Couples diagnosed with infertility may want to consider in vitro fertilization (IVF), the process of fertilization by combining an egg and sperm in a laboratory dish and then transferring them back into a woman’s body. IVF is never the first step in treating infertility, but may be the only option if the cause of infertility is due to:

»» Endometriosis

»» Low sperm count

»» Problems with the uterus or fallopian tubes

»» Problems with ovulation

Every couple should consider health, age and financial stability before considering parenthood, but for couples considering IVF treatment, there are additional factors to consider.

1. Costs of an IVF Cycle
In the U.S., the average cost of one IVF cycle is approximately $10,000 to $15,000, and is usually not covered by insurance. Fees for a single IVF cycle include medications, surgery, anesthesia, ultrasounds, blood tests, processing the eggs and sperm, embryo storage and embryo transfer.

Oftentimes, more than one procedure is required for success, so couples could feasibly be looking at more than $20,000 even if there are frozen embryos used for subsequent procedures.

2. Time Commitment
It will be necessary for couples to adjust their schedules to undergo an IVF procedure. Patients will need to take drug injections up to three times a day so if being home is not an option, the medications will need be transported and properly stored; some need refrigeration.

IVF requires numerous doctor visits; at least twice a week for approximately one month.

During the first two weeks, the medical team will watch how the follicles grow and test hormone levels. The retrieval process takes several hours followed by an appointment two days later for the transfer, which also takes several hours.

After the transfer, there will be more monitoring and blood checks. If the IVF cycle results in a pregnancy, the woman would continue her pregnancy care with her OB/GYN.

3. Multiple Births
During each IVF cycle, the doctor can transfer up to four embryos.

Although this helps increase the chance of pregnancy, it also increases the chances of a multiple pregnancy, so couples must be prepared emotionally, physically and financially. Twins and multiple births increase the risks of a miscarriage or other pregnancy complications, such as diabetes or premature births.

4. Medications
During IVF, medication is prescribed to stimulate the ovaries and to increase the chance of collecting multiple eggs. This is known as ovulation induction.

Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Once mature, the eggs are surgically removed and allowed to fertilize in the laboratory. If the embryos successfully grow, they are placed back into the uterus in the hopes of implantation and a pregnancy.

Occasionally, too many follicles develop and a condition called Ovarian Hyper-Stimulation Syndrome (OHSS) may occur.

This condition causes a build up of fluid in the abdomen and chest. It occurs when too many eggs develop in the ovaries, which become very large and painful. Symptoms include pain and bloating in the lower abdomen, nausea or vomiting. OHSS can usually be treated with bed rest, but in severe cases require the fluid to be drained.

Common symptoms from infertility drugs are tenderness and swelling of the abdomen, breast tenderness, slight nausea, dizziness, headaches, and mood swings much like during a regular menstrual cycle. Many IVF medications must be taken by injections several times a day. Not only can this be a physical strain, but can be emotional as well.

5. Ectopic Pregnancy
An IVF procedure can slightly increase the chances of an ectopic pregnancy. The good news is that the patient will have a series of hormone tests to make sure the embryo is growing properly.

While this close monitoring will not prevent an ectopic pregnancy, it may help reduce risks of complications if an ectopic pregnancy does occur. As in any pregnancy, it is important to consult your doctor immediately if you experience vaginal bleeding or stomach pain after an IVF cycle.

6. Miscarriage
The risk of a miscarriage after IVF is no higher than after a natural conception. Pregnancy results take two weeks, which can be the most emotional time for an infertile couple. It is important not to worry since stress can be related to infertility and miscarriage.

7. Other Risks
The egg retrieval process and the use of laparoscopy carry the usual risks associated with receiving anesthesia. There is a risk of bleeding, infection, and damage to the bowel, bladder or blood vessel, although the risk is low and less than one patient in 1,000 will require surgery to repair damage caused during the egg retrieval process.

8. Success Rates
Success is based on the ability to ovulate and produce multiple eggs for fertilization. IVF success rates can vary depending on age and health status; one cycle requires a significant physical, emotional, financial and time commitment, especially for those who face multiple IVF cycles before you get pregnant.

While certain fertility problems are more challenging to treat than others, age plays a significant role in the success of an IVF treatment. The number of eggs collected is lower in older women and the quality of the embryos is usually decreased. Higher doses of hormones are usually required in older women; there is also a higher risk of low or no response to the stimulating drugs.

Couples must remember that when committing to an IVF procedure, they are making a huge emotional and financial commitment. But, for most couples it is a commitment worth the investment.