Vitro Fertilization (IVF) is a highly complex assisted reproductive technique used in all fertility centers to help couples or single women who have difficulty getting pregnant.
The success of this treatment depends on many factors, but the age of the woman is one of the most important. It will also influence that the male sperm have good quality.
Due to the cost of hormonal medication and all the technology used to do IVF, the total price of this assisted reproductive technique is quite high.
- 1.Definition of in vitro fertilization
- 1.1.Difference of IVF with artificial insemination
- 2.When is IVF needed?
- 2.1.Male infertility
- 2.2.Feminine infertility
- 3.Requirements for IVF
- 4.What is in vitro fertilization?
- 5.Results and chances of success
- 6.Advantages and disadvantages
- 6.1.Advantages of IVF
- 6.2.Disadvantages of IVF
- 7.Possible risks
- 8.IVF price
- 9.Interview with Dr. Gorka Barrenetxea
- 10.Questions from users
- 10.1.What negative effects can IVF medication have?
- 10.2.Is it true that there is an increased risk of multiple pregnancy in IVF?
- 10.3.What are the requirements for IVF in Social Security?
- 10.4.Is it possible to have a natural pregnancy after IVF?
- 10.5.Is IVF medication always the same?
- 10.6.What are the symptoms of a positive IVF?
- 10.7.What is the probability of success of a second IVF?
- 10.8.Is rest needed after IVF?
- 10.9.What type of IVF is best? Conventional IVF or ICSI?
Definition of in vitro fertilization
In vitro fertilization is a fertility treatment that consists of extracting the eggs from the woman’s ovaries using follicular puncture and then fertilizing them in the laboratory with the male’s sperm. Next, the evolution of the embryos in culture is observed until they are transferred to the uterus of the future mother in order to achieve pregnancy.
Depending on the technique used to fuse the gametes (ovum and sperm) and give rise to an embryo, the following types of IVF are distinguished:
- Conventional IVF
- Eggs and sperm are placed in the same culture dish, waiting for them to be able to fuse on their own.
- ICSI (intracytoplasmic sperm injection)
- the sperm is introduced directly into the egg through a microinjection.
Performing one or the other method will depend on the infertility conditions of each couple, as well as the preferences of each assisted reproduction center. In any case, the previous treatment steps in both types of IVF are the same. You can see them in detail in the following video:
Difference of IVF with artificial insemination
The artificial insemination (AI) is another technique simpler than IVF assisted reproduction. AI consists of introducing the male’s semen into the woman’s uterus and allowing fertilization to occur naturally.
Therefore, IVF is more complex and requires more steps throughout the treatment, including a small surgical procedure to remove the eggs in the follicular puncture.
Despite this, the probability of pregnancy is higher in IVF than with AI, which is why it is usually the technique applied in a greater number of cases.
There are people who mistakenly refer to IVF with the concept of in vitro insemination. Likewise, it is also possible to find the term in vitro fertilization, which is used more in Latin America.
When is IVF needed?
There are several situations of sterility that can lead a couple to need the IVF technique in order to achieve pregnancy. Infertility can be due to both male and female problems or even a combination of both.
Here are the most common indications for in vitro fertilization :
In moderate or severe cases of male infertility, in vitro fertilization can be used to try to achieve pregnancy:
- few sperm in the ejaculate.
- slow or immobile sperm.
- abnormally shaped sperm on the head, neck and / or tail.
- the concentration of sperm is almost nil.
- combination of several alterations.
Causes of infertility due to female factors
In women, complications generally occur at the following points:
- Ovarian endocrine factor
- hormonal problems that cause alterations of the menstrual cycle, anovulation, etc.
- Tubal factor
- alterations in the fallopian tubes that cause a blockage.
- Uterine factor
- malformations in the uterus, tumors such as polyps or fibroids, endometriosis, etc.
- Cervical factor
- changes in the cervix that prevent the passage of sperm into the uterine cavity.
Requirements for IVF
In order to apply in vitro fertilization it is necessary for the woman to be able to produce eggs. In addition, it is necessary that you do not have uterine problems or abnormalities that prevent the implantation of the embryo or the evolution of the pregnancy.
In the case of men, the requirements vary depending on the type of IVF that we are going to perform. If the seminal quality allows it, that is, if you have a REM (motile sperm count) of between 1 and 3 million / ml, conventional IVF will usually be performed. If, on the other hand, the sperm has severe mobility, morphology or concentration problems, ICSI will be chosen.
When semen samples do not come from ejaculate, as is the case with a testicular biopsy, an ICSI is also required, since its quality is usually very low. The same is true for frozen semen or vitrified eggs.
In any case, even if the requirements for conventional IVF are met, there are fertility clinics that prefer to perform ICSI.
On the other hand, if the woman has a diminished ovarian reserve and it is not possible to obtain mature eggs, she can perform IVF with donor eggs.
It is also possible to perform IVF with donor sperm in cases of azoospermia or absence of male partner, and even IVF with double donation, that is, with donated eggs and sperm.
What is in vitro fertilization?
The IVF process is complicated, since there are several steps that must be passed through to achieve the final success of the treatment. We are going to discuss them one by one below:
- Controlled ovarian stimulation : the woman receives hormonal medication for approximately 10 days to stimulate the production of eggs and thus be able to obtain a greater number of them. In addition, this medication allows you to control the time of ovulation, thus increasing the chances that the eggs obtained are mature and suitable for fertilization.
- Ovarian or follicular puncture : it is the surgical intervention in which the mature eggs are extracted from the ovary. It is done by aspiration, lasts about 20-30 minutes and requires anesthesia.
- Collection and preparation of semen : the male sample is collected, usually by masturbation, although it can also be obtained by epididymal aspiration or testicular biopsy. Next, the sperm goes through a sperm capacitation process that will make the sperm capable of fertilizing and giving rise to the embryo.
- Fertilization : egg and sperm fuse, either by themselves (conventional IVF) or by microinjection (ICSI). If you want to know more details about the differences between one and the other way of merging gametes you can read this article: Differences between IVF and ICSI.
- Embryo culture : once the ovum has been fertilized, the embryos are left in a specific incubator that maintains optimal conditions for embryonic development. Its evolution is observed until the transfer, which can be carried out on day 3 or on day 5-6 of development.
- Endometrial preparation : the woman receives estrogen and progesterone so that her endometrium (uterine layer where embryos implant) has the appropriate appearance and thickness to facilitate implantation.
- Embryo transfer : the highest quality embryo (s) will be chosen and transferred to the uterus of the future mother while waiting for implantation to take place and thus the pregnancy begins. Although it is recommended to transfer a single embryo, in Spain it is allowed up to a maximum of 3 embryos.
- Embryo freezing the remaining non-transferred embryos that have good quality are cryopreserved by the vitrification method for their later use.
- Pregnancy test : about 14 days after the follicular puncture, the woman will be able to perform the pregnancy test that detects the beta-hCG hormone, produced since the embryo implantation.
Results and chances of success
As in all assisted reproductive techniques, the success of the treatment is measured according to several factors, the age of the patient being one of the most influential.
Specialists have managed to stipulate certain parameters for the success of IVF treatment. They are as follows:
- 40% in women under 35 years of age.
- Between 27-36% in women between 35 and 37 years old.
- Between 20-26% in women between 38 and 40 years old.
- Between 10-13% in women over 40 years of age.
When we talk and compare success rates between different techniques or between different reproductive centers, it is important to take into account what we understand by success, since sometimes the results are in the probability of pregnancy, the probability of delivery, the probability of a healthy child at home, etc.
The real success of IVF refers to the birth of a healthy child and not only to the fact of achieving pregnancy, since unfortunately not all pregnancies are evolutionary.
Advantages and disadvantages
As with other reproductive techniques, such as artificial insemination, in vitro fertilization has advantages and disadvantages. We summarize them below:
Advantages of IVF
The main advantages of IVF are as follows:
- High success rates.
- It allows pregnancy in couples with serious fertility problems. Specifically, ICSI offers the possibility of fertilization in cases of severe male factor such as obstructive azoospermia.
- It is possible to carry out the process with donor eggs and sperm, thereby allowing pregnancy in many cases of infertility.
- In general, the possible side effects are not serious.
Disadvantages of IVF
However, IVF also entails a series of drawbacks that we must also take into account:
- The patient must self-administer hormonal medication, which can lead to complications.
- It requires surgical intervention under anesthesia, which, although it is a simple and short-term operation, is not totally without risks.
- Its price is higher than other reproductive techniques such as AI.
Regardless of doing conventional IVF or ICSI, the drawbacks are the same.
As we have seen in the previous section, ovarian stimulation and follicular puncture that are carried out in the IVF process can give rise to certain risks that the patient should be aware of before starting treatment. We discuss them below:
- Ovarian hyperstimulation syndrome (OHSS)
- It occurs as a consequence of the high response of women to ovarian stimulation medication. There is an increase in the size of the ovaries and the extravasation of fluids out of the bloodstream due to the increased permeability of the blood vessels. In extreme cases, it can compromise the hepatic, hematological, renal and respiratory systems.
- Multiple pregnancy
- if a single embryo is transferred, the probability of multiple pregnancy is low. However, if two embryos are transferred, there is a 6% probability of a twin pregnancy and if 3 are transferred, the probability of having twins is 12% while that of triplets is 3%. In any case, these rates will depend on other factors such as, for example, maternal age or the state of the uterus.
Main risks and side effects of IVF
- Spontaneous abortion
- about 20% of pregnancies achieved by IVF end in a miscarriage and the majority occur in the first weeks of pregnancy. In any case, as in multiple pregnancy, this will depend on the age of the patient and the conditions of each woman or couple.
- Ectopic pregnancy
- It is a pregnancy in which the embryo has implanted outside the uterine cavity. Between 2% and 5% of women who undergo IVF treatment may experience an ectopic pregnancy. This figure contrasts with the approximate 1% of cases in which this type of pregnancy can occur naturally.
Risks of in Vitro Fertilization
In vitro fertilization has an approximate cost of between € 3,000 and € 5,000. The price will vary depending on the needs of each situation, the fertility clinic where the treatment is to be performed, the necessary tests, etc.
Normally, the medication that the patient receives is not included in the initial budget. Drugs for stimulation usually cost between € 1000 and € 1200 and those for endometrial preparation around € 300.
If you need to undergo an in vitro fertilization treatment to become a mother, in 3 simple steps, this “tool” will send you a totally personalized report, with detailed information on the treatment you need, the clinics in your area that meet our quality criteria and their budgets. In addition, it includes tips that will be very useful when making the first visits to the clinics.
Complementary techniques such as preimplantation genetic diagnosis (PGD) or long culture have an additional cost. Therefore, it is very important to carefully review the expenses that are or are not included in the price given by the specialist.
It should be noted that pregnancy is not always achieved in the first IVF attempt, so it is advisable to consult the cost of embryo freezing and substituted cycle transfer for future attempts. You can know the details of this treatment in the following post: The transfer of frozen embryos.
On the other hand, there are also assisted reproduction centers that offer special discounts from the second or third IVF attempt.
Questions from users
What negative effects can IVF medication have?
Medications used in assisted reproduction can produce various side effects such as headaches, mood swings, abdominal pain, hot flashes and bloating. Sometimes they can cause ovarian hyperstimulation syndrome.
With ovarian stimulation, more eggs develop than in a natural cycle, but this will not cause menopause to come earlier. Women are already born with a finite number of eggs and maturation does not have any effect nor will it cause the reproductive stage to end earlier.
Is it true that there is an increased risk of multiple pregnancy in IVF?
Yes, the explanation for this is that patients often choose to transfer two embryos instead of one to increase the chances of successful IVF.
However, the current trend in most assisted reproduction centers is to transfer a single high-quality embryo to avoid the possible risks that a multiple pregnancy can trigger.
What are the requirements for IVF in Social Security?
The basic requirements to be able to access in vitro fertilization treatment in Social Security are the following: that the couple does not have healthy children in common and that the woman is under 40 years of age.
In the case of single mothers and lesbian couples, there may be limitations depending on the Autonomous Community.
Is it possible to have a natural pregnancy after IVF?
There are numerous couples who achieve the second pregnancy naturally after having undergone an “in vitro pregnancy”, as the IVF pregnancy is often called. This occurs in situations where the cause of infertility is reduced or disappears.
Stress is an example of this. Some couples have their fertility reduced due to stress caused by the pursuit of pregnancy. Anxiety can affect the quality of your eggs and sperm, making conception difficult.
A change in lifestyle (relaxation, eating, reducing toxins, etc.) can lead to a substantial improvement in fertility potential.
This can also happen in cases of sterility or infertility of unknown cause.
Is IVF medication always the same?
No, although the objective of the administered medication is the same, there are different protocols and ways to stimulate the ovary and prepare the endometrium.
Depending on the situation of each woman, the medication and the most appropriate dose for her characteristics are determined. For this reason, it is essential to carry out a good fertility study in women prior to the IVF process. It is also important to monitor the response to the prescribed medication and change the type of drug or dose accordingly.
What are the symptoms of a positive IVF?
After the success of IVF, that is, after obtaining a positive pregnancy test, the symptoms do not have to be different from those of natural pregnancy. It is possible that the medication administered gives rise to some special discomfort such as swelling or heaviness, but in principle they do not have to vary.
What is the probability of success of a second IVF?
Depending on the cause of failure in the first IVF attempt, a second attempt may or may not improve the probability of success.
For example, if the failure of the first IVF has been caused by poor endometrial preparation, the second attempt will change the medication protocol to try to improve this aspect.
Normally, in the second attempt some guidelines are changed to improve the treatment and this usually leads to a greater probability of success, although as we have commented, it will depend on each situation.
Is rest needed after IVF?
Usually not. Neither after the follicular puncture nor after the transfer is the woman required to rest beyond the subsequent minutes indicated by the doctor. Yes, it is recommended that women do not make great efforts or carry a lot of weight, but they must continue with their usual rhythm of life. Only in exceptional cases, the specialist will recommend rest.
What type of IVF is best? Conventional IVF or ICSI?
There is no better technique than another, as both have advantages and disadvantages. Depending on the characteristics of each couple and their infertility situation, it will be more advisable to carry out one or another method to fertilize the ovum.
There will be cases, such as severe asthenozoospermia, in which ICSI will need to be performed to have a chance of achieving pregnancy. However, in other cases such as ovulation disorders or tubal obstruction, conventional IVF may solve the problem.
Conventional IVF is closer to the natural process and requires less manipulation. However, with ICSI we are one step closer to pregnancy, as we force the union of the egg and sperm.