IVF- What is it?

Infertility and In Vitro Fertilization

WebMD Medical Reference
Reviewed by Nivin Todd, MD, FACOG

Today, in vitro fertilization (IVF) is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as “test-tube babies.” Louise Brown, born in England in 1978, was the first such baby to be conceived outside her mother’s womb.

Unlike the simpler process of artificial insemination — in which sperm is placed in the uterus and conception precedes otherwise normally — IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.

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Infertility: Why It Happens and What You Can Do

Anyone who has struggled with infertility will tell you this: It can be quite the roller-coaster ride. “The hardest thing for us was not having answers,” says one woman, now 38. She and her 45-year-old husband were derailed for several years while doctors tried to figure out the cause of their infertility. Unlike this couple, about 80% to 85% of U.S. couples are able to get pregnant after a year of trying. When you get past the year mark, however, it’s time to seek help. If you’re over age 35, it’s…

Read the Infertility: Why It Happens and What You Can Do article > >

What Causes of Infertility Can IVF Treat?

When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:

  • Endometriosis
  • Low sperm counts
  • Problems with the uterus or fallopian tubes
  • Problems with ovulation
  • Antibody problems that harm sperm or eggs
  • The inability of sperm to penetrate or survive in the cervical mucus
  • An unexplained fertility problem

IVF is never the first step in the treatment of infertility. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked.

If you think that IVF might make sense for you, carefully assess any treatment center before undergoing the procedure. Here are some questions to ask the staff at the fertility clinic:

  • What is your pregnancy ratio per embryo transfer?
  • What is your pregnancy rate for couples in our age group and with our fertility problem?
  • What is the live birth rate for all couples who undergo this procedure each year at your facility?
  • How many of those deliveries are twins or other multiple births?
  • How much will the procedure cost, including the cost of the hormone treatments?
  • How much does it cost to store embryos and how long can we store them?
  • Do you participate in an egg donation program?

What Can I Expect From IVF?

The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one.You will then be tested to determine whether you’re ready for egg retrieval.

Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won’t develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.

What Can I Expect From IVF? continued…

During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour.

Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner’s sperm, which he will have donated on the same day.

While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage.

Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring three or four embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.

Following the procedure, you would typically stay in bed for several hours and be discharged four to six hours later. Your doctor will probably perform a pregnancy test on you about two weeks after the embryo transfer.

In cases where the man’s sperm count is extremely low, doctors may combine IVF with a procedure called intracytoplasmic sperm injection. In this procedure, a sperm is taken from semen — or in some cases right from the testicles — and inserted directly into the egg. Once a viable embryo is produced, it is transferred to the uterus using the usual IVF procedure.

What Are the Success Rates for IVF?

Success rates for IVF depend on a number of factors, including the reason for infertility, where you’re having the procedure done, and your age. The CDC compiles national statistics for all assisted reproductive technology (ART) procedures performed in the U.S., including IVF, GIFT, and ZIFT, although IVF is by far the most common; it accounts for 99% of the procedures. The most recent report from 2009 found:

  • Pregnancy was achieved in an average of 29.4% of all cycles (higher or lower depending on the age of the woman).
  • The percentage of cycles that resulted in live births was 22.4% on average (higher or lower depending on the age of the woman).

Are There Other Issues With IVF to Consider?

Any embryos that you do not use in your first IVF attempt can be frozen for later use. This will save you money if you undergo IVF a second or third time. If you do not want your leftover embryos, you may donate them to another infertile couple, or you and your partner can ask the clinic to destroy the embryos. Both you and your partner must agree before the clinic will destroy or donate your embryos.

A woman’s age is a major factor in the success of IVF for any couple. For instance, a woman who is under age 35 and undergoes IVF has a 39.6% chance of having a baby, while a woman over age 40 has an 11.5% chance. However, the CDC recently found that the success rate is increasing in every age group as the techniques are refined and doctors become more experienced.

What Are The Costs of IVF?

The average cost of an IVF cycle in the U.S. is $12,400, according to the American Society of Reproductive Medicine. This price will vary depending on where you live, the amount of medications you’re required to take, the number of IVF cycles you undergo, and the amount your insurance company will pay toward the procedure. You should thoroughly investigate your insurance company’s coverage of IVF and ask for a written statement of your benefits. Although some states have enacted laws requiring insurance companies to cover at least some of the costs of infertility treatment, many states haven’t.

Also be aware that some carriers will pay for infertility drugs and monitoring, but not for the cost of IVF or other artificial reproductive technology. Resolve: The National Infertility Association publishes a booklet called the “Infertility Insurance Advisor,” which provides tips on reviewing your insurance benefits contract

Paternal age a determinant of birth success rates- Jill Stein

Paternal age a determinant of birth success rates with stimulated IUI

Thursday 22 May 2014 – 12am PST

Editors’ Choice

Advancing paternal age is an independent predictor of live birth success rates with stimulated intrauterine inseminations, according to data released at the 2014 Annual Meeting of the American Urological Association (AUA). 


Dr. Natan Bar-Chama, of Mount Sinai School of Medicine in New York, NY, and colleagues examined the impact of paternal age on stimulated intrauterine inseminations (IUI) cycle success using data from 18,806 stimulated IUI cycles conducted at their institution over a recent 8-year period. Success was defined as live birth.

The study is the largest to date to track outcomes from stimulated IUIs.

After adjusting for standard predictors of live birth including maternal age, maternal body mass index (BMI), follicle-stimulating hormone levels and antral follicle count, a 20% decline per decade of advanced paternal age (P < 0.0001) was observed in stimulated IUI success rates.

The decline appears to start when men are in their 20s.

The impact of paternal age on the decrease in the live birth rate was seen irrespective of the stimulation protocol.

“Historically we have looked at female age as a limiting factor in fertility, and our take-home message is that paternal age is also a contributor,” says Dr. Bar-Chama, who is also the director of male reproductive medicine and surgery at Reproductive Medicine Associates of New York.

The mean maternal age in the cohort was 36.4 years, and the mean paternal age was 38.4 years.

‘Effect of age on fertility is both maternal and paternal’

“Some earlier studies have shown a decline in semen quality with age as well as the ability of sperm from older men to fertilize eggs and achieve pregnancy with advanced reproductive technologies, such as in vitro fertilization [IVF],” Dr. Bar-Chama says, and adds:

“In addition, advanced paternal age has been found to be associated with a variety of disorders includingschizophreniaautism, and attention-deficit disorder. Our new data convincingly demonstrate that advancing paternal age also leads to a decline in successful stimulated IUIs.”

Stimulated IUI is one of the most widely used techniques to assist couples with infertility and is actually more popular than the more “high-tech” approach involving in vitro fertilization, he notes.

Dr. Bar-Chama recommends that when counseling couples, physicians need to emphasize that the effect of age on fertility is both maternal and paternal.

Finally, he called for future research aimed at identifying causes for the age-associated decline in male fertility. “In particular, we need to examine possible risk factors that might play a role in this decline,” he says. “In fact, if we can identify modifiable risk factors, we may provide therapies that will be able to counterbalance this observed negative effect of paternal aging on fertility.”

Written by Jill Stein

Does Caffeine affect your fertility? Dr. S. Pauli MD and Dr. D. Session MD

Caffeine: Does it Affect Your Fertility and Pregnancy?

 

 

By Samuel A. Pauli, MD and Donna R. Session, MD
Published in Resolve for the Journey and Beyond, Winter 2009

Chocolate, coke, coffee, cappuccinos, espresso, lattes… the list goes on, let’s face it, Americans love caffeine. Caffeine is one of the most widely available drugs. The website coffeeresearch.org estimates that more than half of adults consume coffee daily and another quarter of adults are occasional drinkers. A matter of fact, a recent survey of more than 10,000 caffeinated beverage drinkers estimated the average woman of reproductive age consumes approximately 100 mg of caffeine a day with the top ten percent of caffeine drinkers exceeding an excess of 229 mg a day.

With such widespread consumption of caffeine, the potential health impact of caffeine use cannot be underestimated. Caffeine is a nervous system stimulant which helps provide that morning pickup for millions of Americans. However, caffeine also affects other organ systems of the body. Caffeine consumption is responsible for a rise in heart rate and blood pressure, revs up metabolism and increases urine formation.

Multiple studies have suggested that caffeine consumption increases the risk of miscarriage. A study published last year demonstrated an increase in the risk of miscarriage with increasing caffeine intake. Women consuming greater than 200 mg of caffeine per day had twice the miscarriage rate (25.5%) as compared to nonusers (12.5%). Moreover, pregnant women may be more sensitive to caffeine as it is metabolized or broken down slower during pregnancy. An additional concern in pregnancy is the ability of caffeine to cross the placenta and directly affect the developing baby.

While studies suggest the importance of limiting caffeine use during pregnancy, caffeine may also impact the ability to become pregnant. Several studies have shown that caffeine increases the length of time it takes to conceive. One study showed that women who drank more than one cup of coffee a day were half as likely to become pregnant per cycle as compared to women who consumed less. Another study in patients undergoing in vitro fertilization (IVF) demonstrated that women who consumed even modest amounts of caffeine (50 mg) were likely to have decreased live birth rates. While the exact mechanism by which caffeine affects fertility is unknown, the answer may be related to the ability of caffeine to influence the quality of the developing oocyte (egg). Preliminary studies in mice and monkeys suggest caffeine inhibits oocyte maturation. An immature oocyte does not fertilize and therefore is unable to produce a pregnancy.

With most studies indicating that the effects of caffeine are related to amount of caffeine consumed, it would seem prudent for women contemplating pregnancy to limit caffeine consumption. Thus some experts have suggested an arbitrary threshold of less than 100 mg per day. Caffeine intake may be derived from several sources including coffee, tea, soft drinks and chocolate (see Table). Women who consume large amounts of caffeinated beverages should taper their caffeine intake gradually to avoid withdrawal symptoms such as headaches, irritability, restlessness and nausea. Ultimately, as no “safe” level of consumption has been documented, the goal should be judicious consumption during the preconception period and during pregnancy to minimize any potential harmful effects.

Samuel A. Pauli, MD is a Clinical Fellow, Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics at Emory University School of Medicine. Donna R. Session, MD, Associate Professor and Chief, Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, at Emory University School of Medicine. For more information, contact Samuel A. Pauli, MD. at spauli@emory.edu or 404.778.3401.

Common Caffeinated Beverages Amount (ounces) Caffeine (milligrams)
Starbucks Grande Coffee 16 330
Starbucks Latte or Cappuccino 16 150
Plain Drip Coffee 8 95
Red Bull Energy Drink 8.3 76
Starbucks Espresso 1 75
Instant Coffee 8 62
Tea 8 47
Cola 12 29
Chocolate Cake 8 25
Dark Chocolate Bar 1.55 21
Milk Chocolate Bar 1.55 9
Chocolate Ice Cream 8 4
Decaf Coffee 8 2

(Sources: Starbucks Corp., 2009; USDA National Nutrient Database for Standard Reference, 2008)

 

Doctors Share 7 Biggest Fertility Misconceptions for National Infertility Awareness Week

(HealthNewsDigest.com) – According to a national study released in Fertility & Sterility, infertility among reproductive-age U.S. women is widely misunderstood. While 40 percent were concerned about their ability to get pregnant, one-third didn’t understand the adverse effects of obesity on infertility and 40 percent weren’t familiar with the ovulatory cycle.

To combat this nationwide lack of awareness, Fertility Centers of Illinois is sharing the biggest misconceptions they hear from patients in honor of National Infertility Awareness Week on April 20-26, and hosting events to build infertility awareness.

“The individuals and couples that we see are educated, hard-working, and focused on to having a family. However, many have planned their lives with a vast misunderstanding about their fertility,” explains Dr. Angie Beltsos. “The more couples and individuals know earlier in their lives about the realities of fertility, the more effectively they can achieve their family dreams, often without our help.”

During patient visits, the Fertility Centers of Illinois team hears seven common misconceptions from patients:

1. “He had kids in a previous marriage, his fertility is fine.”

Paternal fertility decreases with age, particularly after age 40. A study found a direct link between paternal age and an increased risk of autism and schizophrenia, with fathers passing on as many as four times more genetic mutations when compared to mothers. With age, there is a decrease in the concentration of healthy, mobile sperm as well as semen volume.

2. “My mom had a baby in her 40s and I have a child, I am fertile.”

Previous fertility and genetic fertility history doesn’t ensure prevention of secondary infertility, which is defined as a couple with a child being unable to conceive again after a year. The Center for Disease Control estimates that 11 percent of couples experience secondary infertility.

3. “Smoking doesn’t affect our chances of getting pregnant.”

Smoking as few as five cigarettes per day is associated with lower fertility rates in males and females. The British Medical Association found smokers may have a 10-40% lower monthly fecundity (fertility) rate, and the American Society for Reproductive Medicine estimates up to 13 percent of infertility is due to smoking.

4. “We always have sex right after ovulation.”

Once ovulation is over, pregnancy is not possible. Ovulation, when an egg drops from the ovary into the fallopian tubes, occurs once a month roughly 7-10 days prior to a woman’s period. To become pregnant, a sperm must meet the egg during this 24-48 hour timeframe. Couples should have sex prior to and during ovulation as sperm can survive in the reproductive tract for 72 hours.

5. “I know my biological clock is ticking, but my eggs are fine until 40.”

Women are born with seven million eggs, which is reduced to 400,000 at puberty. In a woman’s lifetime approximately 400-500 eggs will ovulate. Ovarian reserve declines as a woman ages, with egg supply taking a rapid decline in the late 20s and again in the 30s, particularly after 35. Pregnancy rates in the early 30s are 15 percent, then decline to 10 percent after 35 and 5 percent over 40.

6. “I am healthy, my age won’t affect my fertility.”

Being healthy and fit can aid in pregnancy, but the age of your eggs is unaffected by your fitness and diet regimen. Age is the most critical component of fertility potential.

7. “His weight or my weight doesn’t affect our chances or pregnancy.”

Extra weight causes hormonal shifts that can affect ovulation and semen production, and can make pregnancy more difficult to achieve. It is estimated that 70 percent of women with infertility are also obese. Losing 5-10 percent of body weight can boost fertility in men and women.

 

Infertile women want more support Main Page Content UI study shows infertile women feel a lack of support and suggests ways loved ones can help BY:

Many women coping with infertility count on relatives or close friends for encouragement and assistance. But according to research at the University of Iowa, when it comes to support, women may not be receiving enough—or even the right kind.

“Infertility is a more prevalent issue than people realize. It affects one in six couples, and in almost all cases, women want more support than they are getting,” says Keli Steuber, assistant professor in communication studies at the UI and co-author of the paper, published this week in the print edition of the journal Communication Monographs.


UI researchers Kelly Steuber and Andrew High talk about infertility. Video by Matt Jansen

The study comes on the heels of National Infertility Awareness Week, a movement started in 1989 by the National Infertility Association to raise awareness about infertility and to encourage the public to better understand their reproductive health.

Steuber and Andrew High, assistant professor in communication studies at the UI and the paper’s co-author, surveyed more than 300 women across the nation who were coping with infertility.

They found that infertile women want more support of all kinds—ranging from practical aid such as help with household chores, to advice and emotional reassurance like hearing a spouse say, “I love you.”

Without this support, women wrestling with infertility may become depressed or be less able to cope with stress, according to the researchers.

The good news is there are easy ways a spouse, relative, or friend can be more supportive, say Steuber and High. Though family and friends have the best of intentions, the study found they tend to dole out too much advice.

The researchers say it’s best to keep the advice to a minimum and instead focus on other ways to be supportive. That could be as simple as cooking a meal or connecting your loved one to other women with whom she can share her feelings.

“People are overwhelmed by unsolicited advice from family and friends,” says Steuber, who cites mom, female relatives, and other women with children as key perpetrators when it comes to doling out excessive information.

“Parents perceive themselves to be experts in having children, but they may not be well-informed. That puts women in an awkward position,” she explains.

As for spouses? High and Steuber found that while women cited their husbands as the strongest source of emotional support, many felt their spouses could provide more.

That’s not surprising, say High and Steuber, who note previous research has suggested that men feel uncomfortable talking about infertility issues. That can leave women feeling like some of their emotional needs are not being addressed.

“It’s a very real strain on the marriage,” says High.

The researchers suggest that husbands become a more active participant in their wives’ infertility treatments by attending appointments, advocating for their spouse, and helping them explore alternatives to pregnancy or other treatment options.

“Becoming more involved gives you the opportunity to be more emotionally invested,” says High.

And Steuber adds that couples who stick together through the infertility experience often have a stronger marital foundation moving forward. “If you can find effective, supportive ways to communicate with each other, you’re better equipped to handle stressors down the road,” she explains.

In addition to close friends and family, the researchers also looked at the support provided by doctors and nurses. “We found those in healthcare often see themselves as sources of information rather than someone who can provide emotional support or suggest a valuable network of contacts,” says High.

Though the researchers acknowledge there is no simple solution, they suggest doctors and nurses could help women feel better supported by spending additional face time with their patients, phrasing questions in an empathetic manner, and handing out resources tailored to individual needs.

The UI Office of the Vice President for Research and Economic Development funded the study.

Canada’s fertility specialists weigh guidelines for treating obese mothers-to-be

As hospitals deal with growing numbers of obese mothers-to-be, Canada’s fertility specialists are considering guidelines over whether they should be helping severely obese women get pregnant.

Doctors opposed to a weight cutoff for in vitro fertilization say denying obese women access to IVF would smack of discrimination, while those in favour of restricting access based on weight say it’s purely a medical issue, and not a social one.

Recently published research involving nearly 7,000 women who gave birth at The Ottawa Hospital found the heavier the woman, the greater her risk of pregnancy-repeated complications, including preeclampsia — a potentially life-threatening rise in blood pressure — gestational diabetes and emergency caesarean sections.

Risks to babies include premature birth and stillbirths, as well as a higher risk of spinal abnormalities and other birth defects.

“Right now, many of us are confused as to whether or not we should restrict treatment by weight,” said Dr. Jason Min, chair of the clinical practice guidelines committee of the Canadian Fertility and Andrology Society.

“We think there are more adverse outcomes if you do have a higher BMI. But whether or not that actually says you shouldn’t treat somebody who is heavy, I think that’s a very complicated issue and will ultimately require a lot of input from the stakeholders before we formalize that kind of guideline.”

The issue sparked a firestorm of debate at the group’s annual general meeting three years ago.

“There is no doubt — there is going to be bun fights over this one. The guidelines are not going to be easy,” said Toronto fertility specialist Dr. Carl Laskin.

“Those that feel that there’s no reason for a cutoff think that, if you can manage to do the procedures safely, then why should there be a cutoff?” said Laskin, a past president of the CFAS.

“To me, it’s a medical issue. It is not a discrimination issue. (Obese) women are running risks in pregnancy, and if they’re running risks in pregnancy, why should you be helping them get pregnant?”

Laskin has a BMI cut off of 35. “Mine is a brick wall,” he said. Other clinics will go as high as 40. Some have no cut off.

Laskin said obesity makes IVF technically more difficult. With IVF, eggs are retrieved from the woman’s ovaries via an ultrasound-guided needle. “But you may have difficulty getting to the ovary,” Laskin said. The ovary tends to be pushed up higher in the woman’s anatomy and excess fat can make it harder to visualize the ovaries on ultrasound.

Obese women also tend to respond more poorly to fertility drugs. “You have to use a lot more drug to get a reasonable response,” Laskin said.

“When I do see women with BMIs that are high, I work with them,” he said. “I don’t think it’s right to say, ‘you’re too heavy, go away and lose X amount of pounds and then call me.’

“I work out a plan for them. I say, ‘this is who you want to see, these are the options you can look at to lose weight, yes, you may have been there before but now you have a bigger reason for it.

“I give them all the risk factors and then I bring them back every three months until they are in a range that I believe is safe.”

In B.C., private IVF clinics outside hospitals are not permitted to perform egg retrievals in women with a BMI over 38.

Alberta has no restrictions, said Min, of Calgary’s Regional Fertility Program.

“In Calgary, at our clinic, we don’t have a BMI cutoff above which we won’t treat a patient with IVF,” said Min. “We’re not at a point where we think it’s fair or ethical to limit access to treatment based on a person’s weight.”

According to Statistics Canada, 23 per cent of Canadian women are obese. A woman with a body mass index of 30 or more is considered obese.

Obese women not only have more difficulty getting pregnant with IVF, they are also at higher risk of complications during delivery.

“Surgically, when you have to do a caesarean section, it’s very difficult and very dangerous because the blood loss, infections — all your complications are more common,” said Dr. Mark Walker, a high-risk obstetrician at The Ottawa Hospital

“You’re operating through a much more challenging operating field.”

Some pregnant women now have BMIs into the 60s, 70s and 80s, he said. The phenomenon is forcing obstetricians to re-fit their weigh-in rooms with scales that can accommodate women weighing more than 350 pounds while maternity wards are buying extra-wide chairs and beds and stronger operating tables.