Patients review reproductive facts with healthcare provider

What is In Vitro Fertilization?

In vitro fertilization (IVF) is a process in which an egg and sperm are combined in a laboratory dish to facilitate fertilization. If fertilized, the resulting embryo is transferred to the uterus. You may also hear IVF referred to as an Assisted Reproductive Technology (ART).

View all of our resources on IVF

Unassisted Reproduction

In order to understand assisted reproduction and how it can help infertile couples, it is important to understand how conception takes place naturally. For traditional conception to occur, the man must ejaculate his semen, the fluid containing the sperm, into the woman’s vagina around the time of ovulation, when her ovary releases an egg. Ovulation is a complex event controlled by the pituitary gland, which is located at the base of the brain. The pituitary gland releases follicle-stimulating hormone (FSH), which stimulates follicles in one of the ovaries to begin growing. The follicle produces the hormone estrogen and contains a maturing egg. When an egg is mature, the pituitary gland sends a surge of luteinizing hormone (LH) that causes the follicle to rupture and release (ovulate) a mature egg.

Following ovulation, the egg is picked up by one of the fallopian tubes. Since fertilization usually takes place inside the fallopian tube, the man’s sperm must be capable of swimming through the vagina and cervical mucus, up the cervical canal into the uterus, and up into the fallopian tube, where it must penetrate the egg in order to fertilize it. The fertilized egg continues traveling to the uterus and implants in the uterine lining, where it continues to develop.

When was In Vitro Fertilization (IVF) first introduced?

IVF was introduced in the United States in 1981. Since 1985, when we began counting, through the end of 2017, more than 1.2 million babies have been born in the United States as a result of reported Assisted Reproductive Technology procedures (IVF, GIFT, ZIFT, and combination procedures). IVF currently accounts for more than 99% of ART procedures with GIFT, ZIFT and combination procedures making up the remainder. The average live delivery rate for IVF in 2005 was 31.6 percent per retrieval--a little better than the 20 percent chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term. In 2002, approximately one in every hundred babies born in the US was conceived using ART and that trend continues today. Currently, more than 2.5% of all births in the United States are a result of successful Assisted Reproductive Technology procedures.

View more IVF trends on the SART Website

What is the process of In Vitro Fertilization (IVF)?

In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman's uterus, thus bypassing the fallopian tubes.

Extra embryos remaining after the embryo transfer may be cryopreserved (frozen) for future transfer. Cryopreservation makes future ART cycles simpler, less expensive, and less invasive than the initial IVF cycle, since the woman does not require ovarian stimulation or egg retrieval. Once frozen, embryos may be stored for prolonged periods, and live births have been reported using embryos that have been frozen for almost 20 years.

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Risks of In Vitro Fertilization (IVF):

  • Possible side effects of injectable fertility medicines which can include soreness and mild bruising at the injection site; nausea, mood swings, fatigue; breast tenderness and increased vaginal discharge; temporary allergic reactions; or Ovarian hyperstimulation syndrome (OHSS)
  • Possible risks of egg retrieval which can include mild to moderate pelvic and abdominal pain; and very rarely, bowel or blood vessel injury can require emergency surgery.
  • Possible risks associated with embryo transfer include mild cramping or vaginal spotting afterward and very rarely, an infection may develop, which can usually be treated with antibiotics.

How do I choose an IVF Clinic?

When looking for an IVF clinic, the first thing you should do is verify that it is a member of the ASRM-affiliated society SART, the Society for Assisted Reproductive Technology.

  • SART clinics are committed to the highest quality standards of care.
  • All clinics are required to advertise truthfully.
  • SART clinics accurately report outcomes so that you, the patient, can trust your provider.
  • All SART clinics work with nationally accredited laboratories to ensure the best possible reproductive environments.
Visit the SART Website where you can find a clinic near you and view their individual success rates

What to expect when you start IVF

During your initial consultations with the fertility clinic, you can expect several things to happen:

  1. Your healthcare provider will take down a detailed medical history that will include information about previous pregnancies, menstrual cycles, previous fertility treatments, and any underlying medical conditions, surgeries, or medications that might affect your treatment.
  2. Lifestyle issues will be addressed. Smoking, for example, may lower a woman’s chance of success by as much as 50%. Live birth rates after IVF decrease significantly with obesity, due to a combination of lower pregnancy rates and higher miscarriage rates. Alcohol and recreational drugs may be harmful, and excessive caffeine consumption should be avoided. 
  3. The couple will undergo an examination to assess their health which will include blood tests to look at hormone levels, an ultrasound to evaluate the health of reproductive organs, and a semen analysis to check for sperm abnormalities
  4. The healthcare professionals will also explain the IVF process and your treatment plan and answer any questions you might have.
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4 facts about ovarian reserve

What if I don't respond to the drugs for ovarian stimulation?

A response to ovarian stimulation depends on a number of different factors, the most important include available eggs, appropriate hormone levels, proper administration of any medications and lifestyle/environmental factors.

In order to respond to ovarian stimulation, a patient must have eggs available to respond; this is sometimes referred to as ovarian reserve. If they have diminished ovarian reserve (identified by high blood levels of follicle stimulation hormone (FSH), low blood levels of anti Müllerian hormone (AMH) or a low antral follicle count on ultrasound), they may not have as robust (or any) response to stimulation. For these patients, an alternate stimulation protocol may be tried or donated eggs may be used (from a woman known or unknown to the patient).

It is possible that a patient does have the necessary eggs but lacks the appropriate pituitary hormones to respond. In this case, using a different medication- one which may contain both FSH and luteinizing hormone (LH) may allow for an optimal response. Read the Ovarian Reserve Fact Sheet

What if my eggs don’t fertilize?

Most eggs will fertilize when they are placed in a culture dish with several thousand normal sperm. When there are not enough normal functioning sperm for IVF, fertilization will usually occur after a single live sperm is injected into each egg, termed “intracytoplasmic sperm injection” or “ICSI.” On rare occasions, fertilization does not occur even with ICSI, presumably because of a problem inherent to either eggs or sperm. In these cases, the use of donor sperm or donor eggs will usually result in fertilization. Your fertility specialist and IVF laboratory personnel will help you determine which approach is most likely to result in egg fertilization.

Read the Intracytoplasmic Sperm Injection fact sheet
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Preimplantation Genetic Testing

Preimplantation genetic testing (PGT) is a technique in which one or more cells are taken from an egg or embryo (fertilized egg) for testing to provide information about the genetic makeup of the rest of the cells in that embryo. It is done in a lab using in vitro fertilization (IVF). Cells from the embryo can be tested for a gene that may produce a specific disease. This will show if an embryo is normal (no disease) or affected (has the disease). It will also show if the embryo is carrying the disease but unaffected by it. An unaffected carrier is someone who can pass the disease to his or her children but does not personally have any signs of the disease. Genetically healthy embryos are transferred to the uterus, where they may attach to its lining and produce a pregnancy.

Patients with many inherited familial diseases can have their embryos tested to determine their genetic makeup. Specifically, this would include patients with a history of single-gene disorders (such as cystic fibrosis or sickle cell anemia) and patients with a history of sex-linked disorders (such as Duchenne muscular dystrophy and Fragile X syndrome). In addition, even families searching for a bone marrow donor may be able to use PGT to bring a child into the world that can provide matching stem cells for an affected sibling. Watch the Genetic and Fertility video series
Couple reviews insurance information for reproductive care

Is In Vitro Fertilization Expensive?

Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to be successful. While IVF and other assisted reproductive technologies are not inexpensive, they account for only three-hundredths of one percent (0.03%) of U.S. healthcare costs.

ASRM has a breakdown of infertility coverage by US State and Territories to help you make financial decisions. 
View your state's insurance coverage legislation

ASRM is also advocating not only to safeguard reproductive medicine procedures like IVF but also to increase healthcare coverage for patients.
Find out how you can help

What are my options if I decide not to use my stored embryos?

If you have stored embryos that you have decided not to transfer into your uterus to attempt pregnancy, you have four options for their final disposition.
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First, you can donate your embryos to another woman with fertility problems that you don't know so that she can attempt pregnancy through a process called anonymous embryo donation.”

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Second, you can donate your embryos to another woman that you do know so that she can attempt pregnancy through a process called “directed embryo donation.”


Third, you can donate your embryos for laboratory research to help improve pregnancy rates for infertile couples in the future.


Finally, you can ask that your embryos be thawed and discarded.

Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

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