she says.
Some explore IVF after less-invasive fertility methods have been unsuccessful, such as intrauterine insemination (IUI). In vitro is also a reproductive option for same-sex couples, or for anyone interested in using donor eggs, sperm, embryo(s) or employing a gestational carrier.
How Much Does IVF Cost?
It’s difficult to know how much treatment will cost beforehand, and it’s somewhat dependent on where you live or your insurance benefits.
According to the National Conference of State Legislatures, the average cost of a single IVF cycle in the United States is between $12,000 and $17,000, but this total does not include medication or additional tests and procedures—some of which are optional, some not depending on the clinic—that can be added to the base price. A recent article in “Forbes Health” reports that medication alone can account for up to 35 percent of overall charges, and because each patient’s individual medication needs are different, the range of cost is likely closer to $15,000 to $20,000 or more per cycle.
How you approach IVF will also affect the price. For example, the cost of non-donor IVF differs from that with a donor; another example is using a frozen embryo for implantation, which comes with cryopreservation and storage fees. The best place to start planning financially for treatment is to ask your provider for facility recommendations and learn about their treatment options.
What Should I Look for in a Facility and Provider?
“You should seek a fertility clinic with well-trained and experienced health care physicians and embryologists,” says Dr. McCarthy-Keith, while adding that individuals should research potential facilities’ treatment success rates and clinic reviews online.
“Look for a clinic that is supportive and patient-focused. While many patients focus primarily on the financial preparations for IVF treatment, it is equally important to ensure that you are physically, emotionally, and psychologically prepared. Going through fertility testing and fertility treatment (as well as the side effects) can be stressful and emotional, so ensuring that you have a good support system and effective ways to cope with the ups and downs of treatment is key,” she explains.
From a provider standpoint, Dr. Rush agrees that how often a physician is successful is also important and notes other signs to observe.
“Considerations for selecting a provider include their pregnancy success rates (live newborn births not including miscarriage), the cost of the IVF cycle and whether they reimburse for a failed cycle, whether they have a dedicated physician or a number of providers, and whether they have their own lab/embryologist,” says Dr. Rush. He adds, “The [potential] clinic should allow you to interview them prior to proceeding with treatment, so that you are familiar and comfortable with their process.”
Some common interview questions and concerns Dr. Rush receives from new patients include options for unused embryos, how many eggs will be used in the process, and whether eggs, sperm, and embryos are stored on-site or at a different location.
How Long Does Treatment Take?
“The IVF process typically lasts six to eight weeks from initial consultation to transfer of the embryo(s),” explains Dr. Rush. However, the process involves many steps that can take longer in some cases. “Week one consists of the initial visit and consults; a clinical workup is also performed, and financial information is discussed. Weeks two through four involve prep, usually including either birth control pills or Lupron [hormone injections]. Week five is stimulation [of the ovaries] and week seven involves retrieval, fertilization, and then hopefully embryo transfer.”
Some patients are able to conceive on the first try, but many people need more than one round of IVF to get pregnant. The good news is that IVF treatments do increase your chance of pregnancy if experiencing infertility, though there’s no guarantee that treatment will work for everyone.
How Successful is IVF?
According to the Centers for Disease Control and Prevention (CDC), ART success rates vary in the context of patient and treatment characteristics, such as age, infertility diagnosis, number of embryos transferred, type of ART procedure, use of techniques, and history of previous births, miscarriages, and ART cycles.
The CDC compiles national statistics for all ART procedures performed in the U.S., including IVF, which accounts for 99% of the procedures. The latest report from 2018 shows that 48.8% of IVF transfers in women ages 35 and under (with or without prior ART cycles) resulted in a live birth, and the rates continue to decrease with age:
- Ages 35-37: 44.1%
- Ages 38-40: 37.6%
- Ages 41-42: 26.6%
- Ages 43 and older: 12%
What Should I Do Before Starting Treatment?
IVF is both physically and emotionally demanding, but there are ways to prepare yourself to increase your chances of conception.
- Eat a healthy, well-balanced diet
- Avoid processed foods
- Maintain a healthy weight
- Take prenatal vitamins and a folic acid supplement
- Stop smoking, drinking alcohol, and using recreational drugs
- Avoid travel to any countries or regions that may put you at risk of exposure to significant infectious diseases, which could delay treatment
- Reduce or eliminate your caffeine intake
- Decrease stress and anxiety levels
- Join an infertility support group
In addition, Dr. Rush advises patients “become familiar with the required testing, medications, and other steps in the process; and to be aware of the associated risks, including multiple gestation, increased rate of prematurity, miscarriage, and ectopic pregnancy (pregnancy outside of the uterus).”
Even without complications, in vitro fertilization can be draining to your mental well-being. “Psychological counseling is an effective way for patients to foster their mental health and receive support before, during and after treatment,” recommends Dr. McCarthy-Keith.
Ensuring you’re well supported throughout the process is crucial, even in the early days of doing your research. Share your findings with your partner or a trusted friend, and have an open conversation with your provider about considering IVF to receive their guidance before making your next move.