A Guide to the IVF Process

what is IVF?

Thinking about overcoming infertility with in vitro fertilization (IVF)? Here’s how it works, plus everything you need to know about the IFV timeline, injections, side effects and more.

 

About one in eight American couples struggle with infertility, or the inability to conceive despite having regular unprotected sex. As a solution, increasing numbers of people are turning to in vitro fertilization (IVF), a procedure in which surgically-removed eggs are fertilized with sperm in a laboratory, then inserted directly into the uterus.

About 5% of all children born in the United States were conceived through IVF, says Amy Schutt, M.D., a reproductive endocrinologist at the Family Fertility Center at Texas Children’s Pavilion for Women. That equates to more than one million total babies. If you’re seeking to get pregnant through IVF, it’s important to understand the success rates, method, and possible side effects. Here’s all you need to know about IVF before signing up for the procedure.

 

• Who Gets IVF Procedure?

Infertility has a wide range of causes in both women and men. Treatment usually involves correcting the underlying problem with medication or surgery. But sometimes conventional treatment proves difficult, and couples turn to assisted contraception methods like IVF instead. For example, women with fallopian tube blockage often opt for IVF; since the fertilized egg is inserted directly into the uterus during the procedure, the tubes aren’t necessary for conception. Similarly, IVF procedure is common if the man has low sperm count (oligospermia) or a lack of sperm in ejaculate (azoospermia).

• Not every woman suffering from infertility is a candidate for IVF. According to Dr. Schutt, patients should think twice about IVF if they have premature ovarian failure or a serious medical problem that precludes pregnancy. Religious beliefs and financial constraints may also deter women from undergoing the procedure (the average cost of IVF is $12,000, plus an additional $3,000-5,000 for necessary medications). What’s more, women who don’t produce eggs – whether because of menopause or another condition – can’t undergo IVF unless they use a donor or frozen eggs, according to Dr. Timothy Hickman, the medical director of CCRM Houston and director of the Division of Reproductive Endocrinology and Infertility at Houston Methodist Hospital.

IVF Process: How is IVF Done?

“IVF involves handling of both eggs and sperm within the laboratory to allow for the fertilization of eggs and early development of embryos,” says Dr. Schutt. To prepare for IVF, a woman takes injectable fertility medications for approximately 10 days, during which the growth of her eggs is closely monitored. “When the eggs are ready to be collected (about 14 days later), the woman takes one final HCG injection that assists in maturation of the eggs – and 36 hours afterwards, the eggs are collected from the ovary,” says Dr. Schutt. Doctors use a narrow needle, suction device, and ultrasound imaging to retrieve the eggs. This IVF process usually involves anesthesia or sedation to relieve pain.

Next, the embryologist places the collected eggs on a Petri dish. She combines the eggs with sperm taken from the male in a process called insemination. If the sperm has low motility (impaired movement) the embryologist may insert sperm directly into the eggs (ICSI).The fertilized eggs, or embryos, are stored for three to seven days. "If genetic testing (chromosomal defect screening that lets you see the sex of the embryo) is to be performed, then the embryo is biopsied between the fifth and seventh day of development," adds Dr. Schutt. Note that some clinics allow you to choose the sex during genetic testing, while others do not. 

Finally, doctors transplant one or more embryos into the uterus with a catheter. Implantation – and subsequent pregnancy – usually takes place one or two weeks later.

 

IVF Success Rate

According to Dr. Schutt, the success rate of IVF depends largely on egg quality and quantity. “Egg quality is primarily a reflection of the age of the woman from which the eggs are obtained. The younger a woman is when she goes through IVF, the greater chance her eggs will potentially result in a healthy pregnancy,” she says. “Egg quantity is more variable, and it’s measured via ultrasound (to count the number of antral follicles) and lab work,” including blood tests. Other factors that affect IVF success include weight, alcohol intake, and tobacco use. 

 

IVF Side Effcts

Most women who undergo IVF don’t have any symptoms, but possible IVF side effects include:

• Cramping
• Bloating
• Breast tenderness
• Clear or bloody fluid, which comes from the vagina in small amounts
• Mood swings
• Constipation

Some women also experience side effects from the hormonal injections they take before IVF. These include headaches, abdominal pain, mood swings, bloating, hot flashes, and ovarian hyperstimulation syndrome (OHSS) – a rare condition that occurs from excess egg production. Symptoms are weight gain, abdominal pain and swelling, nausea, shortness of breath, and dizziness. Consult your doctor if you think you developed OHSS – or if you experience other worrisome side effects of IVF like heavy vaginal bleeding or excessive pain.

 

A Guide to the IVF Process

Increase Your Chances of IVF Success

How to Increase Your Chances of IVF Success

If you are looking to increase your chances of conceiving during IVF, here are 8 tips from 5 different fertility doctors.

• 1. Maintain a healthy weight.

"Maintaining a healthy weight is extremely important in fertility and IVF," says Linnea Goodman, MD, Assistant Professor of Obstetrics and Gynecology at the UNC School of Medicine. "We know that being obese (BMI >35) and underweight (BMI <19) increases time of conception by 2 and 4 times respectively, and negatively effects IVF success rates. Being overweight also makes monitoring the ovaries during IVF more difficult and increases the chance of complications during egg retrievals."

This is best implemented with changes in diet and activity with professional help.

"Working with dietitian, and in some programs enrolling in a cardio metabolic weight loss program can help achieve these goals," says Zaraq Khan, MD, reproductive endocrinologist at Mayo Clinic in Rochester, MN.

2. Optimize sperm health.

"Use of multivitamins and maintaining optimal body weight, as well using boxers over briefs, could improve sperm quality," says Dr. Khan. "Under appropriate care, men can also be started on medications that can help boost sperm numbers and quality that can have a beneficial impact on IVF outcome. In certain cases, sperm aspirated directly from the testicle over ejaculate could also be beneficial. Involving a male infertility specialist for any form of abnormalities in semen analyses is key."

• 3. Partner with an excellent doctor and embryology laboratory.

"Choosing an excellent reproductive endocrinologist is twofold: in addition to experience and commitment to evidence-based medicine, look for someone with whom you feel comfortable and connected. Your doctor will accompany you on this very emotional journey and it is important for you to feel supported and heard," says Elizabeth Fino, MD, fertility specialist at NYU Langone Fertility Center. "Asking for recommendations from friends and family who know you best can help guide you to a knowledgeable physician with whom you feel comfortable, but also be sure to do your research."

In a world of online reviews, it can be difficult to determine credibility.

"Be careful of online reviews—they are often completed by select patients who had an extreme experience for one reason or another and may not be universally applicable. FertilityIQ offers a unique model which hones in on specific aspects of the experience after vetting patient reviews.

To find an excellent embryology laboratory, look for a long history of exceptional outcomes. One source is the Society for Assisted Reproductive Technology which details the clinic's volume and live birth rate."

4. Reduce your stress.

"Basal stress levels can influence natural and assisted conception rates," says Dr. Khan. "Reducing stress troubles during an IVF stimulation cycle can be one of the hardest things to achieve for couples. Several reports suggest improvement of pregnancy outcomes with the use of acupuncture and other stress relieving techniques, like enrolling in mind-body programs, stress reduction, and resilience training workshops."

5. Quit smoking

"Smoking can drastically decrease chance of success while doing IVF because it effects egg and sperm quality," says Dr. Khan.

But you don't have to do it on your own.

"Quitting smoking is not an easy task and often requires a great deal of personal as well as professional support. Try to involve your friends and family to help encourage you in the process. For smoking cessation, structured programs and/or pharmacological assistance have proven to be most successful," says Dr. Fino.

6. Look into taking supplements

"DHEA and CoQ10 are supplements that have shown some promise in association with an increase in egg quantity and quality," says Dr. Fino. "Talk to your doctor to see if he or she recommends them for you."

Multivitamins may also be helpful, adds Dr. Khan.

7. Ensure you have adequate levels of vitamin D

"Over 40% of individuals are deficient in Vitamin D, and there is emerging data on its association with infertility and worse IVF outcomes," says Tarun Jain, MD, medical director of Northwestern Medicine Fertility and Reproductive Medicine Oakbrook Terrace. "Ask your doctor to check your vitamin D level, and consider taking a vitamin D supplement."

8. Focus on persistence and patience.

"Many patients require more than one cycle of IVF to achieve an embryo for transfer and outcomes may vary significantly from cycle to cycle," says Shannon DeVore, MD, at NYU Langone Fertility Center. "If your first cycle wasn't successful, your doctor may be able to adjust the medications to optimize a subsequent one. Other times, it just means keeping at it. Try not to be discouraged by sub-optimal outcomes and setbacks—you are doing everything right. The single biggest thing to remember is that most (or all) of this is out of your control. Nobody likes lack of control, but sometimes letting go can help you endure the journey. Take care of yourself and don't blame yourself when things don't go well. You are not alone, it often takes a village to build a family."

 

Increase Your Chances of IVF Success

tips for increasing IVF success rates

Read any article on “tips for increasing fertility” and you’re bound to see something about the importance of lifestyle – typically diet and exercise. A wide range of studies show a correlation between women with healthy weights and increased IVF success rates.

Exercise and IVF, however, is a trickier business. Too much exercise – particularly cardiovascular activity – seems to have an effect on reproductive hormone production, and that affects your ability to conceive.

Another challenge in determining “how much is too much” is that “exercise” for one woman is very different from exercise for another. The frequent low-impact walker exercises, as does the regular triathlete, as does the lifelong equestrian rider or rock climber. However, the intensity levels and risks associated with these various exercises is very different, and some are more conducive to a successful IVF cycle and a healthy pregnancy than others.

Take it Easy and Other Exercise Tips for IVF Success

After reviewing studies regarding exercise, pregnancy and IVF success, we’ve found these 6 tips will help you achieve the healthy pregnancy and live birth you so anxiously desire.

1. Take it easy. That’s the most important and more general advice we can give to women who are pursuing IVF. We realize that taking it easy is a major challenge for women who are used to vigorous exercise. However, the more studies you review, the more you will see a correlation between increased physical activity and decreased rates of conception. If you are a regular runner, biker, marathon runner or participate in workout regimens designed for moderate/advanced athletes, your doctor is probably going to tell you to take it easy while pursuing your fertility treatments.

2. Four hours or less. What does “take it easy mean?” Well, good question. A study, published in Obstetrics and Gynecology, reviewed IVF results for more than 2200 women over a nine year period. Their conclusion was, “Women who reported exercising 4 hours or more per week for 1-9 years were 40% less likely to have a live birth and were almost three times more likely to experience cycle cancellation and twice as likely to have an implantation failure or pregnancy loss than women who did not report exercise.” These findings may inspire you to pare your routine down a bit during the months preceding, during and after your IVF cycle to give you and your baby the best chance for success. Keep your cardio workouts to no more than 4 hours per week and fill in the gaps with lower-intensity options that still increase strength and flexibility, like yoga, water exercise, or tai chi.
3. Ditch high-impact anything. If your exercise of choice is high-impact, it’s time to put it on the backburner for a while. Any serious falls, injuries or impact to the abdominal wall can seriously compromise your reproductive health, especially if there is a freshly implanted baby in there, or if you are prone to miscarriages.
4. Prepare for “no exercise” during the week of egg retrieval. This isn’t because you shouldn’t (although you will want to take it easy), but more because you probably won’t feel like it. The fertility medications you’ll take, combined with some of their potential physical side effects – like bloating, fatigue and mild discomfort – will make you feel more like lying down and taking a nap than going outside to run a few miles. This is A-OK, and we always recommend you listen to your body and not push anything. You are embarking on a very intricate and delicate process, so you don’t want to do anything that could compromise it.
5. Start finding other modes of stress release. For many women, regular exercise is as much about the stress relief and endorphin rush as it is about weight loss or overall health. If this is the case for you, start learning new ways to reduce or eliminate stress. What are some of the things you’ve always wanted to try but haven’t? Yoga, meditation, more outdoor time, a hobby or craft class, all those books you’ve meant to read but haven’t had time to? Now is the time to start fostering a relationship with other modes of stress release and “escape” so you won’t be so shell-shocked when you have to back off from exercising.
6. Take the long view. Perhaps one of the best pieces of advice for any situation in life is to “take the long view.” Your months, or even a couple years, of lower-impact exercise may seem like forever to you, but they’re really not. You are making a tremendous commitment – mind, body, soul and wallet – to bring a baby into your life. The months you spend cutting back on excessive exercise now will be well worth the final results. Once you have your beautiful baby in your arms, you’ll enjoy nothing more than loading him or her up in your jogging stroller and getting back in shape. For now, just enjoy the miraculous process of transforming two single cells into a healthy, happy, miniature human being!

 

IVF and Exercise: 6 Tips for a Successful and Healthy Pregnancy

what to eat during ivf

For those couples embarking on the journey through IVF, diet is as important as ever. The foods you eat create a nutritional foundation upon which all your bodily functions are built. Your diet factors in hormone production, semen production, your egg count, egg quality, the quality of your uterine lining, and a whole slew of other fertility-related processes. Therefore, it stands to reason your diet plays a fairly significant role in the success of your IVF treatment, from the start.

.

 

 

FOODS THAT AID IVF SUCCESS

An anti-inflammatory diet is instrumental in IVF success. To that end, minimize the intake of processed foods, fast foods, and sugar. Healthy fats, whole grains, fruits and vegetables, and clean proteins such as fish, legumes, and low-fat poultry are all part of an anti-inflammatory diet. Whole grains, omega 3 rich fish, and nuts contribute significantly to a healthy uterine lining. Soy products are fine, and even considered to be beneficial, for women undergoing IVF.

Here are some suggestions to power you through your day while you undergo IVF treatment:

 

BREAKFAST

Avocado toast is a healthy, easy-on-the-tummy way to start your day. Simply toast up your favorite whole grain bread, and top with sliced avocado. Not only will you keep the morning munchies at bay, you’ll also get a healthy dose of good fat, and important pregnancy vitamins C, E, and K, along with zinc, riboflavin, magnesium, and folate. Top that toast with a poached protein-rich egg and you’ll make breakfast even more nutritious.

Oatmeal is an easy, on-the-go breakfast that brings the pregnancy boosting ability of whole grain to the table. Top with some fresh fruit and low-fat, or dairy free milk and you have a complete breakfast.

 

MID-MORNING SNACK

Smoothies fire up your mid-morning slow down more than any coffee drink or donut ever could. Blend antioxidant-rich berries, some folate heavy greens like spinach, or kale, and nuts or wheat germ, yogurt, non-dairy or low-fat milk, and you have the power of nutrients to aid in IVF success. For a cool treat, make your smoothie the night before and leave on your desk until snack time.

 

LUNCH

Try to center your lunch around whole grains, fresh veggies, and lean protein. A salad of ancient grains like farro, freekeh, quinoa, and kamut, mixed with deep green leaf lettuces, kale, or spinach, sunflower seeds, and a light vinaigrette, served with low-mercury fish, grilled chicken, or tofu, is a delicious way to get all the best nutrients to aid in IVF.

 

AFTERNOON SNACK

Afternoon is the ideal time to enjoy a nice, healthy helping of fruit. Go for fresh fruits like pineapple, citrus, strawberries, grapes, kiwi, apple and papaya-whatever your favorite fresh fruits. Sprinkle with a tablespoon of chia seeds, sesame seeds, or sunflower seeds, or have some peanut, almond, or soy butter for a healthy fat addition.

 

DINNER

Dinner is a great time for an easy-prep “nourish bowl”. Delicious and comforting bowls begin with a foundation of brown rice, or any whole grain you prefer. Top with greens sautéed in olive oil, grilled vegetables, your choice of protein, and a tahini-lemon sauce, or the healthy sauce of your choosing.

These are just a few ideas to get you started on a diet that will improve your odds of IVF success. Of course diet is a huge part of your health, but lifestyle also plays a role in your successful IVF treatment.

 

what to eat during ivf

Lifestyle tips for IVF

lifestyle and diet go hand-in-hand, for the success of your IVF outcome. Obviously alcohol and smoking are counterproductive to your health, and the health of your baby, as are any other recreational drugs. If you’re feeling stressed try some of these healthy ways to cope, today and going forward.

 

 

• Talk with a friend, or seek out a therapist who specializes in helping those undergoing fertility treatment. Ask your fertility team for a referral.
• Exercise, especially if you’ve maintained a fitness program for a while. But, as always, check with your physician first.
• Practice yoga and meditation. These ancient arts have calmed and centered people for centuries.
• Treat yourself! Schedule a day at a spa. A little pampering and self-care does wonders for the soul. And don’t leave it at the spa. Extend your feel-good self-care by taking regular bubble baths, schedule therapeutic massages, and learn to listen to your body.
• Say no to outside stresses right now, including family gatherings and other social obligations, volunteering, extra work commitments, and even something as simple as doing the grocery shopping. Learning to say “not right now” is one of the healthiest things you can do for you and your future family.

Lifestyle tips for IVF

how to make ivf successful

 In vitro fertilization or IVF, effectively treats many causes of male and female infertility. IVF can be an excellent option for many patients who have struggled to get pregnant with other fertility treatments. It is an especially successful treatment for women with tubal issues, endometriosis, or polycystic ovarian syndrome. For women of advancing maternal age, IVF is also very successful with the use of donor eggs. Men with low sperm counts and couples with inherited diseases also benefit from IVF.

IVF has been around since the mid-1980s to treat couples experiencing infertility. Back then, the chances of bringing home a baby after IVF was a dismal 10%, less than what you would expect from Mother Nature at about 20%. Today, over 190,000 IVF cycles are conducted in the U.S., with average live birth rates of over 32% for women of all ages. Younger women with younger eggs have even better success, with live birth rates approaching 50%.

What has accounted for this incredible increase in success with IVF? Most notably are the new techniques that have arisen over the last several years that offer the possibility of improving a patient’s odds of having a baby through IVF. Let’s take a look at some of these success-boosting techniques.

 

Assisted Hatching

Sometimes viable embryos do not implant in the uterine wall simply because they are unable to break free from their surrounding “jelly coat,” called the zona pellucida. We perform assisted hatching in the lab right before embryo transfer using a laser to create a hole in the zona. This allows the embryo to “hatch” and make contact with the lining of the uterus and implant.

Intracytoplasmic Sperm Injection

We first used ICSI, or intracytoplasmic sperm injection, to treat cases of severe male factor infertility. In this technique, a single sperm is injected into the cytoplasm (interior) of the egg. Today, the use of ICSI is now routinely applied to a wide range of clinical situations whenever there is a possibility that fertilization may not occur. Such situations may include unexplained infertility or when frozen sperm samples survive their thaw poorly. Further, ICSI is used in any case where there is an extreme need to maximize normal fertilization, such as when a woman has only a few eggs retrieved.

“Freeze All Embryos” IVF Cycle

In the past, we preferred to perform fresh embryo transfers for most patients because the embryos had a better chance of implanting and developing into a baby than frozen embryos did. However, over the past several years, vitrification techniques for freezing and thawing embryos have improved so much that frozen embryos now have an equal or perhaps better chance of implanting than fresh embryos.

When there is a planned “freeze all embryos” IVF cycle, the developing embryos are frozen via vitrification and stored until they are transferred at a later time. This technique is especially beneficial for women at risk of hyper ovarian stimulation caused by the medications used to produce multiple eggs during the cycle. We have found that high hormone levels associated with ovarian stimulation might affect the lining of the uterus, making it less likely for the transferred embryos to implant. We see this particularly in patients who develop higher progesterone levels earlier in the ovarian stimulation cycle.

Preimplantation Genetic Screening (PGS)

PGS helps us answer the question of which embryos have the greatest potential to become a healthy pregnancy and baby. Humans have 23 pairs of chromosomes, inheriting one copy of each chromosome from either parent. When sperm fertilizes an egg, it creates an embryo which should consist of 23 chromosomes from the mother and 23 chromosomes from the father. But often, embryos are created with too many or too few chromosomes. This is a major cause of miscarriage and increases dramatically with maternal age. One of the most common examples is Down Syndrome, or Trisomy 21, which is caused by the presence of a third copy of chromosome 21.

PGS gives the patient two advantages. First, it allows us to be 99% certain the embryo has the correct number of chromosomes thereby increasing the chance for a healthy pregnancy. Second, it allows the patient to transfer only ONE embryo thereby decreasing the chance of twins (which have a much higher rate of complications). The pregnancy rate of transferring just one embryo that has undergone PGS and is deemed chromosomally normal is the same as transferring two embryos that are not tested.

 

how to make ivf successful

IVF success factors

Considering in IVF Then it’s important to learn about IVF success factors that can help or hinder your getting pregnant.

 

 

IVF Success Factor 1 – Age

Your age and using your own eggs are important IVF success factors to consider. While younger women have higher chances of IVF success, factors that reduce the chances of IVF success include being an older womanwith fewer eggs and the lower quality of an older woman’s eggs.

In fact, the live birth IVF success rate for women under 35 who start an IVF cycle is 40 percent. However, women over age 42 have a 4 percent success rate.

 

IVF Success Factor 2 – Previous pregnancy

 

More IVF success factors to think about include whether or not you were pregnant previously and if it was with the same partner.

If you were pregnant previously with the same partner that’s currently undergoing IVF treatment, there is a greater probability of IVF success. Factors such as a history of recurrent miscarriage or a different partner may reduce the chances of IVF success.

 

 

IVF Success Factor 3 – Type of fertility problems

While some male infertility problems do impact IVF success, factors like uterine abnormalities, exposure to DES or fibroid tumors also decrease the likelihood of success with IVF.

Very important to know: IVF success factors are dependent on ovulation. Ovarian dysfunction, like high FSH levels which indicate a low ovarian reserve, may reduce the chances of IVF success.  Factors that may lower pregnancy rates and reduce success with IVF include needing large amounts of ovulation stimulation drugs.

When both partners are infertile with lower chances for IVF success, factors such as the length of time you have been infertile is important to consider. The chances of IVF success decrease with the amount of time a couple has been infertile.

 

 

IVF Success Factor 4 – Use of donor eggs

Donor eggs are a significant consideration, especially if you are over 35-40, as there may be a higher rate of IVF success. Factors such as egg quality and age of donor are important. Using donor eggs from younger women may increase the chances of pregnancy for women over 40. 2011 findings show a 55 percent live birth success rate with a fresh donor egg/embryo transfer.

 

 

IVF Success Factor 5 – Lifestyle habits

Stop smoking if you want to improve your chance of having a baby. In fact, many times the woman is required to stop smoking at least 3 months before starting IVF treatment.

• Smokers require higher dosages of fertility drugs to stimulate their ovaries
• Smokers have lower implantation rates than nonsmokers
• Women who smoke require almost twice as many IVF attempts
• Women who smoke experience more failed fertilization cycles

More IVF success factors to mull over include losing weight if you are overweight or obese. Women who are overweight have an increased risk of infertility as well as miscarriage. Overweight women also have less IVF success with fertility treatments than women of normal weight. Underweight women are also at greater risk of having success with IVF. Bottom line: aim to stay within a healthy weight range.

 

 

IVF Success Factor 6 – Fertility clinic

The center you choose to perform the IVF treatment can greatly affect your IVF success. Factors to think about when reviewing the success rate of fertility centers include:

• The training and experience of the IVF clinic and staff
• The live birth rate per IVF cycles started
• The rate of patients pregnant with multiples (twins, triplets or more)
• The laboratory used by the clinic and the qualifications of their staff
• The types of patients accepted at the clinic, more specifically their age and fertility problem

Keep in mind that some clinics are more willing to accept patients with a lower chance of IVF success or they may specialize in particular treatments.

 

 

Know  your IVF success factors as you plan to get pregnant

Remember, just as with any chronic illness, knowledge is power with infertility. The more you learn about specific IVF success factors, the more control you will feel about high-tech treatments that help you get pregnant and start a family.

 

IVF Success factors