What to Expect During In Vitro Fertilization (IVF)
In vitro fertilization is the preferred or most common infertility treatment used when the fallopian tubes are severely damaged or absent, for poor ovarian reserve and for unexplained or male factor infertility. Due to its high success rate, IVF has been used more frequently in recent years as a first line of therapy for all causes of infertility.
Steps of IVF
The following steps are taken when performing in vitro fertilization:
- You’ll be given fertility drugs that stimulate your ovaries. The drugs will allow your body to produce multiple egg-containing follicles each month, instead of just one.
- You’ll receive transvaginal ultrasounds and blood tests regularly to monitor your hormone levels and follicular development.
- Once your eggs are ready to be retrieved, you’ll have an outpatient surgical procedure called an egg retrieval. During the procedure, your doctor will use a transvaginal ultrasound to guide a thin needle into each ovary to retrieve your eggs.
- The recovered eggs are immediately transferred to the laboratory where they are cultured and fertilized. It usually takes a few hours for a sperm to fertilize an egg. The embryologist may also inject the sperm directly into the egg, which is known as intracytoplasmic sperm injection (see below).
- Fertilized eggs are then cultured in the laboratory for 5 to 7 days. At that point, they are either transferred into your uterus, or, much more commonly, they undergo preimplantation genetic testing (PGT) and are frozen for future transfer.
- PGT is a screening test used to determine if genetic or chromosomal abnormalities are present in embryos produced through IVF. Learn more about PGT.
In vitro fertilization involves a variety of carefully choreographed procedures to help boost the likelihood of success. The procedure itself, including the laboratory work, is performed in our state-of-the-art facility. We also offer hospital-based IVF if you require more complex care.
What to Expect During Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI) is a procedure that has revolutionized the treatment of male infertility. As a result, we can offer men with a failed vasectomy reversal, low sperm count or a congenital (from birth) absence of the vas deferens a high chance of fatherhood without using donor sperm.
During ICSI, sperm are injected directly into the egg. This means sperm that cannot swim or bind to an egg are still able to fertilize an egg. This procedure has decreased the need for donor sperm and almost eliminated the concept of untreatable male infertility.
Steps of ICSI
The following steps are taken when performing intracytoplasmic sperm injection:
Sperm is collected from either masturbation, electro-ejaculation or other surgical techniques.
- A woman's egg cells are collected and transferred to a special media in a laboratory dish. The procedure is done under a microscope using multiple micromanipulation devices (i.e., micropipettes).
- A pipette stabilizes the egg and, from the opposite side, a micropipette collects the sperm.
- The micropipette pierces through the egg and releases the sperm into the egg.
- After the procedure, the egg is placed into cell culture and checked on the following day for signs of fertilization.
IVF Success Rate Information
Our interdisciplinary teams of professionals are dedicated to providing excellent care and service to all patients in a compassionate and respectful environment.
The in vitro fertilization (IVF) success rate data in this section (from Penn Medicine's Philadelphia location) is part of an ongoing effort to increase the level of transparency around quality data and to help our patients make informed decisions about their health.
The figures and tables on the success rates represent statistics for non–donor egg IVF cycles. The Centers for Disease Control and Prevention (CDC), in collaboration with the Society for Assisted Reproductive Technologies (SART), have been mandated by federal law to annually publish statistics from IVF programs.
Quality improvement is embedded in the culture throughout the Penn Medicine system and has become a way of life for its staff members. Penn's success with quality initiatives is not attributable to one department or person, but rather to the hard work of all staff members at every level of care, from environmental services to nursing staff to medical leadership and senior administration. Penn Medicine closely monitors the latest advances in data analysis, as well as recommended regulatory requirements and national benchmarks, to keep abreast of important developments that are critical to patients' quality of care.
Understanding IVF Success Rate Statistics
The Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technologies (SART) clearly state that "a comparison of clinic success rates may not be meaningful because patient medical characteristics and treatment vary from clinic to clinic."
However, there is important information a patient should obtain by studying some of the details in the published statistics. In addition, it is important to evaluate and compare program statistics and to research the physician you choose for infertility treatment.
In general, the ability to achieve a pregnancy following IVF treatment depends on following:
- The patient's age
- Ovarian reserve, as assessed by a day 3 to 5 follicle stimulating hormone (FSH) level, anti-mullerian level (AMH) and antral follicle count (AFC)
- The cause of the infertility
The reported success rates reference IVF statistics and do not represent pregnancies that result from other, less technical procedures such as various surgeries, insemination or ovulation induction.
To learn more, please review Penn Fertility Care's ART statistics.
Evaluating and Comparing Program Statistics
The following information regarding an IVF program should be considered:
1. Are there parameters, such as age or FSH level that exclude patients from participation in the program?
For example, a program that excludes all patients above a certain age and/or with decreased ovarian reserved (borderline or elevated FSH) may have better statistics and lower cycle cancellation rates than a program which accepts even the most difficult cases.
2. What is the mean number of embryos transferred per fresh IVF cycle and what is the high order multiple pregnancy rates (triplets or more)?
Responsible programs should try to maximize their pregnancy rates while minimizing the high order multiple pregnancy rates. For example, does a particular program transfer more embryos to achieve a similar or, sometimes, even lower pregnancy rate? This may indicate sub-optimal laboratory conditions, or a less refined embryo transfer technique, which usually results in lower viability rates for the embryos. Painstaking laboratory quality control and continuous updating of procedures as advances in the science of IVF occur are key in improving a program's success.
It should be pointed out that studies have clearly shown that increasing the numbers of embryos transferred to greater than 3 does not substantially increase the pregnancy rates, but increases the high probability of multiple pregnancy rates.
3. What are the frozen embryo pregnancy/delivery rates and what are the guidelines for freezing embryos?
For more information, please review Penn Fertility Care's ART statistics.