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IVF Provides Additional Resources in Reproductive Health
In vitro fertilization (IVF) provides an additional resource for those unable to conceive naturally, expanding the tools used in reproductive health.
The overturning of Roe v. Wade in the 2022 Dobbs v. Jackson Women’s Health Organization United State Supreme Court case has brought about a lot of conversation about reproductive rights, including in vitro fertilization (IVF). The primary benefit of IVF is its use as a reproductive tool to assist in conception for those unable to do so naturally.
Planned Parenthood characterized IVF as an assisted reproductive technology — sometimes abbreviated to ART.
History of IVF
An article in Missouri Medicine states that the first IVF birth occurred approximately 4.5 decades ago, in 1978.
Researchers in the report explained, “in this sentinel IVF birth, the mother had a natural menstrual cycle, physicians laparoscopically retrieved a single pre-ovulatory oocyte from her ovary, fertilized it in vitro, and then transferred the resulting eight-cell embryo into her uterus.”
By 1981, the first IVF baby in the US was delivered, marking the fifteenth IVF birth in the world.
In the early days of IVF, under 10% of IVF attempts were successful. Since then, IVF success rates have increased nearly five times. In the Missouri Medicine article, clinicians state that 1–3% of births in the US and Europe result from IVF.
IVF Basics
Penn Medicine states, “IVF has been around for decades, and you most likely already know the basic idea behind IVF: uniting egg and sperm outside the body in culture. But there's so much more to IVF that happens before and after that.”
On a basic level, the IVF process is composed of the following steps:
- ovulation induction
- egg extraction
- egg fertilization
- embryo implantation
Before IVF
Before starting IVF treatments, several tests and procedures must be conducted to ensure that the procedure will be safe and effective.
First, the person in which the embryo will be implanted will undergo ovarian reserve testing. This test functions as a measure of the quantity and quality of the eggs. In addition, this testing measures the follicle-stimulating hormone (FSH), estradiol, and anti-mullerian levels.
Additionally, if a partner or sperm donor is being used to fertilize the egg, a sperm analysis is done. Additional tests include infectious disease screening, a mock embryo transfer, and a uterine exam.
Ovulation Induction
The first step of IVF is ovulation induction, which is relatively self-explanatory. In this step, physicians use medications such as synthetic hormones to induce ovulation and help the ovaries produce more than one egg at a time so that multiple eggs can be extracted in case of a failed fertilization.
Medications are used to assist ovarian stimulation, oocyte maturation, prevent premature ovulation, and prepare the uterine lining.
The period of ovarian stimulation is typically two weeks long and is concluded with vaginal ultrasound and blood tests to determine if the eggs are ready for extraction.
Egg Retrieval
According to the Mayo Clinic, “transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs.”
The egg retrieval process can result in some discomfort for the patient, including cramping or pressure. The procured eggs are placed in a nutritional liquid and incubated until the healthy eggs are fertilized.
IVF Eligibility
A plethora of different populations can utilize IVF for fertility. According to the Mayo Clinic, “IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions.”
The Mayo Clinic lists multiple reasons for the use of IVF:
- damage or blockage of fallopian tubes
- ovulation issues
- uterine fibroids
- tubal ligation or hysterectomy
- depleted or impaired sperm function
- genetic disorders
- other fertility issues
“Depending on your individual circumstances, you may perform IVF with your own eggs and your partner’s sperm or with donor eggs, sperm, or embryos. You may also consider using a gestational carrier (surrogate), who will carry the pregnancy if the female partner is unable to do so,” explained an article by the Advanced Fertility Center of Chicago (AFCC).
According to AFCC, IVF provides an opportunity to conceive for people with the following conditions: blocked fallopian tubes, pelvic adhesions with distorted pelvic anatomy, 2–4 failed cycles of ovarian stimulation with intrauterine insemination (IUI), advanced female age (over about 38 years of age), severe endometriosis, or male infertility factor.
In addition to these populations, IVF provides additional opportunities for LGBTQ+ couples who want a child but cannot conceive naturally.
While IVF treatment plans vary between people, the general guidelines are the same.
While IVF is an excellent option for many people having fertility issues, it is not the only method of conception. The Washington University Physicians website states, “our physicians may recommend one of several medical therapies that can help people who are trying to get pregnant. These often serve as first-line and even second-line treatments prior to IVF.”
Other options include medications to induce ovulation and intrauterine insemination.
Risks Associated with IVF
Despite the benefits of IVF, there are multiple potential risks associated with the treatment. The Mayo Clinic states that IVF increases the risk of multiple births due to the number of embryos typically transplanted. Multiple child pregnancies and births are often associated with increased pregnancy risks and complications, which can threaten the person giving birth.
Additionally, the Mayo Clinic highlights an increased risk of premature delivery, lower birth weight, ovarian hyperstimulation syndrome, miscarriage, ectopic pregnancy, congenital disabilities, cancer, and stress.
In addition to the physical side effects, IVF can be an emotional journey for the patient and their family. Many people who enroll in IVF treatment have struggled with infertility, and a history of infertility can lead to depression, anxiety, and additional stress.
Costs of IVF
The costs of IVF vary from facility to facility and with insurance coverage. According to the AFCC, the average price of a single cycle of IVF is $12,000, excluding eligibility testing, medications, embryo storage, pregnancy testing and monitoring, and physician consultation.
Again, the cost of testing will vary based on the patient, facility, and insurance. According to the AFCC, ovarian reserve testing is typically around $355, while semen analysis is only $75. Additionally, IVF medication costs can range between $3,500 and $7,000, with the average price being $5,000.
Below is a graphic from FertilityIQ itemizing the cost of IVF treatment in varying parts of the US.
These costs are doubled or tripled for most patients as IVF does not always work in the first round. According to FertilityIQ, most patients need anywhere from 2.3–2.7 rounds of IVF. Taking that into account, most IVF patients spend nearly $50,000.
Looking Ahead
“The field of reproductive endocrinology and infertility has progressed at an astounding pace over the past three decades as we have developed new techniques, medications, testing, and strategies to treat infertile couples. Now, many previously sterile couples are able to conceive, carry, and deliver healthy children of their own,” concluded Ashley Eskew, MD, in her article in Missouri Medicine.
Despite the potential benefits of IVF, it is pertinent that physicians share the potential risks with patients considering this treatment. Patients unable to reproduce may consider using other reproductive health tools first. As more and more IVF babies are born, clinicians will observe and analyze the benefits of this form of reproduction on parents and children.
