In vitro fertilization is a common procedure which is been performed thousands of times throughout the world each year. Its advent in the 1980’s and the improvements made to the science since then have allowed so many people to create families when they may not have had that option before. It’s an amazing option, and while it can be prohibitively expensive, it’s becoming more and more accessible as insurance coverage increases. While IVF is fairly common, it’s still shrouded in mystery for most. What exactly is it? How does it work and why does it increase the odds? Having an expert you can talk to when you have questions about IVF is key.
Not everyone has a Patient Care Advocate or immediate access to a physician to discuss the ins and outs of IVF, and it’s a complex process involving medications, monitoring, a minor surgical procedure and an embryology lab. Having worked with IVF patients for almost 10 years, I know that most people have a lot of questions. So, I talked to a physician about the five unconventional questions I've seen women ask.
Lora Shahine is a board-certified reproductive endocrinologist who practices at Pacific NW Fertility, a clinic in the Progyny Provider Network. She’s a specialist in recurrent miscarriage and has authored two books on pregnancy loss and fertility. She’s an expert in all things fertility and as you’ll see, is skilled at explaining this complex process in a way that is easily understood. Here are her answers to those questions you might not have known to ask about IVF.
Before you start any medical procedure, you should understand the prognosis or success rate. So much is understood about IVF, but many don’t completely understand the efficacy. Simply stated, success of the procedure is tied closely to the age of the female patient. Women are born with all of the eggs they’ll ever have. As we age, our egg count decreases in quantity, as well as quality. A decrease in quantity means we have fewer eggs, but the decrease in quality matters a lot, too. Dr. Shahine explains that “as eggs age, fewer of them are able to complete the complex genetic changes required to become a healthy baby.”
So, how do you predict your own success with IVF? The reasons for success are multifactorial and Shahine says “before undergoing IVF, age and estimated number of eggs likely to be retrieved (based on an AMH blood test) are the best ways to predict success.” She says the more eggs that are retrieved, the better one’s chances of a successful pregnancy. Your age and reproductive health are both factors, but so is the clinic you choose — specifically their embryology lab.
However, according to the CDC, women under the age of 35 on average have about a 40 percent chance of a live birth using IVF. For women who are 33-36, the success rates are about 34 percent. Women who are 38-40 have about a 25 percent chance at a live birth utilizing IVF, while women who are 40-42 have about a 15 percent chance at achieving a live birth.
We all see celebrities have babies well into their late forties and beyond. But if you paid attention at all in biology class, you know that women reach peak fertility in their twenties. Dr. Shahine says that her patients see celebrities on the cover of magazines celebrating their pregnancies in their late forties or fifties, but most women conceiving at that age "are often using donor eggs.”
Fertility begins to decline drastically in female’s late 30’s and Dr. Shahine mentioned that while there is no magic age where fertility ends, “IVF has a very low chance of success in women age 42 and older.” It’s because of this that many clinics have an age-cutoff for women using their own eggs in their mid-forties. While there is not a high probability, Dr. Shahine says she has, “had patients have success with their own eggs in their mid-40s, but it usually takes multiple stimulation cycles and more women are unsuccessful than successful.” However, women can have high chances of success with pregnancy with the use of donor eggs well into their forties and even fifties.
Most people take about three shots a day and then one at the end of the cycle. The daily shots are subcutaneous (a small needle) and the shot at the end of the cycle is an intramuscular shot in the butt. Dr. Shahine explained that while there are many kinds of injections for IVF, “People are usually asking about the stimulation medication leading up to the egg retrieval. These shots are gonadotropins that a woman’s body naturally makes each month to recruit and ovulate one egg. The goal of IVF is to recruit more than one egg, so these shots have a higher dose of gonadotropins to help recruit multiple eggs.” In other words, the medication makes a bunch of eggs grow in one cycle, increasing your chances at pregnancy.
First, it makes sense to understand what IVF is on a high level. A patient will undergo a number of tests to make sure they are a good candidate. Then, they will begin taking medications that stimulate the ovaries. The medication is self-injected each day for about 10 days. During this time the doctors will monitor the response to the medication using blood work and ultrasounds. When the eggs have grown to the appropriate size, the patient undergoes a minor surgical procedure to retrieve the eggs and mix them with sperm in the lab. The process is generally well tolerated by most. Dr. Shahine says her patients often report that it "it wasn’t as bad as I thought it would be.”
“Shots can be uncomfortable but manageable, and the egg retrieval is often done with sedation to minimize any discomfort," she says.
Most people feel some side effects from the medication — bloating is the most commonly reported symptom — but many say they are back to normal within a few days to a week.
The embryology lab is where all the magic happens! Most experts will tell you that a mediocre doctor in a fantastic lab will yield much better results than a fantastic doctor with a mediocre lab. Dr. Shahine agrees: “I wouldn’t have the success rates I do without the excellent care and expertise of the embryologists in my lab.”
In the lab, the eggs are mixed with sperm — either in a dish or with a process known as Intra-cytoplasmic sperm injection (ICSI). The eggs that fertilized are cultured for several days. Once embryos have developed in the lab, they are either frozen, transferred or biopsied then frozen. It’s the most expensive part of IVF and arguably the most important part. If the lab isn’t maintained at very high standards, then the success rates will suffer.
IVF can be overwhelming if you don’t understand the process, so it’s critical to feel as prepared as possible. It’s important to be fully informed about the entire process — both what to expect as the patient, and how the clinic’s success rates compare to national averages. If you have any questions, don’t be shy about speaking to your fertility specialist. It’s your health and your family building future, and having all of the information up front will help you along the way.
Lissa Kline, LCSW is currently the VP of Member and Provider Services at Progyny, overseeing the Patient Care Advocates and Provider Relations Team. She worked at Columbia University Medical Center for several years in the division of Reproductive Endocrinology and Infertility. Involved in Patient Services and the Donor Egg Program she loved working with patients while they underwent fertility treatment. Lissa graduated with a Master of Science in Social Work from Columbia University.