In vitro fertilization is considered a first-line therapy for many cases of in fertility involving male-factor infertility, age-related infertility, or fallopian tube damage.

“In vitro” literally means "within the glass," a reference to the fertilization of eggs in a laboratory before in the womb.

Below is a list of common conditions that can be indications for IVF treatment:

-Fallopian Tube Damage: If the fallopian tube is damaged from endometriosis, pelvic inflammatory disease, or surgery, IVF treatment bypasses the tubes, allowing fertility specialists to collect eggs from the female patient in an outpatient procedure.

- Male Factor Infertility: Intracytoplasmic sperm injection (ICSI) is the injection of sperm directly into the egg for fertilization. Doctors use ICSI in cases where sperm do not swim well (a condition that doctors describe as “poor motility”) or when sperm cannot penetrate the egg's exterior membrane.

- Preimplantation genetic diagnosis (PGD): For patients at risk for diseases such as cystic fibrosis, sickle cell disease, or thalassemia, geneticists can test embryos for abnormalities and select healthier embryos for implantation into the uterus.

-Age-Related Infertility: A woman's ovarian function and likelihood of getting pregnant diminish as she ages. From birth through menopause, a woman looses eggs naturally, and those remaining decline in quality. In many cases, fertility doctors successfully use IVF to treat women with reduced ovarian function.

-Endometriosis: When endometrial cells spread outside the uterus causing anatomical distortions and adhesions, getting pregnant becomes difficult. Using medical therapy or surgical techniques, IVF has proven a successful infertility treatment for endometriosis.

-Ann ovulation: A cycle or repeated cycle in which ovaries fail to release an egg is a common cause of infertility. The clinical term for this condition is annovulation, which fertility doctors can address and help women overcome often with medication, although some women may require IVF treatment to achieve conception.

-Unexplained Infertility: Sometimes there is no identifiable cause of infertility even after a comprehensive evaluation has been performed. Generally, 40 percent of fertility problems are female related, 40 percent are male related, and the remainders are a combination or those that doctors consider to be unexplained fertility. IVF is often successful when doctors can find no clear reason for infertility.

With in vitro fertilization, the processes that normally occur in the woman's fallopian tubes are taking place in the laboratory instead. Doctors surgically remove eggs from a patient’s ovary, and an embryologist places sperm in a dish or injects a single sperm into the egg to achieve fertilization through a process called intracytoplasmic sperm injection (ICSI). A few days later, the doctor places the resulting embryos inside the woman's uterine cavity by passing a catheter through the cervix. The embryologist can then freeze and store any extra embryos for later use if the patient wishes.

An IVF treatment cycle includes the following steps:

 

1) - Ovulation Induction: To stimulate the production of eggs, doctors sometimes prescribe patients hormone injections. Some patients will have to inject themselves daily for as much as a week. Other ovulation medications only require a single injection and some are instead taken orally.. Doctors monitor the progress of ovulation induction using ultrasounds and checking on blood estrogen levels for several days. Because the timing is very delicate, patients may need an ultrasound daily as the doctors need to retrieve the ripening eggs before they are fully developed, or else they are lost.

2)- Retrieval of Eggs:  The location of the eggs in the ovarian follicles is first determined using ultrasound. Using a special needle inserted into the abdomen, doctors extract fluid containing eggs.  A short-acting intravenous sedation eliminates minor discomfort from this procedure.

3) –Embryo Fertilization and Culture:  After retrieval, an embryologist places the extracted eggs into an incubator. Selected eggs are mixed with thousands of sperm in a culture dish and left overnight to fertilize. When sperm have difficulty swimming or exhibit abnormalities, intracytoplasmic sperm injection (ICSI) allows the embryologist to inject a single sperm directly into the egg for fertilization. ICSI permits couples with male-factor infertility to achieve fertilization and pregnancy rates equal to traditional IVF. After checking for cell division, an early sign of fertilization, the embryologist places the newly formed embryos in a solution to promote growth for three to six days.

4) - Embryo Transfer: Embryos grow in the laboratory for at least a few days before they are implanted in the uterus. Using a small catheter, a doctor pushes the embryo through the cervix and into the uterine cavity for implantation and growth.

5) - Pregnancy Testing: About two weeks after the embryo transfer, doctors test patients with ultrasound to check for pregnancy.

IVF offers the highest success rate for fertility treatment

The graph above* will help you understand the relative success of a single IVF treatment compared to other common infertility treatments and to no treatment. The statistics show that IVF offers the highest success rate and a faster, more effective treatment.

* The graph contains hypothetical data. NATURAL refers to spontaneous pregnancy rates (PR) without treatment; COH/IUI refers to Controlled Ovarian Hyperstimulation with  Insemination; and IVF refers to In Vitro Fertilization. For illustration purposes, the graph assumes that patients who have failed to conceive after 18-24 months, have approximately a 5% / month NATURAL PR. Using COH/IUI treatments, the PR / month is about 15%. IVF offers an average of 50% / cycle in many situations (rates vary by age group). We assume that about 50% of IVF cycles achieve frozen embryos and that the PR with FET cycles are about 2/3 the success of fresh embryo transfer cycles. Please note that not all IVF patients have a 50% success rate per cycle but if the IVF rate per cycle decreases, so too do the success rates for COH/IUI and Natural cycles decrease.