What to Expect Along the Path to Conceiving With IVF?

Starting the IVF treatment procedure can be an exciting and nerve-wracking encounter. Usually, IVF is pursued only after other fertility treatments have failed. You may have been trying to conceive for weeks oreven more likely, for years and years.

But this is not always the case. From time to time, IVF is the very first treatment tried.

As an example, IVF may be the first option:-

1. An egg donor is used
2. A surrogate is necessary
3. In acute cases of male infertility
4. When a woman's fallopian tubes are blocked

If formerly cryopreserved eggs are used
However, even in these cases, IVF may come after years of attempting to become pregnant and several fertility evaluations.

Just looking on the schedule of ultrasounds, blood work, and shots can have you feeling fragile. (And that's prior to the medication can mess with your moods! ) ) Add to that the price of IVF, especially in the event that you're paying out-of-pocket, and it's no surprise if you're feeling stressed.

On the other hand, the more you understand about what's coming , the more in control you'll feel. While each practice 's protocol will probably be slightly different and treatments are adjusted to get a few 's individual requirements, here is a step-by-step breakdown of what generally takes place through in vitro fertilization, as well as information about the risks, expenses, and what's next in case your IVF treatment cycle fails.

In Vitro Fertilization Basics

IVF stands for in vitro fertilization. In vitro means "in the lab" and fertilization means conception. Usually, IVF involves taking many eggs (recovered via a transvaginal ultrasound-guided needle) and placing them into a petri dish with specially washed sperm cells (recovered via masturbation.) If all goes well, a few of the recovered eggs will become fertilized by the sperm cells and become embryos. One or two of these healthy embryos will be transferred into your uterus.

In some cases, the semen cells require extra help with the fertilization procedure. ICSI, or intracytoplasmic sperm injection, may be used, which is an assisted reproductive technology that involves injecting a single sperm cell to an egg. This may be done in cases of severe male infertility, even formerly cryopreserved eggs, or when past IVF cycles have failed to have success at the fertilization stage.

But before eggs can be recovered, the ovaries have to be stimulated. Without the help of fertility medications, your body will typically only mature one (or maybe two) eggs each month. For conventional IVF, you will need a lot of eggs. Injectable fertility drugs are used to stimulate the ovaries to mature a couple or more eggs for retrieval.

This isn't always the case, however. With minimal stimulation IVF (aka mini IVF), oral fertility drugs or very low dose injectable drugs may be used to stimulate just a few eggs.

IVF Success Rates

IVF is pretty successful. According to a study of approximately 156,000 women, the average live-birth rate for the first cycle was 29.5 percent. This is comparable to the success rates for a natural cycle in couples with healthy fertility

Your best odds for success may come from repeated treatment cycles. This same study found that after six IVF cycles, the cumulative live-birth rate was 65.3 percent. These six cycles usually took place over two years.

Age does play an important role in your success, as does the reason for your infertility. Using an egg donor will also affect your success.

Be sure to discuss your personal odds for success with your doctor before starting treatment. While your doctor can't tell you for certain whether treatment will work for you, she ought to have an idea of your chances in relation to the average and in relation to other patients like yourself.

IVF Costs and Risks

IVF is expensive. It's also often not covered by insurance, setting the treatment out of reach for many men and women who want it. In fact, studies have found that just one in four couples who want IVF to conceive can actually get the treatment they want.

The average price of IVF often quoted is between $12,000 and 15,000 each cycle. Some say this estimate is really beneath the reality, and the out-of-pocket average costs are really higher. One study revealed that the average couple paid $19,234 due to their initial IVF cycle, with an additional $6,955 for each additional cycle. (Why such a difference between the initial and succeeding? Partially because a number of the second and third cycles are frozen embryo transfers.)

This is all about conventional, no-frills IVF. Should you will need any additional technology --like ICSI, PGD, assisted hatching, an egg yolks, or surrogacy--prices will probably be higher. Occasionally higher.

There are ways to pay less or acquire financial assistance for IVF treatment, and you ought to start looking into all your choices before making a decision on whether you can afford treatment.

Safety and Risks of IVF

IVF is generally safe, however as with any medical procedure, there are risks. Your physician should explain all the potential side effects and risks of each procedure before you start.

Ovarian hyperstimulation syndrome (OHSS) occurs in 10 percent of girls going through IVF treatment. For the majority of women, symptoms will be moderate, and they will recover easily. For a small percentage, OHSS can be serious and may require hospitalization. Greater than 1 percent of girls going through egg retrieval will undergo blood clots or kidney failure because of OHSS.

The egg retrieval may cause cramping and discomfort during or after the process. Rare complications include accidental puncture of the bladder, gut, or blood vessels; rectal infection; or bleeding in the ovary or rectal vessels.

If pelvic disease does happen, you'll be treated with intravenous antibiotics. In rare cases of acute illness, the uterus, ovaries or fallopian tubes may have to be surgically removed.

The embryo transfer may cause mild cramping during the procedure. Rarely, girls will also experience cramping, bleeding, or spotting after the transfer. In very rare cases, infection can occur. Infection is typically treated with antibiotics.

There is a risk of multiples, including twins, triplets, or even more. Many pregnancies can be risky for both the babies and the mother. It's 's important to discuss with your physician how many embryos to transfer, as transferring more than necessary may increase your risk of conceiving twins or longer.

Some research has found that IVF may raise the risk of some very rare birth defects, however, the risk is still relatively low. Research has also discovered that the use of ICSI with IVF, in certain cases of male infertility, may increase the risk of infertility and a few sexual birth defects for male kids. This risk, however, is quite low. (Greater than 1 percentage guessed with IVF-ICSI.)

The Cycle Before Treatment

1. Woman holding birth control pills
2. PhotoAlto / Ale Ventura /

The cycle prior to your IVF treatment is scheduled, you may be placed on birth control pills. This may appear backward--aren't you trying to get pregnant?

Using birth control pills before a treatment cycle has been shown to potentially improve your odds of success. Also, it may decrease your risk of ovarian hyperstimulation syndrome and ovarian cysts.

But not every doctor uses birth control pills the cycle before. Another possibility is that your doctor will ask you to track ovulation the cycle before. Most likely, she will recommend using an ovulation predictor kit. However, she may also suggest basal body temperature charting, especially if you have experience charting your cycles.

Then, you will need to let your doctor know as soon as you detect ovulation.

Sometime after ovulation, the fertility clinic may then have you start taking a GnRH antagonist (like Ganirelix) or a GnRH agonist (like Lupron). These are injectable drugs, but some are available as a nasal spray or implant.

These medications allow your doctor to have complete control over ovulation once your treatment cycle begins.

If you don't receive your cycles in your own, your physician may take still another approach. In this case, he may prescribe progesterone in the kind of Provera. This could bring on your time.

In this case, your physician will probably ask that you start taking the GnRH agonist or antagonist about six days or longer after your initial Provera pill.

Again, however, this may vary. Always follow your physician 's directions.

1. When You Get Your Period
2. Nurse getting ready for a blood draw for IVF

The first official day of your treatment cycle is the day you get your time. (Even though it may feel like you've already started with the medications you started earlier in the following one.)

On the next day of your period, your physician will likely order blood work and an ultrasound.

This is going to be a transvaginal ultrasound. An ultrasound throughout your period isn't exactly pleasant, but try to remember this is the same for every woman going through IVF.

These first-day ultrasounds and blood work are referred to as your baseline blood work and your baseline ultrasound. In your blood work, your doctor will be looking at your estrogen levels, specifically your E2 or estradiol. This is to make sure your ovaries are "sleeping. " That's the intended effect of the Lupron shots or GnRH antagonist.

The ultrasound is to check the size of your ovaries. Your doctor will also look for ovarian cysts. If there are cysts, your doctor will decide how to deal with them. Sometimes your doctor will just delay treatment for a week. Most cysts resolve on their own with time. In other cases, your doctor may aspirate the cyst (suck out the fluid) with a needle.

Usually, these tests will be fine. If everything looks OK, treatment moves on.

Ovarian Stimulation and Monitoring
woman giving herself an injection of fertility drugs
Tina Stallard / Contributor / Getty Images
Ovarian stimulation with fertility drugs is the next step.

Depending on your treatment protocol, this may mean anywhere from one to four shots every day for about a week to 10 days. (Ouch!)

You are probably a pro at self-injection by now, since Lupron and other GnRH agonists are also injectables. Your clinic should teach you how to give yourself the injections before treatment begins. Some clinics offer classes with tips and instruction.

Don't stress. They won't just hand you the syringe and hope for the best!

You can read more about the fertility drugs you may take during IVF here:

All About Gonadotropins
Gonadotropin Side Effects
GnRH Agonist (Lupron) Side Effects
GnRH Antagonists (Antagon, Ganirelix, Orgalutran, and Cetrotide) Side Effects
Commonly Prescribed Fertility Drugs
During ovarian stimulation, your doctor will monitor the growth and development of the follicles.

At first, this may include blood work and ultrasounds every few days. Your doctor will be monitoring your estradiol levels. During the ultrasounds, your doctor will monitor the oocyte growth. (Oocytes are the eggs in your ovaries.)

Monitoring the cycle is very important. This is how your doctor will decide how to adjust your medications. You may need to increase or decrease dosages. Once your largest follicle is 16 to 18 mm in size, your clinic will probably want to see you daily.

Final Oocyte Maturation
syringe with pink background
Paper Boat Creative / Getty Images
The next step in your IVF treatment is triggering the oocytes to go through the last stage of maturation. The eggs must complete their growth and development before they can be retrieved.

This last growth is triggered with human chorionic gonadotropin (hCG). Brand names for this include Ovidrel, Novarel, and Pregnyl.

Timing this shot is vital. If it's given too early, the eggs will not have matured enough. If given too late, the eggs may be "too old" and won't Heard correctly.

The daily ultrasounds at the conclusion of the last measure are meant to time this trigger taken just perfect.

Usually, the hCG shot is given when four or more follicles have increased to be 18 to 20 millimeters in size and your estradiol levels are greater than 2,000 pg/ML.

This shooter is typically a one-time shot. Your doctor will likely give you an exact hour to perform this shot. Make sure you follow these directions!

IVM vs. IVF
During conventional IVF, eggs have to finish their growth and expansion prior to being recovered.

IVM treatment is a bit different. IVM stands for in vitro maturation. It's a relatively new technology that is similar to IVF but significantly differs at this stage in the procedure.

During IVM, the eggs are recovered before they proceed through all stages of maturity. You are not going to have a "trigger shot" through IVM. The eggs recovered will be matured in the lab environment. After the eggs are matured, the remainder of the measures follow the IVF procedure.

What Should the Follicles Don't Grow
We've assumed to this point that the ovarian stimulation drugs have worked properly. But that isn't always how it goes. On occasion the follicles don't grow. Your doctor may increase the medications, but if your ovaries still don't react, the cycle will likely be canceled.

This doesn't mean another cycle won't perform. You may just require unique medications. But if this happens repeatedly, your physician may suggest having an embryo or egg donor. You may want to find a second opinion prior to going forward at this time.

What Should You're at Risk for OHSS
Another potential problem is your ovaries respond also. If your physician believes you're at risk of developing severe ovarian hyperstimulation syndrome (OHSS), your cause taken is going to probably be canceled and the cycle is going to be stopped at this time.

Another chance is your health care provider will recover the eggsfertilize thembut delay the embryo transfer. This is because pregnancy can aggravate and expand healing from OHSS.

As soon as your body recovers, you can try out a frozen embryo transfer.

During your next cycle, your physician may suggest lower doses of medications, try various medications before your cycle starts, or perhaps indicate IVM instead of IVF (explained above.)

What Should You Ovulate Prematurely
While not as common, a bicycle may also be canceled if ovulation happens before retrieval can take place. After the eggs ovulate on their ownthey can't be retrieved. Your doctor will likely tell you to refrain from sexual intercourse.

It's important you follow these instructions! It's possible you've ovulated up to a dozen eggs. Maybe even more. There is danger to both the mother and children if you got pregnant naturally with even half of those eggs.

How Often Are IVF Cycles Canceled?
Cancellation happens in 10 to 20 percent of IVF treatment cycles.

The chance of cancellation rises with age, with those older than age 35 more likely to experience treatment cancellation.

Egg Retrieval
medication being injected into an IVF bag
Echo / Getty Images
About 34 to 36 hours after you receive the hCG shot, the egg retrieval will take place. It's normal to be nervous about the procedure, but most women go through it without much trouble or pain.

Before the retrieval, an anesthesiologist will give you some medication intravenously to help you feel relaxed and pain-free. Usually, a light sedative is used, which will make you "sleep" through the procedure. This isn't the same as general anesthesia, which is used during operation. Side effects and complications are less frequent.

When the medications take their influence, your physician will use a transvaginal ultrasound to guide a needle through the back wall of your vaginaup for your ovaries. She will then use the needle to aspirate the follicle, or suck the liquid and oocyte in the follicle to the needle. There is one oocyte each follicle. These oocytes will soon be transferred into the embryology lab for fertilization.

The number of oocytes recovered varies but can usually be estimated before retrieval via ultrasound. The average amount of oocytes is 8 to 15, with more than 95 percent of patients having at least one oocyte recovered.

After the retrieval process, you'll be retained for a couple hours to make certain all is well. Light spotting is most common, as well as lower abdominal cramping, but many feel better in a day or so after the process. You'll also be advised to watch for signs of ovarian hyperstimulation syndrome, a negative effect from fertility medication use during IVF treatment in 10 percent of patients.

Egg Fertilization
eggs from IVF in a petri dish
Medic Image / Getty Images
Despite the fact that you're at home recovering from the retrieval, the follicles that were aspirated will be searched for oocytes, or eggs. Not each follicle will contain an oocyte.

After the oocytes are located, they'll be evaluated by the embryologist. When the eggs are excessively mature, fertilization may not be prosperous. If they are not mature enough, then the embryology lab may be able to stimulate them to maturity at the lab.

Fertilization of the oocytes should happen with 12 to 24 hours. Your partner will likely offer a semen sample the same morning you have the retrieval. The strain of the day can make it hard for a while, and therefore only in case, your partner may offer a semen sample for backup earlier in the cycle, which can be suspended prior to the day of the retrieval.

When the semen sample is ready, it'll be put through a special washing process, which separates the semen in the other substance that is found in semen. The embryologist will decide on the "best-looking sperm," placing about 10,000 semen in each culture dish having an oocyte. The culture dishes are stored in a special incubator, and after 12 to 24 hours, they are scrutinized for signs of fertilization.

With the exception of severe male infertility, 70 percent of the oocytes will get fertilized.

In the case of severe male infertility, ICSI (pronounced ick-see) may be used to fertilize the eggsinstead of just placing them into a culture dish. With ICSI, the embryologist will select a healthy-looking semen and inseminate the oocyte using the sperm with a special needle that is thin.

Embryo Transfer
Couple speaks with their physician regarding embryo transfer
Tetra Images / Getty Images
About three to four days after the retrieval, an embryologist will determine the healthiest looking embryos. This is typically done visually (using a microscope), but in a few cases, genetic screening is done. This is known as preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS.)

Occasionally, together with PGD/PGS, the embryos are cryopreserved and transfer is delayed until the following cycle. Otherwise, a "fresh" transfer takes place

The process for embryo transfer is like IUI treatment. You won't need anesthesia.

During the embryo transfer, a thin tube, or catheter, will be passed through your cervix. You may experience very light cramping but nothing more than that. Through the catheter, they will transfer the embryos, along with a small amount of fluid.

The number of embryos transferred will depend on the quality of the embryos and discussion with your doctor. Depending on your age, anywhere from one to five embryos may be transferred. Transferring two embryos is the most common option.

More doctors are suggesting having just one embryo transferred and then freezing the rest. This is known as elective single embryo transfer (eSET), and it can reduce your risk of a multiple pregnancy. When you get pregnant with just one healthy baby, you reduce your risks for pregnancy complications. Speak to your doctor to find out if elective single embryo transfer is best for you.

After the transfer, you'll stay lying down for a couple hours (bring a book) and then head home.

If there are "extra" high-quality embryos left over, you may be able to freeze them. This is called embryo cryopreservation. They can be used later if this cycle isn't effective in a frozen embryo transfer, or they can be donated.

Progesterone Support and the Two Week Wait
Friends holding hands
PeopleImages.com / Getty Images
On or after the day of your retrieval, and until the embryo transfer, you'll start committing yourself progesterone supplements. Usually, the progesterone during IVF treatment is given as an intramuscular self-injection as progesterone in oil. (More shots! ) ) From time to time, however, progesterone supplementation can be taken as a tablet, vaginal gel, or vaginal suppository.

Aside from the progesterone, there really isn't much going on for the next two weeks. In some ways, the two weeks after the transfer may be more difficult emotionally than the two weeks of treatment. During the previous steps, you will have visited your doctor perhaps every other day. Now, after transfer, there will be a sudden lull in activity.

You may have lots of questions about the two-week wait. Can you have sex? What if you have cramps? Of course, your doctor is the number one source for any of your concerns.

All you can do is wait the two weeks and see if pregnancy takes place. It can help to keep busy with your life during this wait time and avoid sitting and thinking about whether or not treatment will be successful.

Pregnancy Test and Follow-Up
Positive pregnancy test being held by a happy smiling woman who took the test at the right time
IAN HOOTON / Science Photo Library / Getty Images
About nine to 12 days after the embryo transfer, a pregnancy test is ordered. This is usually a serum pregnancy test (more blood work) and also will include progesterone levels testing. The test may be repeated every few days.

If the test is positive (yeah!) , you may need to keep taking the progesterone supplementation for another several weeks. Your doctor will also follow up with occasional blood work and ultrasounds to monitor the pregnancy and watch for miscarriages or ectopic pregnancies.

Possible IVF Pregnancy Risks

Your doctor will also monitor whether or not the treatment led to a multiple pregnancy. IVF has a higher risk of conceiving multiples, and a multiple pregnancy carries risks for both the mother and the babies. Risks of a multiple pregnancy include premature labor and delivery, maternal hemorrhage, C-section delivery, pregnancy induced high blood pressure, and gestational diabetes.

If it's a high-order pregnancy (4 or more), your doctor may discuss the option of reducing the number of fetuses in a procedure called a "multifetal pregnancy loss. " This is sometimes done to increase the chances of having a healthy and successful pregnancy.

Women who conceive with IVF are more likely to experience spotting in early pregnancy, though it's more likely for their spotting to resolve without harm to the pregnancy.

The risk of miscarriage is about the same for women who conceive naturally, with the risk going up with age. For young women in their 20s, the rate of miscarriage is as low as 15 percent, while for women over 40, the rate of miscarriage may be over 50 percent.

There is a 2 to 4 percent risk of ectopic pregnancy with IVF conception.

If you developed OHSS from the fertility drugs, and you get pregnant, recovery may take longer.

When IVF Treatment Fails

If the pregnancy test is still negative 12 to 14 days post-transfer, your doctor will ask you to stop taking the progesterone. Then, you'll wait for your period to start as per the procedure of IVF center in Mumbai.

The next step will be decided by you, your partner, and your doctor. If this was your first cycle, another cycle may be recommended. Remember that your best chances for success are after doing several cycles.

Having a treatment cycle fail is never easy. It's heartbreaking. It's important, however, to keep in mind that having one cycle fail doesn't mean you won't succeed should you try again.

Taking the Upcoming Steps After Fertility Treatment Failure