IVF: What is it and When Should It Be Considered? | The Doctor Weighs In
IVF is much more successful than intrauterine insemination, another commonly used fertility procedure. Unlike IUI, it can help treat almost any type of infertility problem.
In vitro fertilization, also known as IVF, is a common infertility treatment that involves using fertility drugs to stimulate the development of multiple eggs. The eggs are retrieved from the ovaries using a small needle. They are then fertilized with sperm in a specialized lab. The embryos grow for 3 to 5 days before one or more is placed into the uterus.
Who is a good candidate for in vitro fertilization?
IVF is the most successful infertility treatment for almost all patients, including those with the following:
- ovulation problems
- fallopian tube damage/obstruction
- pelvic adhesions
- poor semen quality
- unexplained infertility
- prolonged infertility.
It can also be used to enable preimplantation genetic testing (PGT) of embryos.
However, IVF does not make new eggs for patients, and if the uterus is incapable of implanting and carrying a pregnancy, IVF cannot solve that problem.
Assisted reproductive technologies (ART), which include IVF, include the use of donor egg, donor sperm and gestational carrier (surrogate) which can overcome almost all biological infertility limitations. It can also be used for single people and other non-traditional family building.
IVF Success Rates
Age is the primary factor that most affects IVF success rates. Women younger than age 35 have approximately a 50/50 chance of having a baby with their first IVF egg retrieval and subsequent embryo transfer(s). Women who don’t get pregnant following the first IVF cycle still have a very good chance of getting pregnant on second, third and even more cycles of IVF.
According to the Society for Assisted Reproductive Technology (SART) Clinic Report, the average cumulative live birth percentage chance of live birth from IVF by age are:
- 55% for women under age 35
- 40% for women age 35–37
- 26% for women age 38–40
- 13% for women age 40–42
- 4% for women over the age of 42
The cumulative success rate for a live birth increases with additional IVF cycles for all women. Success rates also depend on:
- patient selection,
- diagnosis, protocols used,
- amount of ovarian stimulation,
- laboratory quality,
- use of add-on techniques,
- number of embryos transferred,
- and other factors.
It is very difficult to compare live birth rates from clinic to clinic. However, you should discuss pregnancy rates with your clinic.
The major factor limiting success with IVF is female age which results in diminished ovarian reserve. This problem can also occur but less often in younger women. Using donor eggs is sometimes the only option in such situations.
How Much Does IVF Cost?
The cost of an IVF cycle ranges from $10,000 — $15,000 with an average of $12,000; While about half of the patients have a baby on their first cycle, the others need to try a second, third or even more times. The average number of cycles per patient is approximately 2.
This dollar amount does not include fertility medications which can range from $1,500 to $6,000 per cycle. The total cost will be higher if donor eggs or sperm are used and if embryos are frozen and stored. An additional cost of $5,000 may be incurred if genetic testing is needed.
Insurance coverage for IVF in the US varies widely and remains inadequate. Even with coverage, restrictions on procedures and other limitations often result in significant out-of-pocket costs for patients.
Many fertility clinics offer IVF treatment packages that bundle services such as multiple IVF cycles or offer discounts on fertility medications to make treatment more affordable. A successful and popular national program can be found at www.arcfertility.com (with which I am affiliated).
What are the Advantages, Disadvantages, and Risks of IVF?
IVF is much more successful than intrauterine insemination (IUI), another commonly used fertility procedure. Unlike IUI, it can help treat almost any type of infertility problem. It can also provide access to genetic testing of embryos. Further, IVF has much more capability to prevent multiple births by the use of single embryo transfer (SET). It is also generally a faster way to get pregnant because success rates are higher.
IVF can also be beneficial for people wanting more than one child. Often additional frozen embryos that are not used to get the first pregnancy can be used in the future to attempt to have additional children.
Disadvantages are that it is a more demanding process than IUI. IUI involves only mild ovarian stimulation, a small amount of monitoring and an office-based IUI.
IVF requires much stronger ovarian stimulation, frequent daily monitoring, an egg retrieval procedure with conscious sedation anesthesia, laboratory fertilization and embryo growth, usually cryopreservation (freezing) and storage of embryos, and embryo transfer followed by progesterone injections or suppositories.
Decisions to make
Patient factors such as age, fertility diagnosis and family medical history will help women and men decide if the chances are good enough to try IVF. If chances are very poor, it may be appropriate to consider the use of donor eggs or sperm. Your fertility clinic can refer you to agencies and other sources to obtain these.
Other decisions include:
- consideration of pre-treatment genetic testing of women and men
- preimplantation genetic testing (PGT) of the embryo
- type of treatment cycle, number of embryos to transfer
- number of embryos to freeze
When should someone go straight to IVF?
Patients should go straight to IVF when the chances of pregnancy with IUI are low but relatively higher with IVF. These include fallopian tube damage, moderate to severe endometriosis, pelvic adhesions and more than mild male infertility factor.
Women should also go straight to IVF when they have a short time to try to get pregnant because of age, diminished ovarian reserve or other factors when they can afford IVF, when there is a need for PGT, and when there is a need for donor eggs or a gestational carrier.
The choice of IUI or IVF should be made by each patient in consultation with their fertility specialist. It is best if your doctor is a reproductive endocrinologist who has experience and can provide all types of treatment-ovarian stimulation, IUI, surgery and IVF. That way you are more likely to get a balanced opinion.
Deciding whether to pursue fertility treatment and if so, which ones, can be challenging and complex. But deciding to invest your time and money in trying to have a baby simply offers no greater reward.
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World-renowned, board-certified fertility expert and pioneer David Adamson, MD, founded Advanced Reproductive Care®, Inc. (ARC Fertility) in 1997. Dr. Adamson is a Clinical Professor, ACF, at Stanford University School of Medicine and recognized as one of the country’s top doctors for women. He is past president of the American Society for Reproductive Medicine (ASRM) and a former board member of RESOLVE, the leading nonprofit fertility organization for patients. Board-certified in reproductive endocrinology and an internationally sought-after lecturer in reproductive medicine and surgery, Dr. Adamson remains connected to the latest innovations in care by consulting with patients, performing and publishing research articles, leading professional organizations and participating in scientific meetings.
Originally published at https://thedoctorweighsin.com on July 21, 2019.