In vitro fertilization (IVF) is the fertilization of an egg in the laboratory. Using a variety of hormonal drugs, the woman's ovaries are "super stimulated" to produce eggs. Then, many mature eggs are gathered from the ovaries, and they are fertilized in the laboratory using the man's sperm.

The embryo is then transferred into the uterus to begin a pregnancy or cryopreserved (frozen) for future use. IVF was originally devised to permit women with damaged or absent Fallopian tubes to have a baby. Normally a mature egg is released from the ovary (ovulated), then enters the Fallopian tube, and waits in the neck of the tube for a sperm to fertilize it. With defective Fallopian tubes, this is not possible. The first IVF baby, Louise Joy Brown, was born in England in 1978.

In vitro fertilization literally means "fertilization in glass." A child born by in vitro fertilization is inaccurately known a "test tube baby."

In Vitro Fertilization (IVF) has been providing hope to infertile couples with problems getting pregnant for over two decades. Although more and more people have been undergoing this treatment, it remains a costly procedure, and some couples may have a hard time affording it. On top of treatment costs, medications for stimulation of eggs can range anywhere from $2000 - $4000.

Surgery for hydrosalpinges before in vitro fertilisation treatment

Women with hydrosalpinges should be offered salpingectomy, preferably by laparoscopy, before in vitro fertilisation treatment because this improves the chance of a live birth.

Female age

Women should be informed that the chance of a live birth following in vitro fertilisation treatment varies with female age and that the optimal female age range for in vitro fertilisation treatment is 23-39 years. Chances of a live birth per treatment cycle are:

greater than 20% for women aged 23-35 years
15% for women aged 36-38 years
10% for women aged 39 years
6% for women aged 40 years or older.

The effectiveness of in vitro fertilisation treatment in women younger than 23 years is uncertain because very few women in this age range have in vitro fertilisation treatment.

In vitro fertilization is one of the most expensive and yet most popular fertility treatments being done today. Because of its high rate of success, it is often the last resort of couples who have tried to conceive using other means but failed to do so.

The process involves controlling the hormonal process of the woman using certain hormone-based medications. Once the eggs are produced they are removed and made to undergo fertilization with sperm taken from the husband or a donor. This is done in a fluid medium inside a petri dish or a test tube, hence, the name in vitro, from the Latin root word meaning ‚Äòglass‚Äô.

IVF up Close

First, the woman has to undergo a thorough screening process, which includes ultrasound and blood tests. If everything is ok the woman may start taking ovulation stimulating medications as early as that night. She will continue taking the medications for the next four or five nights. Another medication called the GnRH antagonist is usually given to prevent premature ovulation.

By the fifth day another series of blood tests and ultrasound is also done to determine if eggs have been produced. The process continues until the eggs mature and are ready for retrieval.

Egg retrieval is often done two days after the trigger injection. Egg retrieval is done through needle aspiration, where a fine long needle is threaded into the vagina to collect the follicles. The woman is usually given a sedative and anesthesia to numb the pain as well as antibiotics to prevent infection.

Once the eggs have been collected they are joined with the sperm from the male partner or a donor. Sperm and eggs can be mixed in a laboratory petri dish or injected individually into each egg in a process called intracytoplasmic sperm injection. A pregnancy test is done a week later to check if fertilization has been achieved.

In vitro fertilization is the most common assisted reproductive technique done to treat infertility today. It is usually one of the options open to couples when they have failed to conceive after one year of trying through natural means.

In in vitro fertilization, the woman’s reproductive system is hormonally controlled to produce eggs and the eggs are harvested and fertilized using the husband’s sperm. The resulting embryo is then implanted into the woman’s uterus where a successful pregnancy can be carried out.

In vitro fertilization in Detail

There are four steps involved in in vitro fertilization.

Ovarian stimulation usually starts on the third day of menstruation. The woman is given fertility medications to stimulate her ovaries into producing eggs. Gonadotrophins, like follicle stimulating hormone-analogues are often injected during a ten-day period, during which the estradiol levels and follicular growth is closely monitored.

The next step is egg retrieval. When the follicles are considered mature, the woman is given human chorionic gonadotrophin, which acts an analogue of luteinizing hormone. The eggs are taken out using an ultrasound-guided needle which pierces through the vaginal wall in order to reach the ovaries. The whole procedure takes about 20 minutes under general anesthesia or sedation.

The eggs are then taken to the laboratory, where they are stripped of extraneous membranes and proteins and prepared for fertilization. Semen from the husband or donor is also prepared by removing inactive cells and seminal fluid. The sperm and the egg are then joined in a fluid medium for 18 hours, allowing fertilization to take place. In some instances when the sperm count is low a procedure called intracytoplasmic sperm injection is done to ensure that a sperm penetrates and fertilizes the egg.

Embryo transfer is the last step in the process. Once the egg has reached the 6-8 cell stage of division it is implanted into the woman’s uterus through a thin plastic catheter. Several embryos may be implanted at one time to improve the chances of success, although this also raises the risk for a multiple pregnancy. A pregnancy test is done a week or ten days later to check if the zygote has successfully implanted.