In Vitro Fertilization (IVF)
For pregnancy to occur naturally, an egg must be released from the ovary and united with a sperm. Fertilization normally occurs within a fallopian tube, which joins the uterus to an ovary. However, in IVF the union occurs in a laboratory after eggs and sperm have been collected. Embryos are then transferred to the uterus to initiate pregnancy.
There are five major steps in the IVF and embryo transfer sequence:
- Monitor the development of ripening egg(s) in the ovaries.
- Collect eggs.
- Obtain sperm.
- Put eggs and sperm together in the laboratory, and provide correct conditions for fertilization and early embryo growth.
- Transfer embryos into the uterus.
Fertility drugs selected are prescribed to control the timing of egg ripening and to increase the chance of collecting multiple eggs. To monitor egg development, GIVF utilizes ultrasound examinations of the ovaries (a painless method of imaging the enlarging follicles containing the eggs), and the measurement of serial blood hormone levels. An injection of the hormone HCG is then precisely timed to cause final ripening of the eggs.
The retrieval of the eggs is performed transvaginally using a hollow needle guided by the ultrasound image, a completely comfortable procedure under adequate sedation and local anesthesia. GIVF has extensive experience with transvaginal ultrasound-guided egg retrieval, in fact, we were the first to introduce it to the United States in 1985.
The eggs aspirated from the ovarian follicles are immediately identified by embryologists and placed with the partner's or donor's sperm, which will have been carefully processed. If the sperm are considered less likely than usual to achieve fertilization, intracytoplasmic sperm injection (ICSI) into each egg is performed using special micromanipulation equipment. The sperm and eggs are then placed into incubators and examined carefully at intervals to ensure that fertilization and cell division have taken place; after which the fertilized eggs are then called embryos.
Embryos are ready to be placed in the wife's uterus 2 to 5 days after egg retrieval. Transfer of embryos at about 5 days post-retrieval is often referred to as blastocyst transfer. A speculum is inserted into the entrance of the uterus and the embryos, suspended in a tiny drop of fluid, are very gently introduced through a catheter into the womb, often under ultrasound guidance. The embryo transfer is followed by a brief period of rest. Subsequent blood tests and ultrasound examinations are used to determine if pregnancy has been successfully established.
Probability of Human Reproduction
Human reproduction is a relatively inefficient process. In the average fertile couple, the probability of fertilization for any particular exposure of egg to sperm may be approximately 80%, but by the time of the first expected menstrual period after ovulation approximately one-half of the early embryos have already failed to develop. Many of these lost embryos were fundamentally abnormal and were incapable of survival. The menstrual period may not even be delayed and the couple not even realize that an early pregnancy has been lost. If a menstrual period is missed, one-fourth or more of the remaining embryos may still die later. The probability of a live birth after any one exposure in a normally fertile couple, therefore, is generally estimated at less than 30%.
Various clinical studies have calculated the probability of pregnancy among population groups who do not use contraception and indicate that the probability of a live birth after exposure in any one month is generally about 20%. Therefore, the expectancy of a continuing pregnancy resulting in the birth of a child after any one exposed cycle with intercourse in the typical young fertile couple with one-egg-ovulation is somewhere in the range of 20-30%.
Expected Success of IVF
It is unlikely that the rate of establishing a pregnancy from each egg by fertilization and development in vitro followed by embryo transfer can improve on the rate of normal reproduction. Therefore, the theoretical maximum success per egg in any one cycle is likely to be in the 20-30% range. Fortunately, in many IVF cycles it is possible to obtain and fertilize several eggs. The likelihood of pregnancy in those IVF patients with the greatest probability of success therefore approximates 50% or even more in just a single treatment cycle. However, a woman's age and many other factors will lower this percentage of per-cycle success. For some IVF patients, treatment must be repeated before pregnancy is achieved.
IVF pregnancy rates are one of the most misunderstood aspects of IVF treatment. For a more complete discussion of this issue, please see "What's Your Success Rate?" Understanding IVF Pregnancy Rate Statistics Part I, and "What's Your Success Rate?" Part II. Both practice and theory clearly indicate that aggregate IVF pregnancy rate statistics (the results publicly reported by an IVF program) can be manipulated to achieve nearly any desired statistical percentage through patient selection, treatment selection, cycle cancellation procedures, cycle reclassification, numbers of embryos transferred, transfer and cryopreservation criteria, and other variables. None of this managing of population data, however, helps, and it may even adversely affect the care of the individual patient. Without controlling for all these variables, which is essentially never done and is extremely difficult to achieve, IVF pregnancy rate statistics should never be used as the primary criterion for determining the actual quality of an IVF program. The total experience, record of innovation, professional reputation of an organization, its history of sensitive caring for patients, and the absolute integrity of its staff are far more useful guides to program selection.
IVF success rates are available here and can also be explained by GIVF physicians. Our physicians will realistically define for you as an individual couple the best estimates of your likelihood of success through IVF or alternative therapies. Successful conception and childbirth for any specific couple obviously cannot be guaranteed by any IVF program even if the couple undergoes multiple attempts. The probability of success depends on many factors including patient age, the cause of infertility, and experience of the IVF team.
IVF is of great value for patients with absence of both fallopian tubes or irreversible tubal blockage, infertility related to lowered sperm count, motility, or function (in association with ICSI), and many other causes of infertility, including endometriosis and unexplained infertility.
Your Consultation
Evaluation for IVF may be done in person or by telephone consultation with a GIVF physician. Relevant medical records or other information should be brought on the day of your initial consultation or forwarded to:
IVF Program Coordinator
Genetics & IVF Institute
3015 Williams Drive
Fairfax, Virginia 22031
Records should include, when possible, information on the status of the fallopian tubes and any additional data from prior infertility evaluations (temperature charts, endometrial biopsy results, hormonal studies, relevant x-ray or ultrasound reports, semen analyses, etc.). Please note that it is not necessary to have had a prior infertility evaluation in order to schedule a consultation at GIVF.
Genetics & IVF Institute offers all patients conventional per-cycle fees for its IVF services, and also has pregnancy guarantee programs available for qualified patients. We recommend deferring your decision about the best financial alternatives until medical evaluation is undertaken and the advantages and disadvantages of these options can be better assessed for your specific situation.
International and Out-of-Town Patients
Numerous patients from throughout the United States and abroad have traveled to GIVF for fertility treatment. During a treatment cycle, the female member of an IVF couple must generally be in the Washington area for approximately one week. The husband must be available the day of egg recovery (unless special arrangements are made for prior sperm cryopreservation), and is welcome to be present for the embryo transfer. For information on our concierge services and how we can help plan your trip to GIVF, click here.
Location
The Genetics & IVF Institute is conveniently located in suburban Virginia about 2 minutes from Exit 50 (Arlington Boulevard) on the Washington beltway. We are less than 30 minutes by car from downtown Washington, D.C., the northwestern Maryland suburbs, the Virginia suburbs, and National or Dulles airports. Free parking is available at GIVF. Click here for our maps and directions page.
The History of IVF at GIVF
GIVF has one of the largest and best respected IVF programs in the United States. The founder of GIVF, Dr. Joseph Schulman, worked with Dr. Robert Edwards and Mr. Patrick Steptoe, the original inventors of IVF in England, during the period when IVF was first developed, and helped contribute to discovery of the first successful IVF methods. GIVF has pioneered important improvements in IVF technology, and was the first center in the U.S. to introduce non-surgical egg retrieval for IVF. Over 20,000 IVF pregnancies have been achieved by GIVF worldwide. Many of these pregnancies marked a successful outcome for patients with particularly challenging infertility problems, including some who had been rejected for treatment from programs who select their patients to optimize apparent "success rates."
Your interest in GIVF is appreciated. To schedule a consultation, click here. If you would like more information, please contact us at 800.552.4363 or 703.698.7355, or givf@givf.com.
IVF success rates
Frequently Asked Questions
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