Assisted reproductive technologies (ART) are procedures used to treat infertility in which both eggs and sperm are manipulated outside the body. ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, then returning the fertilized eggs or embryos to the woman’s body or donating them to another woman.
Today over one percent of all babies born in the United States are conceived using ART procedures such as in vitro fertilization (IVF), egg donation, and surrogacy. IVF is by far the most widely used assisted reproductive technology, accounting for 99 percent of all ART procedures.
IVF is a multi-step treatment process. Several weeks prior to the actual procedure, you will take hormonal contraception to suppress your own ovarian function. Following that you will receive one or a combination of fertility drugs, often by injection, to stimulate the production of eggs. During this time, you will have to make several visits to the clinic, where providers will carefully monitor the number and size of the eggs in each ovary.
Once the eggs are ready, the actual IVF procedure consists of two major steps: egg retrieval and embryo transfer. During the egg retrieval, you will be sedated while the mature eggs are surgically removed from your ovaries. This typically takes place at your local fertility clinic.
Follicles from both your left and right ovaries are retrieved through a process called follicular aspiration. Follicular aspiration involves inserting a hollow needle through the cervix and into the ovaries. The needle is then used to suction out any follicles that may be present in the ovaries.
In order to guide the needle into the appropriate area of the ovary, a transvaginal ultrasound will be used. Once the needle is in the proper position, any follicles inside the ovary will be aspirated out. The follicle aspirates will be immediately examined under a microscope to ensure the presence of viable eggs. This is different from the typical menstrual cycle, in which the ovaries process many eggs but only one mature egg is released into the tubes and can be fertilized.
After the egg retrieval process you may feel a little tender in your abdomen. You will also feel fatigued as a result of the anesthetic. After several hours of monitoring, you will be allowed to go home. You may notice some light vaginal spotting. You will also receive antibiotics to prevent infection.
After the retrieval process, your eggs will be joined with sperm from your partner or a donor in the lab. If the eggs are fertilized, they will be allowed to divide for three to five days, then placed back into your—or a gestational carrier’s—uterus. This is called the embryo transfer.
The embryo transfer catheter is loaded with the embryos and passed through the cervical opening up the middle of the uterus. An abdominal ultrasound is used simultaneously to view the catheter tip and ensure its proper placement. When the catheter tip reaches the ideal location, the embryos are released out of the catheter to the lining of the uterus.
Again, this is different from the natural conception process, when typically the sperm meets only one egg in the tubes and after fertilization the one embryo falls into the uterus and implants in the uterine lining to establish a singleton pregnancy. Exceptions occur, and in about two percent of all natural pregnancies more than than one embryo grows in the uterus. However, because the norm is to transfer more than one embryo, in IVF more than 30 percent of the pregnancies are multiple.
Because multiple pregnancies pose more risks for mothers and babies, most experts now recommend single embryo transfers for most women. For more information, see The Importance of Single Embryo Transfers in IVF.
For most women, the embryo transfer procedure feels similar to a Pap test and does not require any sedation or other drugs. You will likely feel no or minimal pain or discomfort.
About nine to eleven days after the transfer, a blood pregnancy test can be done. If one or more embryos have successfully implanted into the uterus, hCG hormone will be detectable.
If there are more viable embryos than are transferred, families may choose to freeze (cryo-preserve) the extra embryos for future use. In addition to saving thousands of dollars in costs, this decision protects women from having to repeat stressful and potentially risky drug therapies to stimulate ovulation again. With recent technological advances, IVF cycles using frozen embryos have the same chance of success as those using fresh embryos.
The success rates of IVF vary greatly, based on many factors, including the quality of the implanted embryos, the skill of the clinic, and, most important, a woman’s age. According to the CDC, on average, a woman younger than 35 who is using her own eggs and fresh embryos has about a 42 percent chance per cycle of getting pregnant and giving birth to a live baby. Women between the ages of 35 and 37 have about a 32 percent chance, women 38 to 40 about a 22 percent chance, and women 41 to 42 about a 12 percent chance. To find out more, see Clinic Statistics and Success Rates.
In general, IVF costs about $10,000 to $15,000 per cycle. Insurance coverage for ART is patchy. Many employers, in an effort to contain costs, don’t purchase such benefits for their employees. Some states have laws mandating that employers offer infertility treatment benefits. Medicaid does not cover ART, not even in states where by law employers must offer the benefits.
To learn more about benefits you might be eligible for, check with your health care insurance plan. The infertility association Resolve keeps track of the states that mandate coverage of infertility treatment and describes the various laws.