What are the side effects of IVF?
For many couples experiencing infertility, in vitro fertilization (IVF) treatments offer their best chance at conception, yet it is not without some considerations. IVF requires a commitment of time, money, emotion, and some physical risks. Before beginning the IVF process, it is important research the risks, as well as the benefits of the process with the reproductive specialists at your fertility treatment center.

Expected Side Effects
The in vitro fertilization process involves suppressing the normal menstrual cycle so the reproductive endocrinologist can induce ovulation when it is optimum to harvest the eggs. The treatment includes frequent blood tests and nasal spray or injection of hormonal drugs, and some bruising can be expected.  Since the menstrual cycle is suspended for a short time, a patient may experience some menopausal symptoms that include:

• Hot flashes
• Mood Swings
• Nausea
• Headaches

Most women experience only mild side effects but any severe headaches or vision disturbances should be discussed with your physician.

Side Effects of Stimulation
Most fertility treatment center protocols require the patient continue to take the suppression drugs while on the stimulation drugs, to prevent premature ovulation. The symptoms women experience from the stimulation drugs vary, and most experience them only minimally.

• Abdominal Bloating
• Fatigue
• Diarrhea
• Weight gain
• Nausea

It is important to discuss any concerns with your physician at the fertility treatment center.

Ovarian Hyper Stimulation Syndrome (OHSS)
OHSS is a potential complication from any fertility drug and is a condition in which the ovaries produce many follicles which become larger than usual. Most commonly, the condition is mild and improves without intervention. However, severe cases can lead to blood clots and kidney failure. Symptoms include:

• Bloating
• Abdominal pain
• Rapid weight gain (As much as 10 pounds within 3-5 days)
• Decreased urination
• Nausea
• Vomiting
• Shortness of breath

Severe OHSS has only been reported in 3-8% of IVF cycles. Fertility treatment centers closely monitor each patient for OHSS, and encourage patients to discuss any concerns with their physician. Fertility treatment centers also reduce the risk of severe OHSS by:

• Reducing the dosage of fertility drugs
• Withholding the human chorionic gonadotrpin (hCG)
• Proceed with egg retrieval but freeze embryos for a later cycle

Egg Retrieval and Embryo Transfer
During the process of egg retrieval, the physician uses a vaginal ultrasound to guide the insertion of a needle through the vagina into the ovary to retrieve eggs. The procedure is performed under sedation or anesthesia. The risks are minimal, but do include:

• Discomfort during or after the procedure
• Possible injury to organs near the ovaries such as the bladder, blood vessels and bowel.
• Bleeding from ovary or pelvic vessels
• Pelvic infection

During Embryo transfer, a patient may experience cramping, bleeding or spotting during the procedure. Infrequently, infections develop. Though the problems many be minimal, it is important to report them to your fertility treatment center and physician.

Is Ovarian Cancer a Risk?
Despite early reports of a possible connection between fertility treatments and ovarian cancer, recent studies fail to provide convincing evidence of any connection. However, fertility treatment centers understand the concern and encourage the patient to discuss their concerns.

What is In Vitro Fertilization (IVF)?

In Vitro Fertilization, or IVF, is the most common of all assisted reproductive technology (ART). The techniques, which was first developed in the United Kingdom by Doctors Patrick Steptoe and Robert Edwards and resulted in the first pregnancy in 1978. Fertility treatment centers in the United States began to adopt the process which resulted in the first IVF pregnancy in the US in 1981, and over 45,000 since that time.

The IVF process involves removing the eggs, or ova, from a woman’s body and placing them in a lab dish with the sperm. After fertilization occurs, the eggs are transferred to the woman’s uterus where they continue to develop.

Before the IFV Process begins, the patient is evaluated by the reproductive endocrinologist to see if IFV is a possible solution to over come their infertility problems. Fertility specialists understand the patient’s desire to have a child but also balance that with the biologic understanding of the possibilities for each patient. Reputable fertility treatment centers will assure that the patient understands their choices and will help guide them to ones bet fit for situation.

Best candidates for IVF include:

• Those with blocked or damaged fallopian tubes
• Male factor infertility
• Those with Endometriosis
• Problems concerning the uterus
• Problems concerning the ovaries
• Unexplained infertility

The IFV Process is very involved and will include many visits to the fertility treatment center for  evaluation, treatments and monitoring. The process includes:

• Ovulation induction medication, such as Pergonal, are administered.
• Eggs are commonly retrieved using ultrasound guided needle which collects the follicular fluid which is placed in an incubator.
• Semen is collected and prepared.
• Sperm and egg are incubated together and fertilization should occur.
• Fertilized eggs are transferred to the woman’s body
• Woman returns to the fertility treatment center in two week for a pregnancy test
• If successful, she is monitored by the physician at the fertility treatment center for a short time then care is released to her regular OB/GYN. If unsuccessful, the woman will wait a month to recover, and then be reassessed for the next or further treatment.

IVF Concerns
The IVF process has involved some controversy over the years, and does evoke some serious considerations. The process has made headlines enabling women well beyond childbearing years to conceive and other to become pregnant with multiples well beyond what medicine deems safe. The medical standard is the placement of no more than two embryos into the womb at a time. Some consideration of IVF include:

• Cost
• How many children desired
• How many embryos remain after treatment
• What will be done with unused embryos

Not every fertility treatment center shares the same protocol, philosophies, or success rates. It is very important for any patient considering fertility treatments to check the physician’s standing with the board as well as the fertility treatment center’s results with the CDC.

How successful is IUI?

For the patient experiencing fertility problems, the success rate of a treatment plays a major role when deciding on a course of treatment, as well as in the choice of fertility treatment centers. If fertility drugs have not been successful alone, many are faced with the option of IUI, intrauterine insemination, also known as AI or artificial insemination.

The Process Briefly Explained
The IUI treatment utilizes a catheter to insert washed sperm directly into the uterus. This increases the chances of sperm reaching the fallopian tubes, which increases the chance of fertilization.

The process may include medication to stimulate the ovaries and increase the production of eggs. The hormone hCG, or human Chorionic Gonadotropin, is then administered which stimulates the release of the eggs

The IUI fertility treatment is often a course of treatment considered by couples who have been unsuccessful  in conceiving after trying for a year or more. Most fertility treatment centers offer IUI as an option to treat conditions such as:

• sperm with decreased mobility
• low sperm count
• cervical conditions not conducive to sperm
• as the requirement of donor sperm
• sexual dysfunctions

Advantages of IUI
The advantages of this course of treatment include simplicity and comfort. Done by a specialist in the privacy of a fertility treatment center, the process is fast and involves little discomfort. The IUI process is also much more affordable than other ART technologies.

IUI Success Rates
The rates of success for IUI vary in studies, but in most are not very high and range from 4-20%. Women under the age of 35 experience more success than those over and for those for whom it is successful, it is so 10-20% of the time within one cycle. It is generally more successful in trying to overcome a problem with the cervical mucus than a problem with the quality of sperm. Many factors play a part in the rate of success of this treatment and include:

• age and health of woman
• health and mobility of sperm
• timing of insemination

Individual fertility treatment center’s success rates can be found at the Center for Disease Control and Prevention website and may be helpful in choosing a fertility treatment center to begin the reproductive journey. It is also helpful to discuss the success rates of IUI and all reproductive treatments with others who have experienced them and can share in their own IUI Success Stories.

The Downside of IUI
One of the main concerns of the IUI is, when cycles have been stimulated, there is an increased risk of developing Ovarian Hyperstimulation Syndrome, or OHSS. OHSS is developed when a woman’s body responds too well to the fertility drugs used to encourage ovulation, causing the ovaries to swell and leak fluid into the abdomen. Your physician will monitor for OHSS and the fertility treatment center may have a patient admitted to the hospital for a few days for observation as the ovaries come back to their normal state.

What is the Success Rate of IVF?

The journey through infertility requires a substantial investment both financially and emotionally, and it is no wonder why most patients want to know the facts upfront. One of the main concerns for patients considering in vitro fertilization (IVF),  is the success rate of the treatment as well as that of the fertility treatment center. Knowing these statistics can be very helpful in choosing a physician and fertility treatment center as well as planning a course of treatment.

General IVF Success Rates
According to data collected by the Center for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART), the rate of pregnancy directly relates to the age of the patient.

• 30 years and younger, 50%
• 30-34 years, 48%
• 35-37 years, 45%
• 38-40 years, 35%
• 40 years and older, 14%

Where to Obtain IVF Success Rates
The rates for individual fertility treatment centers in each state can be found on the CDC and SART websites. Many fertility treatment centers also make that information available to the patient through their clinic materials and on their websites.

Understanding IVF Success Rates
While it is possible to obtain the general success rates as well as the rates of IVF success for individual fertility treatment centers, it is important to understand that there are many factors that play a role in those statistics. Fertility issues are complex, and calculating the rate of success the IVF treatment or a clinic’s success with IVF, is just as complex.

Many are surprised to find that SART does not use any system to independently verify each reporting fertility treatment center’s outcomes. While many clinics are reputable, and reporting IVF physicians are honest and make every effort to submit accurate results, there are still many factors which influence how those results are obtained, depending on the fertility treatment center’s philosophy of practice. Some of the factors that can influence a clinic’s success  include:

• Treating only the patients most likely to conceive
• Classifying the patients experiencing the highest levels of difficulty as “research patients” and therefore excluded from regular statistics
• Transferring larger numbers of embryos
• Reclassification of cycles

Success Rates for Individual Patients
All statistics are based on data gained from a population of people, including that for IVF success rates. However, each patient experiencing infertility comes with a unique set of circumstances that will directly impact their chances of achieving pregnancy which include:

• The particular issues surrounding the infertility
• Duration of infertility
• Age of woman
• Normalcy of uterus
• Quality of semen
• Success of cleavage in vitro
• Numbers of Embryos transferred

Increasing Individual IVF Success Rates
Because each patient is unique and success rates do not necessarily equate to the best care, patients should look for key indicators in a quality fertility treatment centers.

• The reputation of the lab within the medical community
• History and experience of the clinic
• The views of medical professionals outside the field of fertility
• The reviews of patients
• The philosophy of treatment

While it is difficult to truly calculate IVF success rates for the individual patient, understanding available statistics can help direct a patient in considering their options.

Is IVF Covered by Insurance Companies?

When a couple experiences infertility they are faced with many hard decisions. Reproductive medicine can be very costly and the insured is very fortunate if their policy covers the needed treatments. Only 13 states mandate the coverage of some fertility treatments:

• Arkansas requires health insurance companies to cover the cost of IVF up to a lifetime maximum of $15,000. HMOs exempt.
• California requires certain insurers to offer coverage of infertility diagnosis and treatment. Group insurers must inform employers of this availability; however law does not require the employer to offer the plans.
• Connecticut requires individual and group health plans to cover medically necessary infertility procedures, including IVF, IUI, Embryo transfer, GIFT, and ZIFT to a specific maximum.
• Hawaii requires certain insurance providers offer holders a one time benefit for IVF costs already incurred.
• Illinois law requires policies covering 25 or more people and offering pregnancy benefits must cover the cost of the diagnosis and treatment of infertility including IVF, Embryo transfer, GIFT, ZIFT, ICSI.
• Maryland law requires that providers covering pregnancy also cover out patient costs associated with IVF treatment.
• Massachusetts law requires providers covering pregnancy also cover the medically necessary cost of fertility treatments, including IVF, IUI, GIFT, ZIFT and sperm and egg retrieval.
• Montana law requires HMOs to cover all preventable healthcare treatments including fertility. It does not however, define infertility nor specify what treatments should be covered.
• New Jersey law requires group policies covering 50 or more people covering pregnancy also cover the cost of infertility treatments including surgery, including IVF, IUI, GIFT, ZIFT and sperm and egg retrieval.
• New York law stipulates that private and group plans issued within the state cover the treatment of correctable conditions, including infertility. It excluded IVF, ZIFT, and GIFT.
• Ohio law mandates insurers to cover all basic health care expenses including medically necessary infertility treatments, though it does not define medically necessary.
• Rhode Island insurers coving pregnancy must also cover the medically necessary treatments for infertility.
• Texas insurers covering pregnancy must offer coverage for IVF. Employers must be informed of these benefits but it is not mandated that they offer them.
• West Virginia HMOs must cover all basic health care services including infertility treatments but does not define infertility or what treatments must be covered.

At this time, most policies do not cover the full cost of reproductive medicine as it is viewed as elective. However as health care continues to evolve this may change as many fertility treatment centers and patients advocate for inclusion. Currently, most insurance policies which include infertility treatments only cover the cost of treatments and visits to the fertility treatment center until the point of needing in vitro fertilization (IVF) treatments. Most fertility treatment centers have someone that works to assure that the insured is utilizing available coverage however, those considering infertility treatments should be proactive and research the laws in their state, and know their insurance policy.

What is ART (Assisted reproductive Technology)

As many couples are delaying having children until later in life, those experiencing difficulty in conceiving is also on the rise. To over come these difficulties, many see the help of reproductive specialists and fertility treatment centers, to diagnose the sources of problems. For many, conventional drug therapies are tried and are successful. Others find hope in Assisted Reproductive Technology, or ART.

ART Defined
According to the Center for Disease Control and Prevention, Assisted Reproductive Technology includes all fertility treatments in which both the egg and sperm are handled. Performed under the care of specialists at fertility treatment centers, Art procedures generally include the removal of eggs from a woman’s ovaries, combining them with sperm in a laboratory and then placing them back in the woman’s body.

Typical ART Cycle

1. Documentation of cycle and ovulation
2. Beginning of GnRH agonist therapy
3. A baseline ultrasound of the pelvis
4. Gonadotropins are used to stimulate ovaries
5. Serum hormone levels monitored
6. Follicle development is closely monitored by ultrasound
7. The administration of Human chorionic gonadotropin, hCG, given as intramuscular injection
8. Transvaginal oocyte retrieval
9. Embryo is transferred
10. Progesterone supplementation begins
11. Pregnancy test administered and  patient undergoes hormonal studies
12. Patient follows up with physician for several weeks at the fertility treatment center to monitor pregnancy, or further consultation.

The ART process requires careful timing and patients are closely monitored by physicians who specialize in reproductive technologies. Medications are used to stimulate the ovaries, after which the development of the follicles, or eggs, is closely monitored through blood tests and ultrasound. These tests determine the timing of the administration of the hCG, which is critical to the proper maturation of the oocytes. Typically, oocyte retrieval is performed 34 hours after this time. The procedure is performed under the care of your physician and an anesthesiologist in the fertility treatment center. Once the oocytes are collected and semen prepared, the woman is inseminated. Once the embryo is transferred, the patient will receive progesterone supplements daily. A pregnancy test is administered around 12 days after the transfer.

ART Treatments
IVF, the process of combining the egg and sperm in a lab and fertilized eggs are transferred to the woman, is the most frequently used form of ART. Many fertility treatment centers offer other ART treatments which include:

•Intracytoplasmic sperm injection (ICSI) where a single sperm is injected into an egg which is then placed in the patient’s uterus or fallopian tubes.
•Gamete intrafallopian transfer (GIFT) where collected eggs are placed with sperm in a tube then injected into the fallopian tubes for fertilization.
•Zygote intrafallopian transfer (ZIFT) which combines the IVF and GIFT processes.

Treatments Not Considered ART
Not all reproductive therapies received at fertility treatment centers are considered ART. Treatments such as intrauterine insemination (IUI), also called artificial insemination (AI), in which only the sperm is handled or therapies in which only medication is used to stimulate the production of eggs to achieve a pregnancy is not considered to be in this category.

Choosing a Fertility Treatment Center
All ART treatments are performed by endocrinologists in fertility treatment centers, specially equipped to meet the needs of reproductive medicine. Centers and physicians may differ in treatment plans and philosophies, and fertility treatment centers may vary in their success rates. Patients should consider these things in choosing a fertility treatment center.

When fertility problems are experienced, a number of treatment plans are available depending on the underlying cause or causes of the diminished ability to conceive, length of infertility and the age of the person trying to conceive. To identify those causes, a patient should visit a reputable fertility treatment center for a thorough evaluation.

Infertility is usually defined as the inability to conceive after two or more years of trying. Factors inhibiting conception can be caused by the male or female, a combination of factors from both male and female, or of unknown causes. Fertility treatment centers specialize in finding the cause of fertility problems and developing a plan of treatment to help achieve conception.

Male Fertility Issues
Fertility problems most frequently experienced in men may include general sexual problems or problems with the production of sperm or its ability to reach the egg. A thorough examination by a physician specializing in reproductive health can help identify and treat these problems.

Treatment for male fertility treatments, may include:

• Medication
• Behavioral changes
• Diet and exercise modifications
• Surgical intervention
• Hormones
• Assisted Reproductive Technology

Treatment for women experiencing fertility problems may include:

Fertility Drug Interventions

• Clomid- Clomiphene citrate is the most widely used fertility drug and usually the first level of intervention.
• Femara and Arimidex – most commonly used to induce ovulation in women with ovulation disorders.
• Gonadotropins- hormonal medications

Surgical Interventions
Many conditions can play a role in the ability to conceive such as cervical narrowing, scar tissue, blocked fallopian tubes, fibroids, endometriosis or abnormal shape of the uterus. Fertility treatment centers offer surgical interventions that can be used to correct cervical, pelvic, tubal or uterine problems.

Intrauterine Insemination (IUI)
Commonly known as artificial insemination (AI) is a process where sperm is “washed” and injected directly into the uterus. This intervention is sometimes used in cases involving male infertility, when conditions of the woman’s cervical mucus necessitates, or in unidentified fertility problems. Though more affordable than IVF, success rates with this treatment vary at each fertility treatment center and are generally not as high as with IVF.  More info about IUI treatment.

ART is the common broad term for reproductive treatments that include a combination of medications and handling of eggs or embryos.

• IVF (In vitro fertilization)-Eggs are combined with sperm in a laboratory. After fertalization, eggs are placed in the uterus.
• ICSI (Intracytoplasmic sperm injection)- Sperm is injected directly into the egg and embryo is placed into the uterus.
• GIFT (Gamete intrafallopian transfer) Eggs and sperm are placed in a lab dish and inserted into the fallopian tubes. Fertilization and implantation happens naturally.
• ZIFT (Zygote intrafallopian transfer) eggs and sperm are placed in lab dish and after fertilization, doctor places the embryo in the uterus.

The process of dealing with infertility is likely to include many trips to the fertility treatment center while specialists identify the problem and once the problem has been found, develop a treatment plan. Fortunately, most problems can be solved with the use of medications or corrective surgery. Some patients require more invasive treatments in assisted reproductive technologies, such as IVF. The treatment approach and philosophy of each fertility treatment center may vary and patients should find one that best meets their needs.

The most successful fertility treatment centers combine compassion and expertise of reproductive endocrinologists in developing a treatment plan. The success rates of fertility treatment centers varies by clinic and state, and a patient has the right to view information regarding the success rates, broken down by treatments, for each fertility treatment center at CDC.GOV. Because many treatments are either not or only partially covered by insurance, a patient should always carefully review the fertility treatment center’s protocol, philosophy and rates of success while choosing.

IUI, or intrauterine insemination, is a relatively simple infertility treatment and the procedure involves a small tube being specially placed with washed sperm directly into the females uterus. You may hear others call Intrauterine Insemination (IUI) by its’ more commonly used term artificial insemination (AI). But, keep in mind that  IUI and AI are one and the same fertility treatment.

Why IUI?

When considering fertility treatments above and beyond fertility drug use, IUI artificial insemination may be the first tried by many couples. It’s an easier method than assisted reproductive technologies, like IVF, and  the costs for this type of fertility treatment are much less than other treatment options. According to a survey done by RESOLVE, the average IUI fertility treatment costs $895 (compared to $8,000 to $15,000 for IVF).

IUI may be used in some cases of male factor infertility diagnosis,  such as low sperm counts or if a sperm donor is being used for artificial insemination. IUI may also be used if the woman’s cervical mucus is less than the ideal situation.  Also, in cases of unexplained fertility issues, IUI may be tried if fertility drugs like Clomid (clomiphene citrate) don’t help.

IUI may also be used if a couple would like to avoid the higher cost of IVF treatment. Even though IUI artificial insemination is less effective per cycle than IVF, a couple may be able to afford more attempts with IUI.

IUI is pretty simple and while fertility drugs are not always used, most doctors choose to use an ovulation drug like Clomid to increase the chances of success when using IUI treatment for fertility.

Whether or not you’re using fertility drugs, you’ll probably be asked to use an ovulation predictor at home during the cycle that treatment is planned for. Once you detect the LH surge (the hormone that is highest right before ovulation and detected by ovulation kits), you’ll need to call your doctor.

The IUI Process

Assuming you’re not using a sperm donor, your partner will be given instructions for sperm collection (either at home or at the fertility treatment center.) The doctor will then “wash” the collected sperm and the doctor will place the sperm directly into the women’s uterus via the cervix.   This treatment is usually painless, with maybe a little cramping. It is performed in the doctor’s office, and the procedure can be done by a nurse or a doctor.

In reviewing the success rate for IUI artificial insemination, just 4% of women got pregnant per cycle without fertility drugs, and 8% to 17% got pregnant when fertility drugs and IUI were combined.

Though IVF success rates per cycle are much higher, IUI is significantly less expensive, and a much easier procedure.  So, If IVF is out of your price range, multiple IUI cycles might be the better choice, depending on the cause of infertility.