Essential Facts About In Vitro Fertilization and Other Fertility Treatments

When you’re having trouble getting pregnant, going to afertilityclinic can be an overwhelming experience. Besides being stressful in its own right, fertility treatment comes with a whole vocabulary that may sound like a foreign language to you. The terms in this alphabet soup of jargon often refer to a bewildering array of tests, drugs, or treatments that may be recommended for you, depending on the suspected cause (or causes) of your fertility troubles. It’s a lot to take in.

Assisted Reproductive Technology Is Advancing and Improving

The good news is, scientific advances continue to improve fertility treatments, making it possible for increasing numbers of couples to have babies. In fact, astudy published in the August 2017 issue ofActa Obstetricia et Gynecologica Scandinavicaexamined the live birth rates among 862 women and men five years after they underwent assisted reproductive technology (ART): By the follow-up, 72 percent of the women had a child as a result of ART and 28 percent had a spontaneous pregnancy after ART. (1)

Your Fertility Clinic Guidepost

Your best route for navigating the ART maze will depend on the underlying problem. Here’s a step-by-step look at how you might travel through this experience:

If There Are Ovulating or Ovulation Problems

If you’re not ovulating regularly, you may be prescribed a fertility drug such asClomid (clomiphene citrate), an oral medication that causes thepituitary glandto releasekey hormones(such as follicle-stimulating hormone, FSH, andluteinizing hormone, LH) to trigger your ovaries to make eggs; or agonadotropin medication, which is an injectable treatment that stimulates the ovaries to produce multiple eggs. (2) By regulating your ovulation, you may be able toget pregnanton your own.

If There Are Sperm Problems

If your partner’ssperm countis low or his sperm is slow moving, IUI (intrauterine insemination) orIVF (in vitro fertilization)may be recommended. With IUI, a high concentration of good-quality sperm cells — collected from your partner or a donor —is inserted directly into your uterus around the time of ovulation. Before having the insemination procedure, you may take fertility drugs (such asclomiphene) to stimulate ovulation. Because the IUI procedure is timed to follow the detection of ovulation, there’s an improved chance that the egg and sperm will find each other and pregnancy will occur. The actual insemination procedure is simple and quick and can be done in a doctor’s office or at a fertility clinic — withoutanesthesia. (It may cause mild cramping but not pain.) (3,4)

In Vitro Fertilization (IVF) Isthe Most Common Fertility Treatment

In vitro fertilization (IVF) is a more complicated procedure — and one of the more widely known and effective forms of ART. It involves using a combination of fertility medicines (to make your eggs mature and ready to be fertilized) and surgical procedures.

First Steps for IVF Treatments

Before ovarian stimulation occurs, the first step is often for a woman to suppress ovarian function by takingbirth control pillsor injecting a GnRH (gonadotropin-releasing hormone) agonist medication, such asLupron (leuprolide), into her body for one to four weeks to prevent her from releasing hormones that could stimulate natural ovulation. (5)

Getting Fertility Shots, Tests That Monitor Hormone Levels and Egg Production

妇人将开始给自己每天jections of fertility medication to help her ovaries produce several mature, viable eggs. During this stage, she may have regularblood teststo measure her hormone levels andultrasound scansto monitor her egg production. When blood tests andultrasoundmeasurements indicate that the eggs are "ready," it’s time for her to get an injection ofhuman chorionic gonadotropin(HCG) to trigger ovulation. (2,3,4)

Egg Retrieval, Insemination, and Other IVF Steps

Once the ovaries have produced enough mature eggs, a doctor will remove the eggs through a minor surgical procedure (called egg retrieval), either in the doctor’s office or at a fertility clinic. (You’ll likely be given a medication to help you relax and feel comfortable during the procedure.) (4) Then your eggs are mixed with your partner’s (or donor’s) sperm in a dish in a lab (a step called insemination); these are kept together in a special container so that fertilization can occur and the cells in the fertilized eggs can divide and grow into embryos.

Infertility Procedures for Him (Male Factor Procedures)

With an additional procedure called ICSI (short for intracytoplasmic sperm injection), a single sperm is injected into a mature egg to help during IVF. ICSI is most commonly used when a couple is dealing with male factor infertility, whether it’s because of low sperm count, poor motility (movement), or poor sperm quality. (6)

Embryo Transfers and Pregnancy Testing

Within about five days of the egg retrieval, the doctor will place one or more embryos into your uterus in a procedure called embryo transfer; this can be done in a doctor’s office or at a fertility clinic. If any of the embryos attach to the lining of your uterus, you will become pregnant. After the embryo transfer, sometimes women have daily shots ofprogesteronefor the first 8 to 10 weeks to support implantation and the embryo’s survival in the uterus. (2,4) Approximately two weeks after the embryo transfer is done, the woman will have a blood or urine test to detect the hormone HCG in her body; the presence of HCG indicates that pregnancy has occurred.

Prepare to Repeat: Multiple IVF Treatment Cycles May Be Needed

For many women, more than one cycle of IVF treatment — meaning, one fresh embryo transfer — is necessary before they become pregnant. (5) Approximately 27 percent of IVF cycles will result in a live birth, and while many different factors can affect the chances of success, the woman’s age is the biggest one. (5,8) Astudy published in September 2018 inHuman Reproductionfound that at age 30, a woman with two years of primary infertility who starts ICSI treatment for male factor infertility has a 40 percent chance of a live birth from the first complete IVF cycle and a 72 percent chance after three complete cycles.

Gamete Intrafallopian Transfer (GIFT) and Other Possible Next Steps

If these fertility treatments aren’t successful, there may be other options. If a woman has healthy fallopian tubes, she may be a candidate for gamete intrafallopian transfer (GIFT), which involves retrieving a woman’s eggs and transferring them with sperm into a fallopian tube so that fertilization can occur inside the woman’s body; the woman is then given medication to build up the lining of her uterus to support implantation of the fertilized egg. (9,10)

Donor Eggs, Donor Embryo, and More IVF Variables

Other possible interventions might include the use of a donor egg (harvested from the ovaries of another, usually younger, woman) or a donor embryo (from a couple who underwent IVF, became pregnant, and doesn’t want or need their unused fertilized eggs). (10) In addition, using a gestational carrier or surrogate (a woman who agrees to have a couple’s fertilized egg implanted in her uterus and subsequently carries it) may be an option. It’s important to remember that the carrier is not biologically related to the child because she does not provide the egg — that’s a common misconception. (11)