In vitro fertilization (IVF) is a procedure in which the eggs from the women are mixed with the sperm from the man in a laboratory outside of the body. Embryos are then placed into women and the baby develops and is eventually born. IVF is used when other methods are not successful. It can also be used in a situation where the fallopian tubes are not open, either from a tubal ligation or from disease.
IVF is very technical and time consuming. It is not painful. The procedure starts with injectible medications to create a situation where multiple eggs are ready to ovulate. This usually involves daily or every other day doctor visits for blood work, injections, or ultrasounds. When the eggs are ready an office procedure is done to retrieve the eggs. This is done without an incision through the vagina. The egg retrieval can be uncomfortable but not painful. General anesthesia is not required. The eggs are then mixed with the partners sperm in a petri dish and fertilization occurs outside of the body. The embryos are then put into the uterus several days later. The women will be given hormones to support the pregnancy early on but these can be stopped by the beginning of the second trimester.
The number of embryos put back into the women depends on several factors. The higher the number the greater the chance of pregnancy but the greater the chance of multiples as well. Some women may wish to only have one or two embryos transferred into the uterus. If the embryos are of high quality, the chances of successful pregnancy are good without the risk of high order multiples (triplets, quadruplets, etc). If high order multiples occurs, selective reduction is a procedure that may be considered. This is removing some of the embryos from the uterus in attempt to reduce the higher order multiples to just twins. This carries some risk and some women may not want to have the reduction if they do not agree with abortion. It may be possible to freeze some of the embryos for later use. This can make it easier to try again if the transfer is not successful.
In vitro fertilization is expensive and often not covered by insurance. The procedure is expensive and the medications can sometimes cost as much as the procedure. It may be possible to get a loan for IVF. Banks will often loan money like a car loan that can be paid off over time. The cost of IVF is less than the cost of a new car. If this is the only way to have a child the cost may be worth it for many couples.
IVF can be done in conjunction with other procedures. Donor eggs, donor sperm, surrogacy, ICSI, and genetic testing of pre-implanted embryos can all be done along with IVF. Please see Advanced Reproductive Technology for a discussion of these techniques.