Definition

The most commonly used method of assisted reproduction usually proceeds in three steps:

  1. Ovulation induction in which a woman is treated with hormones to make her eggs mature.
  2. Harvest or retrieval of mature egg cells (oocytes) from the ovaries after treatment for their maturation. The egg cells are then mixed with sperm cells in a laboratory dish.
  3. After a few days in the laboratory, fertilized eggs are transferred into the womb or uterus for further development. Two to four embryos are transferred per cycle.

Parts of the Body Involved

  • Uterus
  • Vagina
  • Cervix
  • Ovaries
  • Pituitary (endocrine involvement with treatment of hormones)

Fallopian Tube, Ovary, and Uterus

Fallopian Tube, Ovary, and Uterus

© 2008 Nucleus Medical Art, Inc.

Reasons for Procedure

IVF is done to help a woman become pregnant. It is most often performed when infertility is due to:

  • Damaged fallopian tubes
  • Endometriosis
  • Ovulation disorders
  • Cervical factors
  • Male factors, such as infertility , low sperm count, or poor quality sperm

Risk Factors for Complications During the Procedure

  • Age—Older women are less likely to conceive and carry to term.

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical and pelvic exam
  • Infertility testing for both you and your partner
  • Hormone treatments (clomiphene citrate, human menopausal gonadotropins) to stimulate production of multiple eggs
  • Repeated blood tests and ultrasound exams to monitor the development of multiple eggs
  • Schedule appropriate time for harvesting; harvesting is closely timed to coincide with ovulation.

During Procedure

During harvesting, IV fluids, possibly with a sedative or anesthesia, are used.

Anesthesia

During harvesting, general , spinal, or IV sedation are used. No anesthesia is used during the transfer procedure.

Description of the Procedure

Egg Harvesting

To harvest the eggs, doctors commonly use an ultrasound-guided technique. A laparoscopic method, which involves inserting a long, thin instrument with a light and lens through the abdomen, may be used if a diagnostic assessment of the pelvic organs is needed. However, ultrasound is faster, easier on the patient, and as effective as laparoscopic retrieval.

The doctor inserts the ultrasound probe with an attached needle into the vagina. Using the needle, the doctor punctures egg follicles and removes the fluid. The fluid is inspected and immediately placed in a sterile, nutritive culture material kept in an incubator.

Meanwhile, the male, if fertile, refrains from ejaculating for two or three days and then collects semen through masturbation. If scar tissue or other conditions block the natural release of sperm, a sperm aspiration may be performed. Sometimes, the man's sperm can be frozen ahead of time. If the male partner is unable to produce viable sperm, donor sperm may be used.

Between 50,000 and 100,000 of the most mobile, healthy sperm are mixed with the harvested eggs. The sperm may be treated to increase the chance of fertilization. The culture dish is kept at normal body temperature inside an incubator for two to three days. During that time, sperm are expected to fertilize 60% to 80% of the eggs. Once fertilized, early cell division begins, and embryos develop.

Transferring Procedure

At a prearranged time, you'll return to the fertility center for the transfer procedure, during which a certain number of the embryos (usually 3-5) are placed into your uterus. The other embryos may be frozen and saved for future IVF cycles or donated to other infertile couples.

The doctor inserts a catheter in the vagina and threads it through the cervical canal and into the uterus. The embryos are then passed into the uterus. You may be positioned face down with your knees at your chest or on a special table that tilts the uterus downward to allow gravity to assist with keeping the embryos in the uterus for implantation.

In a review of seven trials, researchers found that acupuncture, as an aid to embryo transfer, increased the rates of pregnancy and live births in women having in IVF. *

After Procedure

Expect to rest at the fertility center for a few hours before going home. You'll have a pregnancy test 10-12 days after the transfer procedure.

How Long Will It Take?

Harvesting takes 30 minutes or less. The transfer procedure lasts about 10 minutes.

Will It Hurt?

Sedation or general anesthesia given during egg harvesting decreases or eliminates discomfort during the procedure.

Possible Complications

  • Multiple conceptions
  • Ectopic pregnancy (embryo develops outside the uterus)
  • Anesthesia-related problems
  • Short- and long-term adverse effects from fertility drugs
  • Rare: ovarian rupture

Average Hospital Stay

None

Postoperative Care

  • Take medications as instructed by your doctor at the fertility center.
  • Return to the fertility center in two weeks for a pregnancy test.

Outcome

You'll probably be able to resume normal activities within a few days.

Many women find it emotionally difficult to wait the two weeks to learn if an egg has implanted. Even if pregnancy occurs, a miscarriage remains a possibility.

If the pregnancy test indicates conception, an ultrasound will be scheduled for two weeks later to confirm a fetal heartbeat and assess if more than one egg is growing. Pregnant women are referred to an obstetrician for follow-up.

If pregnancy did not occur, additional IVF attempts can be scheduled at least one month later.

Success rates for the first three cycles are about the same (about 10% per cycle), then start to decrease. Success rates are influenced by both age and the cause of infertility. Only 15% to 20% of couples using IVF conceive and deliver a baby.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Increasing pain, excessive bleeding, or discharge
  • Any unusual symptoms
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting