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In vitro fertilization (IVF)

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In vitro fertilization (IVF) is the joining of a woman's egg and a man's sperm in a laboratory dish. In vitro means outside the body. Fertilization means the sperm has attached to and entered the egg.

Description
Normally, an egg and sperm are fertilized inside a woman's body. If the fertilized egg attaches to the lining of the womb and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception.

IVF is a form of assisted reproductive technology (ART). This means special medical techniques are used to help a woman become pregnant. It is most often tried when other, less expensive fertility techniques have failed.

There are five basic steps to IVF:

Step 1: Stimulation, also called super ovulation Step 2: Egg retrieval Step 3: Insemination and Fertilization Step 4: Embryo culture Step 5: Embryo transfer
Why the Procedure is Performed
IVF is done to help a woman become pregnant. It is used to treat many causes of infertility, including:
Risks
IVF involves large amounts of physical and emotional energy, time, and money. Many couples dealing with infertility suffer stress and depression.

A woman taking fertility medicines may have bloating, abdominal pain, mood swings, headaches, and other side effects. Many IVF medicines must be given by injection, often several times a day. Repeated injections can cause bruising.

In rare cases, fertility drugs may cause ovarian hyperstimulation syndrome (OHSS). This condition causes a buildup of fluid in the abdomen and chest. Symptoms include abdominal pain, bloating, rapid weight gain (10 pounds within 3 - 5 days), decreased urination despite drinking plenty of fluids, nausea, vomiting, and shortness of breath. Mild cases can be treated with bed rest. More severe cases require draining of the fluid with a needle.

Medical studies have shown so far that fertility drugs are not linked to ovarian cancer.

Risks of egg retrieval include reactions to anesthesia, bleeding, infection, and damage to structures surrounding the ovaries, including the bowel and bladder.

There is a risk of multiple pregnancies when more than one embryo is placed into the womb. Carrying more than one baby at a time increases the risk of premature birth and low birth weight. (However, even a single baby born after IVF is at higher risk for prematurity and low birth weight.)

It is unclear whether IVF increases the risk of birth defects.

IVF is very costly. Some, but not all, states have laws that say health insurance companies must offer some type of coverage. But, many insurance plans do not cover infertility treatment. Fees for a single IVF cycle include costs for medicines, surgery, anesthesia, ultrasounds, blood tests, processing the eggs and sperm, embryo storage, and embryo transfer. The exact total of a single IVF cycle varies, but may cost more than $12,000 - $17,000.

After the Procedure
After embryo transfer, the woman may be told to rest for the remainder of the day. Complete bed rest is not necessary, unless there is an increased risk of OHSS. Most women return to normal activities the next day.

Women who undergo IVF must take daily shots or pills of the hormone progesterone for 8 - 10 weeks after the embryo transfer. Progesterone is a hormone produced naturally by the ovaries that helps thicken the lining of the womb (uterus). This makes it easier for the embryo to implant. Too little progesterone during the early weeks of pregnancy may lead to miscarriage.

About 12 -14 days after the embryo transfer, the woman will return to the clinic so that a pregnancy test can be done.

Call your health care provider right away if you had IVF and have:
Outlook (Prognosis)
Statistics vary from one clinic to another and must be looked at carefully. According to the Society of Assisted Reproductive Technologies (SART), the approximate chance of giving birth to a live baby after IVF is as follows:
Alternative Names
IVF; Assisted reproductive technology; ART; Test-tube baby procedure

References
Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Elsevier Mosby; 2012: chap 41.

Goldberg JM. In vitro fertilization update. Cleve Clin J Med . May 2007; 74(5): 329-38.

The Practice Committee of the Society for Assisted Reproductive Technology and the Practice Committee of the American Society for Reproductive Medicine. Criteria for number of embryos to transfer: a committee opinion. Fertil Steril . Jan 2013;99 (1):44-46.

Jackson RA, Gibson KA, Wu YW, et al. Perinatal Outcomes in Singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol . 2004;103: 551-563.

Update Date: 3/11/2014
Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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