IVF stands for “In vitro fertilization” and it is a series of complex procedures used to improve fertility, prevent genetic disorders, and aid in the conception of a child. During in vitro fertilization, mature eggs are extracted from the ovaries and fertilized in a laboratory. Fertilization takes place in a laboratory dish containing the retrieved eggs and motile sperm. The fertilized eggs develop for three to five days in a controlled environment before being transferred to the woman’s uterus for possible implantation and embryo development. A complete in vitro fertilization cycle takes approximately three weeks. Occasionally, these steps are separated into distinct phases, which can lengthen the process.

In vitro fertilization is the most effective method of assisted reproduction. It is possible to use the couple’s own eggs and sperm for the procedure, or from a known or unknown donor. 

Each couple will be required to undergo a number of tests before beginning a cycle of IVF that will use their own eggs and sperm:

• Evaluation of ovarian reserve. During the first few days of your menstrual cycle, your doctor may measure the levels of the follicle-stimulating hormone, estradiol (estrogen), and anti-mullerian hormone in your blood in order to determine the quantity and quality of your eggs. In conjunction with an ultrasound of your ovaries, test results can aid in predicting how your ovaries will react to medication.
• Sperm examination. Shortly before the start of an in vitro fertilization treatment cycle, your doctor will conduct a semen analysis.
• Screening for infectious diseases. Each of you will be tested for infectious diseases, including HIV.
• Embryo transfer procedure simulation. Your doctor may perform a sham embryo transfer to determine the depth of your uterine cavity and which technique will most likely to result be successful in the embryo transfer.
• Exam of the uterus. Before you undergo in vitro fertilization, your doctor will examine the uterine lining.
• Sonohysterography, in which fluid is injected through the cervix into the uterus, and an ultrasound may be used to generate images of the uterine cavity. Or, a hysteroscopy may be performed, in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus for the same purpose.

The success rates of IVF at your clinic depend on various factors such as the patient’s age, health condition, and specific treatment protocol. Typically, here are some general benchmarks you can share:

1. Women Under 35:
   Success rates are generally the highest, with a 50-60% success rate per cycle due to better egg quality and uterine receptivity.

2. Women Aged 35-40:
   Success rates range between 35-45% per cycle, as fertility naturally declines with age.

3. Women Over 40:
   Success rates are lower, typically 15-25% per cycle, but may improve with the use of donor eggs, which often reach 50-55% success rates.

4. Use of Frozen Embryos:
   If using frozen embryos, success rates are comparable to fresh cycles and can range from 40-50%, depending on embryo quality and uterine health.

5. Egg Donation Programs:
   When using donor eggs, the success rates can be as high as 50-70%, due to the quality of the donated eggs.

The number of IVF cycles a person might need depends on several factors, including age, fertility issues, and overall health. Here’s an overview:

General Estimate

• On average, 1 to 3 IVF cycles are needed for a successful pregnancy.
• Some individuals may conceive in the first cycle, while others may require more.

Factors Influencing the Number of Cycles

1. Age:

   • Women under 35 often have higher success rates, requiring fewer cycles.
   • Women over 40 may need more cycles, as egg quality and quantity decline with age.

2. Fertility Issues:

   • Conditions like severe male factor infertility, poor ovarian reserve, or endometriosis may require additional cycles.

3. Embryo Quality:

   • Higher-quality embryos increase the likelihood of success in fewer cycles.

4. Lifestyle and Health:

   • Factors like weight, smoking, and overall health can influence outcomes.

5. Type of IVF Protocol:

   • Some may benefit from tailored protocols, such as natural cycle IVF, donor eggs, or genetic testing, which might reduce the need for multiple cycles.

Cumulative Success Rates

• The cumulative success rate increases with additional cycles:
  • 1st cycle: ~30-40% success (depending on age).
  • 2nd cycle: ~55-60% cumulative success.
  • 3rd cycle: ~70-80% cumulative success.

Embryo selection is a critical step in IVF, as it increases the chances of implantation and a successful pregnancy. Clinics use a combination of morphological assessment, time-lapse imaging, and genetic testing to choose the healthiest embryos.

1. Morphological (Visual) Assessment

Embryologists evaluate embryos under a microscope based on shape, symmetry, and cell division rate. The grading system depends on whether the embryo is at the cleavage stage (Day 3) or the blastocyst stage (Day 5-6).

Cleavage Stage (Day 3) Grading Criteria:

• Number of cells: Ideal embryos have 6-8 cells on Day 3.
• Cell symmetry: Evenly sized cells are preferred.
• Fragmentation: Less than 10% cell fragmentation is ideal.

Blastocyst Stage (Day 5-6) Grading Criteria:

• Expansion: A well-expanded blastocyst is preferred.
• Inner Cell Mass (ICM): This develops into the fetus. A strong ICM (graded A or B) is ideal.
• Trophectoderm (TE): These cells become the placenta. A well-defined TE (graded A or B) is preferred.

Example grading system: 4AA, 5AB, 3BB, where:

• First number: Expansion (1-6, with 5-6 being best).
• First letter: Inner cell mass quality (A = best, C = lowest).
• Second letter: Trophectoderm quality (A = best, C = lowest).

2. Time-Lapse Imaging (EmbryoScope)

Advanced IVF labs use AI-based time-lapse monitoring to track embryo development continuously. This helps:

• Identify embryos with normal cell division patterns.
• Detect abnormalities that may not be visible in static observations.
• Reduce stress on embryos by avoiding frequent handling.

3. Preimplantation Genetic Testing (PGT)

Some clinics perform genetic screening to select embryos without chromosomal abnormalities. This is especially useful for:

• Women over 35 (higher risk of chromosomal issues).
• Couples with recurrent miscarriage.
• Carriers of inherited genetic diseases.

Types of PGT:

• PGT-A (Aneuploidy Testing): Checks for chromosomal abnormalities (e.g., Down syndrome).
• PGT-M (Monogenic Disease Testing): Screens for specific genetic disorders (e.g., cystic fibrosis, sickle cell anemia).
• PGT-SR (Structural Rearrangements): Detects chromosomal translocations.

Yes, IVF can lead to ovarian hyperstimulation syndrome (OHSS), although modern protocols have reduced its occurrence. OHSS is an exaggerated response to hormonal stimulation, causing the ovaries to become swollen and painful due to fluid leakage into the abdomen.

What Causes OHSS?

OHSS is triggered by excessive ovarian stimulation from gonadotropins (FSH and LH) used in IVF. The risk increases if the ovaries produce too many follicles and respond aggressively to hCG (human chorionic gonadotropin), which is used to trigger ovulation.

Who Is at Risk?

Women with:

• Polycystic ovary syndrome (PCOS) (higher ovarian sensitivity).
• High antral follicle count (AFC) or high AMH levels.
• Young age (<35 years).
• Previous history of OHSS.
• High estradiol (E2) levels before trigger (>3500 pg/mL).
• Use of hCG as a trigger instead of a GnRH agonist.

Symptoms of OHSS

Mild to Moderate OHSS (Common)

• Abdominal bloating and discomfort.
• Nausea and vomiting.
• Enlarged ovaries.
• Mild weight gain due to fluid retention.

Severe OHSS (Rare but Serious)

• Rapid weight gain (>2 kg in 24 hours).
• Severe abdominal pain and swelling.
• Difficulty breathing due to fluid in the lungs.
• Decreased urination (kidney issues).
• Blood clots (increased risk of thrombosis).

How to Reduce the Risk of OHSS

1. Adjusting Stimulation Protocols

   • Use lower doses of gonadotropins in high-risk patients.
   • Use antagonist protocols (instead of agonist protocols).

2. Alternative Ovulation Triggering

   • GnRH agonist (e.g., Lupron) instead of hCG as a trigger shot reduces OHSS risk.
   • Avoid fresh embryo transfer and do a “freeze-all” cycle to allow recovery.

3. Medication to Prevent OHSS

   • Cabergoline helps reduce fluid accumulation.
   • IV albumin can prevent severe fluid shifts.

4. Post-Retrieval Monitoring & Hydration

   • Drink plenty of fluids with electrolytes.
   • Avoid intense physical activity.
   • Frequent monitoring to detect early signs of OHSS.

Does OHSS Affect Pregnancy?

• Mild cases do not impact pregnancy outcomes.
• Severe OHSS may require hospitalization, delaying embryo transfer.
• If pregnancy occurs in an OHSS cycle, symptoms can worsen due to rising hCG levels.

IVF failure can occur at different stages:

• Poor ovarian response: The ovaries may not produce enough eggs.
• Failed fertilization: Eggs and sperm may not combine successfully.
• Poor embryo quality: The embryos may not develop properly.
• Implantation failure: The embryo may not attach to the uterine lining.
• Early miscarriage: Even if implantation occurs, the pregnancy may not progress.

The doctor will review your cycle to determine potential reasons for failure. The next steps after IVF failure are:

• Medical evaluation: A fertility specialist may recommend additional tests, such as genetic screening, hormone testing, or uterine evaluation.
• Changes in protocol: Adjustments in medication, different stimulation protocols, or using donor eggs/sperm may be suggested.
• Lifestyle adjustments: Improving diet, reducing stress, and addressing any underlying health conditions can help.
• Considering other options: If multiple IVF attempts fail, options like donor embryos might be discussed.

Babies conceived through IVF (in vitro fertilization) generally develop and grow similarly to naturally conceived children, but research has identified some potential long-term risks. These risks are generally small and often influenced by factors like parental genetics, maternal health, and multiple pregnancies rather than the IVF procedure itself.

Birth and Neonatal Risks

• Higher chance of preterm birth and low birth weight, especially in multiple pregnancies (twins, triplets).
• Increased risk of congenital anomalies, though the overall rate is low (~2-4% vs. ~1.5-3% in natural conception).
• Higher likelihood of neonatal intensive care unit (NICU) admission.

Childhood and Developmental Risks

• Growth and cognitive development: Most studies show no significant differences in IQ, behavior, or school performance compared to naturally conceived children.
• Increased risk of metabolic conditions: Some studies suggest IVF children may have slightly higher blood pressure, altered glucose metabolism, or increased body fat in childhood, but more research is needed.

Long-Term Health Risks

• Higher risk of cardiovascular issues: Some studies indicate IVF-conceived children may have subtle differences in vascular function or blood pressure later in life.
• Potential epigenetic effects: The process of IVF (including ovarian stimulation and embryo culture) may influence gene expression, but long-term consequences remain unclear.
• Slightly increased risk of certain rare childhood cancers, though the absolute risk is still very low.

Fertility and Reproductive Health

• No strong evidence suggests that IVF-conceived children have fertility issues as adults, but research is ongoing.

After an IVF (in vitro fertilization) procedure, you should take a pregnancy test about 10 to 14 days after the embryo transfer. This waiting period is often called the two-week wait (TWW) and allows enough time for the embryo to implant and start producing hCG (human chorionic gonadotropin), the pregnancy hormone.

Key Timelines:

• Day 10 post-transfer: Some early home pregnancy tests (HPTs) may detect hCG, but results can be unreliable.
• Day 12-14 post-transfer: More accurate results, but false negatives can still happen.
• Day 14 (official test day): A blood test (beta hCG test) is the most reliable way to confirm pregnancy.

Why Not Test Too Early?

• If you had an hCG trigger shot (e.g., Ovidrel, Pregnyl), testing too soon could show a false positive due to leftover hCG from the injection.
• If implantation hasn’t occurred yet, you might get a false negative even if you are pregnant.

Your clinic will usually schedule a beta hCG blood test around 14 days post-transfer, which is far more accurate than home pregnancy tests.

A successful in vitro fertilization (IVF) cycle typically has several key indicators. While the ultimate confirmation is a healthy pregnancy, early signs can provide encouragement. Here are the common signs and milestones:

Good Embryo Development

• Fertilization Success: A good number of eggs are successfully fertilized after retrieval.
• Embryo Quality: The embryos grow well, reaching the desired developmental stages (e.g., blastocyst stage on day 5).
• Genetic Testing Results: If performed, preimplantation genetic testing (PGT) shows chromosomally normal embryos.

Smooth Embryo Transfer

• The embryo transfer is uneventful, with no complications during the procedure.
• The embryo is properly positioned in the uterus, as confirmed by ultrasound.

Healthy Uterine Environment

• The uterine lining (endometrium) is thick and receptive (typically 7-14 mm and trilaminar in structure) during the embryo transfer phase.

Implantation Signs

• Spotting or Light Bleeding: Implantation bleeding may occur around 6-12 days after embryo transfer. This is light spotting, often pink or brown.
• Mild Cramps: Some women experience mild cramping, similar to menstrual cramps, during implantation.

Positive Pregnancy Test

• A positive beta hCG blood test (usually taken 10-14 days after embryo transfer) confirms pregnancy. Rising hCG levels in subsequent tests are a strong indicator of a healthy pregnancy.
• For example:
  • Day 14 post-transfer: hCG > 50 mIU/mL is promising.
  • hCG should double approximately every 48-72 hours initially.

Early Pregnancy Symptoms

• Breast Tenderness: Hormonal changes may cause the breasts to feel sore or swollen.
• Fatigue: Increased progesterone levels can lead to tiredness.
• Nausea or Food Aversions: Some women experience early pregnancy symptoms, though they are not universal.

Ultrasound Confirmation

• Around 6-7 weeks after the embryo transfer, an ultrasound should confirm:
  • Presence of a gestational sac.
  • Detection of a fetal heartbeat.