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In Vitro Fertilization (IVF) - Test-Tube Babies

By Haya Harris


In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child. During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. The fertilized egg (embryo) or eggs (embryos) are then transferred to the uterus. One full cycle of IVF takes around three weeks. However, these steps are occasionally split into different parts, and the process can take longer [1].


IVF is the most effective form of assisted reproductive technology. The procedure can be done using one's eggs and her partner's sperm, or it can also involve eggs, sperm, or embryos from a known or anonymous donor [2]. In some cases, a gestational carrier — a person who has an embryo implanted in her uterus — is used.

Rarely, the drugs used in IVF cause ovarian hyperstimulation syndrome (OHSS). This syndrome occurs when the ovaries over-respond to the gonadotropins (hormones that stimulate the gonads, or sex glands, to carry out their reproductive or endocrine functions), causing too many eggs to develop in the ovaries. Severe abdominal swelling and shortness of breath are side-effects. If OHSS occurs, the doctor may suggest restarting the entire cycle with a lower dose of gonadotropin [3].

There are five basic steps in the IVF and embryo transfer process:

Step 1: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. A transvaginal ultrasound is used to examine the ovaries of the egg donor, and blood test samples are taken to check hormone levels.

Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to extract the eggs. Medication is provided to reduce potential discomfort.

Step 3: The male is asked to produce a sample of sperm which is prepared for combining with the eggs.

Step 4: Insemination is a process where the sperm and eggs are mixed and stored in a laboratory dish to encourage fertilization. In some cases where there are a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) is used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the person's uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.

IVF tends to be a considerably expensive procedure. Some states have laws that require health insurance companies to cover partial or incomplete costs of any fertility treatments, provided the patient fulfills certain criteria. However, many insurance plans do not offer any fertility treatment coverage at all [4].


References

  1. Catherino WH. Reproductive endocrinology and infertility. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 223.

  2. Choi J, Lobo RA. In vitro fertilization. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 43.

  3. MedlinePlus. (2014). In vitro fertilization (IVF).

  4. RESOLVE: The National Infertility Association. (n.d.) IVF/ART.

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