Helping couples to conceive by means of in vitro fertilization

Nearly 1 percent of all children born in the United States today is conceived ‘in vitro,’ Latin for ‘in glass.’

By:Seth Derman, M.D. in Collaboration with Gloria N. Beck
   It is perhaps one of life’s cruelest ironies. A couple delays pregnancy until they’re emotionally or financially prepared, only to discover that when they’re ready for children, they are unable to conceive.
   One in 5 couples in this country struggle with infertility — defined as the inability to conceive after one year of unprotected intercourse — and the significant emotional, physical and financial impact that goes along with it.
   Determining why couples are unable to conceive is the first step toward trying to find a resolution.
   Hormonal imbalances, environmental pollutants and even stress can lead to infertility.
   For men, difficulties can be attributed to a low sperm count, sperm that move poorly or are misshapen.
   Women face many more potential challenges. Age, hormone levels or ovulation issues can affect fertility. In addition, damaged or blocked fallopian tubes and scar tissue from pelvic infections, abdominal surgery or endometriosis can hamper conception. The presence of fibroid tumors, endometrial polyps or even an unusually shaped uterus can also have an impact on a woman’s ability to conceive or maintain a pregnancy.
   The good news, according to the American Society of Reproductive Medicine (ASRM), is that 85 to 90 percent of all infertility cases can be successfully resolved with conventional medical therapies such as fertility medications or minor surgical procedures. For couples that haven’t found help or whose age prohibits further delay, in vitro fertilization (IVF) can offer hope.
   Introduced in the United States in 1981, in vitro fertilization was initially developed to help women with damaged fallopian tubes achieve conception.
   Today, the application of IVF has evolved to include a wide variety of fertility-related issues, helping millions of couples realize their dreams of parenthood. In fact, nearly 1 percent of all children born in the United States today is conceived "in vitro," Latin for "in glass."
   In vitro fertilization is a process that involves uniting egg and sperm in a laboratory to facilitate fertilization. After incubating for several days, the growing embryos are placed back into the woman’s uterus, where it is hoped a viable pregnancy will result.
   Initially, the procedure involves suppressing the ovaries with hormones, such as birth control pills, which will allow precise control over the start of ovarian stimulation. Daily injections of fertility medications cause the ovaries to produce and develop multiple follicles. The eggs are contained within these follicles.
   During this time, hormone levels are monitored with frequent blood tests and ultrasounds are performed that enable the physician to monitor the number and size of the follicles as they mature.
   After one to two weeks of fertility medication, an injection of the hormone hCG (human chorionic gonadotropin) is given, which triggers the body to release the mature eggs. The eggs are harvested from the ovaries — anywhere from three to dozens of eggs — using a needle guided by ultrasound. The egg-retrieval procedure typically takes about 15 minutes, during which time the patient is sedated.
   At this time, a sperm sample is acquired and combined with the eggs in a petri dish. For men with normal semen, approximately half a million of the healthiest sperm will be incubated with his partner’s eggs.
   Men with sperm abnormalities will benefit from Intracytoplasmic Sperm Injection (ICSI), in which a single sperm is injected directly into each egg, facilitating fertilization.
   The eggs are then incubated overnight. The following morning, it can be determined whether fertilization has taken place.
   Three to five days later, several of the developing embryos will be transferred back into the uterus. The number of embryos transferred depends, in part, on the age of the recipient.
   Older patients (such as those in their mid-40s), who are less likely to carry all embryos to term, may be implanted with up to five embryos. Younger patients, who can expect higher pregnancy rates and in whom high multiple pregnancy rates are a concern, may receive as few as two embryos. Remaining embryos can be frozen for implantation in the future.
   After less than two weeks, a pregnancy test will reveal whether the IVF procedure has been successful. There’s just under a 50 percent chance for pregnancy with each IVF attempt in younger women.
   While a large percentage of couples does achieve pregnancy with the first attempt, it’s important to prepare for the possibility that several IVF procedures may be necessary to achieve conception. On occasion, eggs from a younger donor may be required.
   While there are no guarantees, IVF has helped thousands of infertile couples realize their dreams of parenthood.
   If you’re considering IVF, it’s important to know that IVF pregnancies are considered high risk — with a slightly greater risk for pregnancy loss, premature birth and other adverse events. IVF pregnancies are also significantly more likely to result in multiple births — twins, and occasionally more.
   In addition, the cost is a consideration for many couples, as the costs involved in an IVF cycle are significant. Check with your insurance company to see whether all or part of the cost of IVF treatment for infertility may be covered. New Jersey’s Family Building Act, passed in 2001, requires that many New Jersey-based companies cover the cost of up to four cycles of IVF.
   For referral to a University Medical Center at Princeton physician specializing in reproductive endocrinology, call (888) 742-7496 or visit