News and Insights
Let’s Talk About IVF, Baby
March 26, 2024
Last month, the Alabama Supreme Court ruled that frozen embryos may be considered “extrauterine children” under state law; a decision that may have huge repercussions for fertility treatment not only in Alabama but beyond.
Several in vitro fertilization (IVF) clinics in the state had shut their doors and placed IVF treatments on hold for people living with infertility, a condition that affects 1 in 6 people worldwide. Just this past week, a few of them have reopened thanks to a new law signed by Gov. Kay Ivey to protect patients and doctors involved with IVF if embryos are damaged or destroyed.
However, regardless of a person’s politics, most people don’t know what IVF is or the steps involved in the process. IVF uses a cocktail of medications and injectable hormones to stimulate the production of follicles, with the goal of generating eggs that can be collected and used for fertilization. As such, I want to take this time to answer some common questions and dispel myths about IVF.
What is IVF? What are the odds of success on the first try?
IVF is a complex multistep process in which mature eggs are collected from ovaries and fertilized by sperm in a lab to create embryos. These embryos are then transferred back into the uterus, where they will hopefully develop and grow, resulting in the birth of a baby or babies.
According to the Society for Assisted Reproductive Technology (SART), in 2021, the chance of live birth with intended egg retrieval and the first embryo transfer in women under 35 was 35%. This decreased to just 2.6% for those aged 42 or older. Though age is the biggest factor affecting IVF success rates, other factors include egg quantity/quality, sperm quantity/quality, and receptivity of the uterus.
IVF can increase a person’s or couple’s chance of getting pregnant but there is a significant emotional, physical, and financial burden that goes along with it and all fertility treatment procedures.
How long does a typical IVF cycle take?
Depending on the person’s body, a typical IVF cycle takes about 2 to 3 weeks in total. Sometimes these steps are split into different parts and can take longer. Daily hormonal injections used to stimulate follicle growth are required for approximately 10-12 days. During this time, a patient must go to the clinic every other day or sometimes even daily to monitor the progress of their follicles (fluid-filled sacs that hold eggs inside the ovary). Every visit involves a blood draw taken to measure hormone levels and a vaginal ultrasound, a rather invasive exam, performed to count the number of follicles that are responding or growing. Follicles need to get to 18-21 mm in diameter for egg retrieval.
Once a follicle (or preferably several follicles to increase the odds of success) reaches this diameter, an egg retrieval is performed to collect potential eggs. This procedure is performed under anesthesia (IV sedation) during which a doctor inserts a needle into the ovary and follicle, pulling out the fluid and possibly an egg, while guided by ultrasound.
Once the eggs are removed, they’re placed in a dish with sperm so they can be fertilized. At this point, the odds of a mature egg becoming fertilized is ~80%. If someone is freezing their eggs, it is done at this stage, but if you’re freezing or implanting embryos, there are a few more steps involved.
What are the odds a fertilized egg will survive and develop into a baby?
Embryos then need time to grow in the laboratory for a few days before implantation. After 3 days, embryos generally have 6-8 cells which can be counted by an embryologist using a high-power microscope. Most embryos make it to this stage; however, some fertility clinics prefer to transfer embryos once they reach day 5. At this stage, an embryo is called a blastocyst. It’s important to note that only 30-50% of embryos growing on day 3 will reach the blastocyst stage. At this point, the embryo is still hardly visible to the naked eye. It is 0.1-0.2 mm in size (smaller than the thickness of a grain of rice) and contained in a very small droplet.
An embryo must reach the day 5 blastocyst stage to perform genetic testing, known as Preimplantation Genetic Testing for Aneuploidy (PGT-A) testing, and ensure the embryo is healthy. PGT-A testing is optional and typically takes 4-6 weeks for completion. If requested, samples are taken for genetic testing. The embryo is then frozen or transferred to the uterus for implantation.
Still, only about 65% of normal embryos will lead to pregnancy, so a woman or couple with a normal embryo could still fail to get pregnant upon transfer.
Does one follicle equal one egg?
Not always. While undergoing an IVF cycle, follicles can be detected as tiny black bubbles on an ultrasound scan. In contrast, eggs are microscopic structures, which cannot be seen on these scans. They are only ~0.1 mm in size and can be seen only by the embryologist in the IVF lab while scanning the follicular fluid under a high-powered microscope.
Follicles range in size from 4 to 25 mm; however, not all follicles contain eggs. This is why the correlation between the number of follicles seen on the IVF ultrasound scans and the number of eggs retrieved is not perfect. It’s also why the more follicles a person has, the better chances she will have a successful pregnancy through IVF.
How much does IVF cost?
A single IVF cycle can cost up to $30,000, depending on the center and the patient’s medication needs; though most fertility clinics quote between $12,000 to $14,000 for one cycle. Medications can account for up to 35% of those charges, but anesthesia, blood work and other add-ons can bring the total bill closer to between $15,000 and $20,000.
Is IVF only for those who are infertile?
No! IVF is an important procedure that helps many people start a family, not just the 17% of people who experience infertility at some point in their lifetime. IVF is important for the more than 300 million people worldwide living with a rare disease who wish to have a baby but do not want to pass on an inherited disease. This process is also integral to people who have faced cancer and might have no other way of conceiving a child. Similarly, same-sex couples depend on IVF, surrogacy and other ART procedures and treatments to have children.
As a scientist, I am awed by the fact that biology, like having children naturally, can just work. Reviewing the numbers and chances of failure in a single cycle of IVF, it’s astounding to me that things like creating a new life can happen every day. After reading this article, I hope you too experience admiration for our bodies.
I’m also thrilled to live in a day and age in which IVF is an option for people who want to start families and that we’ve reached a point where the chance of success is up to 40% for later embryo transfers. As a science communicator, I think we still have a lot of work to do in making this incredible process understandable to the layperson.
IVF is an amazing technology, but many do not understand the costs—emotional, physical, and fiscal—that go along with the procedure. It’s our job to ensure that the public understands these burdens and the importance of maintaining access to fertility treatments.
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