The Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology provide information online about U.S. clinics’ individual pregnancy and live birth rates.
When choosing an in vitro fertilization (IVF) clinic, keep in mind that a clinic’s success rate depends on many factors, such as patients’ ages and medical issues, as well as the clinic’s treatment population and treatment approaches. Ask for detailed information about the costs associated with each step of the procedure.
Before beginning a cycle of IVF using one’s own eggs and sperm, the couple will likely need various screenings, including:
Ovarian Reserve Testing
To determine the quantity and quality of one’s eggs, the doctor might test the concentration of follicle-Stimulating Hormone (FSH), Estradiol (Estrogen) and Antimullerian Hormone in the blood during the first few days of the woman’s menstrual cycle. Test results often used together with an ultrasound of the ovaries, can help predict how a woman’s ovaries will respond to fertility medication.
If not done as part of the initial fertility evaluation, the doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.
Infectious Disease Screening
The couple will be screened for infectious diseases, including HIV.
Practice (mock) Embryo Transfer
The doctor might conduct a mock embryo transfer to determine the depth of a woman’s uterine cavity and the technique helps to successfully place the embryos into the uterus.
Uterine Cavity Examination
The doctor examines the woman’s uterine cavity before the procedure starts. This might involve a Sonohysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a Hysteroscopy — in which a thin, flexible, lighted telescope (Hysteroscope) is inserted through your vagina and cervix into your uterus.
Before beginning a cycle of IVF, important questions to consider include:
How many embryos will be transferred?
The number of embryos transferred is typically based on the age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs.
Most doctors follow specific guidelines to prevent a higher order multiple pregnancy — triplets or more — and in some countries, legislation limits the number of embryos that can be transferred at once. The couple and the doctor should ensure they agree on the number of embryos that will be transferred before the transfer procedure.
What Happens with Extra Embryos?
Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will.
Cryopreservation can make future cycles of IVF less expensive and less invasive. However, the live birth rate from frozen embryos is slightly lower than the live birth rate from fresh embryos. Unused frozen embryos can be donated to another couple or a research facility. One might also choose to discard the unused embryos.
How to Handle a Multiple Pregnancy
If more than one embryo is transferred to the uterus, IVF can result in a multiple pregnancy — which poses health risks for the woman and her babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction however, is a major decision with ethical, emotional and psychological consequences.
A couple should consider the potential complications associated with using donor eggs, sperm or embryos or a gestational carrier. A trained counselor with expertise in donor issues can help the couple understand legal issues, such as the legal rights of the donor. The couple may also need an attorney to file court papers to help them become legal parents of an implanted embryo.