The majority of couples who are having trouble getting pregnant know that the top infertility option typically offered by infertility clinics is In Vitro Fertilization (IVF). And although more than 95% of all Assisted Reproductive Technology (ART) procedures are IVF procedures, most couples who are just beginning to consider infertility treatment don’t have much real information about IVF, how it works and its success rates. This overview is intended as a primer for those couples.

What is IVF?

IVF is the process of uniting an egg and sperm (fertilization) in a laboratory dish (in vitro). After they are united and form an embryo, that embryo is transferred into the uterus where it should attach and grow. For the average couple, it takes three attempts to become pregnant through IVF.

How does the actual process work?

Step One: Ovulation Induction
Before the process can occur, injectable fertility medicines are prescribed to stimulate the woman’s reproductive system, and her eggs and their development are closely monitored. The process for monitoring is close to daily ultrasounds along with blood and possibly urine tests. The more eggs a woman is able to produce at the stage, the better the couple’s chance for achieving pregnancy from the IVF cycle.

Step 2: Retrieving the Eggs
When it is time (i.e. when monitoring indicates that sufficient egg follicles have matured to a sufficient size), the eggs are retrieved through a surgical procedure in which a hollow needle guided by ultrasound imaging is used to remove the eggs from the woman’s ovaries. Sedation and local anesthesia are provided during this procedure. Most women are able to return to regular activities within a day of the procedure.

Step 3: Collecting Sperm
The sperm is usually obtained through ejaculation and then prepared in the laboratory.

Step 4: Insemination
The combining of the egg and sperm is called insemination. There are two possible insemination processes: the first, and most common, is placing the eggs and sperm in incubators where fertilization can occur relatively naturally, with the sperm finding an egg. The second, which is used when fertilization is suspected to be low (often because of male infertility factors), is called intracytoplasmic sperm injection (ICSI). During this procedure a single sperm is injected directly into an egg.

Step 5: Embryo Culture
After insemination, embryo culture takes place. During this stage the newly formed embryos are monitored by an embryologist to make sure they develop correctly. Embryos that are not developing correctly are discarded. This monitoring ensures a healthy batch of embryos and makes a successful transfer possible. It is also during this stage that the couple will find out how many embryos were successfully fertilized and how many are available to transfer.

Step 6: Transfer
One to six days after insemination the healthy embryos should be transferred to the woman’s uterus. There are two types of transfers. The Blastocyst Transfer is becoming more and more popular. It occurs 5-7 days after insemination when the embryos have reached the blastocyst stage of development. It is in this stage, during a natural cycle, that the embryo would leave the fallopian tubes and enter the uterus. Fewer (1-2) embryos are transferred during this process versus Day 3 Transfers because it is easier, at the blastocyst stage, to tell which embryos are healthy enough and more likely to implant. In a Day 3 Transfer, anywhere from 2 to 4 embryos are typically transferred 3 days after insemination. Because a Day 3 Transfer occurs earlier than a Blastocyst Transfer, the embryos will have been monitored and cultured for less time. As a result, the physician and couple usually decide to transfer more embryos with the idea that not all will develop and implant successfully.

Step 7: Post Transfer
After the transfer occurs the blastocyst hatches from its shell and the embryonic cells should attach and invade the endometrial lining in the uterus. Successful implantation requires a healthy and competent embryo and a receptive endometrial lining. Implantation usually occurs 6-10 days after the egg retrieval (which means, for a Blastocyst Transfer, 1 to 5 days after the transfer procedure). The latest day of possible implantation is probably about 10 days after the egg retrieval. Avoiding stress and even bed rest may be recommended during this final stage to optimize the chances for implantation. The woman’s blood will be tested on day 10, and if implantation has occurred she will test positive for pregnancy.

What is the success rate of IVF procedures?

American Pregnancy Association lists the live birth rate (a pregnancy does not always guarantee a live birth) for each IVF cycle as approximately:

* 30 to 35% for women under age 35

* 25% for women ages 35 to 37

* 15 to 20% for women ages 38 to 40

* 6 to 10% for women ages over 40

Blastocyst transfer is associated with almost a 50% success rate, compared to the usual 35%. Most clinics publish their specific statistics online.

If you are exploring IVF as an infertility option, arming yourself with this understanding of the process will enable you to better ask questions and make decisions with your medical team.

The Food and Drug Administration (FDA) has made a list of medications you should avoid during pregnancy. Not all drugs have been tested, so you still have to consult with your doctor if you are going to take medication during pregnancy.

The FDA Ranking Of Drugs

“A” Category - these drugs have been tested in terms of safety parameters and have been found harmless during pregnancy. They are vitamin B6, folic acid, and thyroid medication, in moderate or prescribed amounts.

“B” Category – these drugs have been utilized much during pregnancy and are not found to cause any big birth disorders or other pregnancy side effects. They include acetaminophen (Tylenol), certain antibiotics, aspartame (artificial sweetener), prednisone (cortisone), famotidine (Pepcid), ibuprofin (Advil, Motrin), and insulin (for diabetes). However, during the last trimester, ibuprofen is not recommended. Read more…

whether antibiotics are safe to consume during your pregnancy? maybe you’ll answer: depends. Since there is such a large variety of antibiotics available, and much depends on dosage and length of use, it is very difficult to generalize as to their safety. Using antibiotics during pregnancy is sometimes unavoidable, since pregnant women are as susceptible to illness and infection as anyone else, and sometimes even more.

Some antibiotics are perfectly safe, some are known to pose risks to a fetus, and many more fall somewhere in between. There are a great many antibiotics where it is simply not known what risks they pose to a pregnant woman because those risks simply haven’t been studied in enough detail. In the case of these, you will need to weigh the risks of taking the antibiotics during pregnancy versus the potential risks your illness poses to your unborn baby. Another thing to consider is how high the dosage will be and how long you will be taking it.

Taking antibiotics during pregnancy can be quite safe if they are in the penicillin family, cephalosporins, and erythromycin. The drug metronidazole used to treat some vaginal infections used to be suspected of causing birth defects, but the research has not substantiated that claim, and it is now considered generally safe for pregnant women to use. Many pregnant women suffer from urinary tract infections, and the drug nitrofurantoin can be taken up to the 36th week of pregnancy. If you continue after that point, there is a small chance it could destroy some of the baby’s red blood cells if taken up to a few days before delivery.

If you must take antibiotics during pregnancy for a urinary tract infection, you may wish to avoid Bactrin and Septra, because they contain trimethoprim, and this compound blocks the production of folic acid. Folic acid is critical to your baby’s development because it reduces the risk of certain birth defects. If for some reason you must take antibiotics during pregnancy that do contain trimethoprim, be sure to take a daily folic acid supplement of at least 400 mgs. Check to see if your prenatal vitamin contains this- many will have twice this amount. A few other antibiotics to avoid during pregnancy are streptomycin and tetracycline. The first can cause hearing loss in the baby, and the latter can cause discoloration of the baby’s teeth.

If you are still wondering how safe are antibiotics when taken during pregnancy, be sure to talk to your doctor. Those that are safe are generally well-known, as well as those that are less so. If you must take antibiotics during pregnancy, keep in mind that even those whose safety isn’t proven will probably have very few adverse effects if taken in the minimum effective dosage for a limited period of time.