Building a Family with In Vitro Fertilization
By Michael M. Alper, M.D.
ormal>Infertility, the inability to conceive after a year of unprotected intercourse, is a common condition that affects an astonishing one in six couples. Simple tests can help unravel the reason for the problem: a semen analysis, blood work, and an x-ray test to determine that the fallopian tubes are open.

ormal>Almost every cause of infertility has an effective treatment. Sometimes simple treatments are not enough and in vitro fertilization (IVF), commonly referred to as “test tube baby,” is recommended. It has been 25 years since the first IVF baby was born and an estimated 1 million babies have been conceived through the procedure worldwide.

ormal>Several steps are required for IVF:

ormal>• A medication called follicle stimulating hormone (FSH) is taken for several days to cause multiple eggs to form.

ormal>• Egg development progress is monitored with ultrasound examinations of the ovaries and blood tests.

ormal>• An egg retrieval operation is performed when the right number of follicles (fluid-filled sacs in the ovary that contain the eggs) appear on the ultrasound. This takes just minutes and is performed under sedation or general anesthesia. It is performed by inserting a needle into the ovary through the vaginal wall using ultrasound as a tool to help the physician see the follicles within the ovary.

ormal>• Eggs are fertilized by placing them in a Petri dish with sperm. Sometimes a technique called ICSI (Intracytoplasmic Sperm Injection) is used to help the sperm get into the egg.

ormal>• Fertilized eggs – now called embryos – are allowed to grow in the laboratory for 3-5 days and are then placed in the uterus with the hope that one will implant successfully. Placement of the embryos through the cervix into the uterus is a simple procedure. Sometimes extra embryos can be frozen for a future cycle.

ormal>• A pregnancy test is performed two weeks after the eggs were removed to see if the cycle was successful.

So, what are the chances of it working? That depends on many factors – an important one is age of the mother. In general, about one in three women under age 35 will conceive for each IVF procedure. Once a woman turns 40, chances begin to decline. In general, the more times a person tries IVF, then the more likely it will ultimately work.  The main risk of IVF is multiple pregnancies, which occur in about one in three women undergoing treatment.

The important points to remember if you are considering IVF is that the procedure has improved over the years.  It is not as invasive and intrusive as it used to be, the medications are simpler to take, the procedures should be comfortable, and the success rates are much improved. 

Although IVF can be expensive, many insurance companies cover some parts of the procedure and some states (including Massachusetts, New Jersey, and Illinois) require insurance companies to cover the procedure.

It is important that you see an expert in the field. Go to an IVF center with a good reputation and credentials. But don’t judge only on published pregnancy rates because programs vary on who they will treat or not treat (which obviously affects their results).

IVF has allowed many infertile couples to build their family. It may not be the ‘old-fashioned way’ but the results are similar – a healthy baby.

Michael M. Alper, M.D., is the medical director of Boston IVF, located in Waltham, MA. He is also an assistant clinical professor of OB/GYN at Harvard Medical School.