^ Jump up to: a b Moreton C (14 January 2007). "World's first test-tube baby Louise Brown has a child of her own". Independent. London. Retrieved 21 May 2010. The 28-year-old, whose pioneering conception by in-vitro fertilisation made her famous around the world. The fertility specialists Patrick Steptoe and Bob Edwards became the first to successfully carry out IVF by extracting an egg, impregnating it with sperm and planting the resulting embryo back into the mother
Fertilization of the oocytes must happen with 12 to 24 hours. Your partner will likely provide a semen sample the same morning you have the retrieval. The stress of the day can make it difficult for some, and so just in case, your partner may provide a semen sample for backup earlier in the cycle, which can be frozen until the day of the retrieval.

All pregnancies can be risky, but there are greater risk for women who are older and are over the age of 40. The older the women the riskier the pregnancy. As women get older, they are more likely to suffer from conditions such as gestational diabetes and pre-eclampsia. If older women do conceive over the age of 40, their offspring may be of lower birth weight, and more likely to requires intensive care. Because of this, the increased risk is a sufficient cause for concern. The high incidence of caesarean in older mothers is commonly regarded as a risk.
Infertility can have a profound impact on one’s mental health. When men and women find out that they can’t conceive, they may experience the same painful emotions as anyone coping with grief or profound loss. Common reactions include shock, frustration, grief, anger, decreased self-esteem, anxiety, and depression, but feelings about infertility can vary greatly depending on the source of the problems. Men, in particular, find it far easier to deal with a partner’s infertility than with their own.
The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood.[15] One of the main challenges in assessing the distress levels in women with infertility is the accuracy of self-report measures. It is possible that women “fake good” in order to appear mentally healthier than they are. It is also possible that women feel a sense of hopefulness/increased optimism prior to initiating infertility treatment, which is when most assessments of distress are collected. Some early studies concluded that infertile women did not report any significant differences in symptoms of anxiety and depression than fertile women. The further into treatment a patient goes, the more often they display symptoms of depression and anxiety. Patients with one treatment failure had significantly higher levels of anxiety, and patients with two failures experienced more depression when compared with those without a history of treatment. However, it has also been shown that the more depressed the infertile woman, the less likely she is to start infertility treatment and the more likely she is to drop out after only one cycle. Researchers have also shown that despite a good prognosis and having the finances available to pay for treatment, discontinuation is most often due to psychological reasons.[16]
In the United States, overall availability of IVF in 2005 was 2.5 IVF physicians per 100,000 population, and utilisation was 236 IVF cycles per 100,000.[166] 126 procedures are performed per million people per year. Utilisation highly increases with availability and IVF insurance coverage, and to a significant extent also with percentage of single persons and median income.[166] In the US, an average cycle, from egg retrieval to embryo implantation, costs $12,400, and insurance companies that do cover treatment, even partially, usually cap the number of cycles they pay for.[167] As of 2015, more than 1 million babies had been born utilising IVF technologies.[27]
If a man and woman 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without getting pregnant, they should suspect secondary infertility. This especially applies to women older than 30 who have experienced pelvic inflammatory disease, painful periods, irregular menstrual cycles or miscarriages, and to men with low sperm counts.
Advanced technologies add to your IVF bill but may also make a huge difference to your success rate. Pre-implantation genetic screening (PGS) can improve implantation rate by selectively transferring genetically normal embryos. For couples with male factor infertility, Intracytoplasmic sperm injection (ICSI) can help deliver a sperm directly into the egg. Nevertheless, ICSI only improves success rate in couples with severe male infertility.

A body mass index (BMI) over 27 causes a 33% decrease in likelihood to have a live birth after the first cycle of IVF, compared to those with a BMI between 20 and 27.[29] Also, pregnant women who are obese have higher rates of miscarriage, gestational diabetes, hypertension, thromboembolism and problems during delivery, as well as leading to an increased risk of fetal congenital abnormality.[29] Ideal body mass index is 19–30.[17]

In egg donation and embryo donation, the resultant embryo after fertilisation is inserted in another woman than the one providing the eggs. These are resources for women with no eggs due to surgery, chemotherapy, or genetic causes; or with poor egg quality, previously unsuccessful IVF cycles or advanced maternal age. In the egg donor process, eggs are retrieved from a donor's ovaries, fertilised in the laboratory with the sperm from the recipient's partner, and the resulting healthy embryos are returned to the recipient's uterus.
Amongst these two patient populations (which we’ll refer to now as PCOS), IUI with clomid and letrozole generally shows no improvement versus when these drugs are taken without IUI. When IUI is coupled with gonadotropins, success rates reach 14 - 26% per cycle, which is higher than almost any other patient class, but still pales in comparison to IVF. It’s also worth noting that PCOS patients who are taking gonadotropins have a very high risk of multiples.
People who have suffered primary infertility tell me that the only way they can get by is to avoid everything and anything to do with babies. But for the secondary infertility sufferer, this is not an option. You are confronted on a daily basis at the school gates by pregnant women, people with babies, large families squashed into multiple buggies. School drop-off becomes a terrible tableau of everything you want but cannot have.

Egg Development – This step is either part of the woman’s natural egg development or stimulated with medications and lasts roughly 5-14 days. Once your follicles are optimal size, a trigger medication may be given to finalize egg maturation and trigger ovulation. This phase of egg development may or may not be accompanied by ultrasound and bloodwork monitoring.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
^ Hozyasz, K (March 2001). "Coeliac disease and problems associated with reproduction". Ginekol Pol. 72 (3): 173–9. PMID 11398587. Coeliac men may have reversible infertility, and as in women, if gastrointestinal symptoms are mild or absent the diagnosis may be missed. It is important to make diagnosis because the giving of gluten free diet may result in conception and favourable outcome of pregnancy.

^ Siristatidis C, Sergentanis TN, Kanavidis P, Trivella M, Sotiraki M, Mavromatis I, Psaltopoulou T, Skalkidou A, Petridou ET (2012). "Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer—a systematic review and meta-analysis". Human Reproduction Update. 19 (2): 105–23. doi:10.1093/humupd/dms051. PMID 23255514.


Ovarian stimulation – You’ll take stimulation medications to increases both the quantity and quality of eggs. This usually begins during days 2-4 of your cycle and continues for around ten days. You’ll be closely monitored during this time to track your uterine lining, follicular development, and hormone levels. Once the follicles are optimal size, a trigger medication is given to fully mature the eggs.
First, consider where the information about the success rates is coming from. Generally speaking, IVF success rates in the United States comes from the clinics themselves or from the Center for Disease Control and Prevention. The Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine both contribute to the CDC data.
When Sarah Bozinovich and her husband, Joe, decided to start a family, they were amazed by how quickly they were on the road to parenthood. "I went off birth control in April and was pregnant in May," says Bozinovich, of Mokena, Illinois. About a year and a half after their daughter's arrival, the couple was ready to expand their family. But they'd try for more than two years and endure many medical tests and fertility treatments to have the second child they so badly wanted. Like many other parents, they struggled with secondary infertility, the inability to conceive or carry a baby to term after having one or more children. Says Bozinovich, who was 27 when her problems began, "It's so surprising because no one could tell me why I couldn't get pregnant, when I got pregnant so easily before."
Success varies with many factors. The age of the woman is the most important factor, when women are using their own eggs. Success rates decline as women age, specifically after the mid-30’s.  Part of this decline is due to a lower chance of getting pregnant from ART, and part is due to a higher risk of miscarriage with increasing age, especially over age 40.  
One, two or three IVF treatments are government subsidised for women who are younger than 40 and have no children. The rules for how many treatments are subsidised, and the upper age limit for the women, vary between different county councils.[154] Single women are treated, and embryo adoption is allowed. There are also private clinics that offer the treatment for a fee.[155]

Ovarian hyperstimulation is the stimulation to induce development of multiple follicles of the ovaries. It should start with response prediction by e.g. age, antral follicle count and level of anti-Müllerian hormone.[60] The resulting prediction of e.g. poor or hyper-response to ovarian hyperstimulation determines the protocol and dosage for ovarian hyperstimulation.[60]
While I’m not on the list to receive a Nobel Prize for mathematics any time soon, I do have enough understanding of how probabilities work to know that roulette isn’t a very viable long term career choice. Figuring that if I could make this costly error in analysis, there must be at least a few others out there that have, or will, make the same mistake as me…
Coping with secondary fertility can be tough. Endless doctor appointments, tests, procedures, and medications. Sleepless nights. Time and energy away from your little one. Guilt over wanting another pregnancy when many women are struggling to have just that. Stress between you and your partner. Sadness when you get invited to yet another baby shower — and guilt for even feeling that way.
Whether you ultimately choose IUI or IVF, the first step is finding a Los Angeles fertility clinic that prioritizes your individual needs over a generic protocol. You need good information to make a good decision, which is why it is so important to start with an in-depth medical investigation and diagnosis. Understanding exactly which issues may be contributing to your infertility helps you and your doctor create a treatment plan which gives you the greatest chance of success.
A doctor or WHNP takes a medical history and gives a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy. If necessary, they refer patients to a fertility clinic or local hospital for more specialized tests. The results of these tests help determine the best fertility treatment.
If a man and woman 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without getting pregnant, they should suspect secondary infertility. This especially applies to women older than 30 who have experienced pelvic inflammatory disease, painful periods, irregular menstrual cycles or miscarriages, and to men with low sperm counts.
The cost of IVF rather reflects the costliness of the underlying healthcare system than the regulatory or funding environment,[168] and ranges, on average for a standard IVF cycle and in 2006 United States dollars, between $12,500 in the United States to $4,000 in Japan.[168] In Ireland, IVF costs around €4,000, with fertility drugs, if required, costing up to €3,000.[169] The cost per live birth is highest in the United States ($41,000[168]) and United Kingdom ($40,000[168]) and lowest in Scandinavia and Japan (both around $24,500[168]).
In males with hepatitis B, The Practice Committee of the American Society for Reproductive Medicine advises that sperm washing is not necessary in IVF to prevent transmission, unless the female partner has not been effectively vaccinated.[37][38] In females with hepatitis B, the risk of vertical transmission during IVF is no different from the risk in spontaneous conception.[38] However, there is not enough evidence to say that ICSI procedures are safe in females with hepatitis B in regard to vertical transmission to the offspring.[38]
When I think back to that time, I recall an almost constant sense of grief. Every 28th day represented another failure, another loss. All around me my friends were having their second and then third babies. My son looked at his classmates with their siblings wistfully, he wished with every birthday candle for a brother or sister and one day he asked, "Can you play tig on your own?"
^ Hozyasz, K (March 2001). "Coeliac disease and problems associated with reproduction". Ginekol Pol. 72 (3): 173–9. PMID 11398587. Coeliac men may have reversible infertility, and as in women, if gastrointestinal symptoms are mild or absent the diagnosis may be missed. It is important to make diagnosis because the giving of gluten free diet may result in conception and favourable outcome of pregnancy.

Sunni Muslim nations generally allow IVF between married couples when conducted with their own respective sperm and eggs, but not with donor eggs from other couples. But Iran, which is Shi'a Muslim, has a more complex scheme. Iran bans sperm donation but allows donation of both fertilised and unfertilised eggs. Fertilised eggs are donated from married couples to other married couples, while unfertilised eggs are donated in the context of mut'ah or temporary marriage to the father.[176]

A recent controversy in California focused on the question of whether physicians opposed to same-sex relationships should be required to perform IVF for a lesbian couple. Guadalupe T. Benitez, a lesbian medical assistant from San Diego, sued doctors Christine Brody and Douglas Fenton of the North Coast Women's Care Medical Group after Brody told her that she had "religious-based objections to treating her and homosexuals in general to help them conceive children by artificial insemination," and Fenton refused to authorise a refill of her prescription for the fertility drug Clomid on the same grounds.[111][112] The California Medical Association had initially sided with Brody and Fenton, but the case, North Coast Women's Care Medical Group v. Superior Court, was decided unanimously by the California State Supreme Court in favour of Benitez on 19 August 2008.[113][114]


Some research has found that IVF may raise the risk of some very rare birth defects, but the risk is still relatively low. Research has also found that the use of ICSI with IVF, in certain cases of male infertility, may increase the risk of infertility and some sexual birth defects for male children. This risk, however, is very low (less than 1%).
Ovarian hyperstimulation syndrome (OHSS) occurs in 10% of women going through IVF treatment. For most women, symptoms will be mild, and they will recover easily. For a small percentage, OHSS can be more serious and may require hospitalization. Less than 1% of women going through egg retrieval will experience blood clots or kidney failure due to OHSS.

The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood.[15] One of the main challenges in assessing the distress levels in women with infertility is the accuracy of self-report measures. It is possible that women “fake good” in order to appear mentally healthier than they are. It is also possible that women feel a sense of hopefulness/increased optimism prior to initiating infertility treatment, which is when most assessments of distress are collected. Some early studies concluded that infertile women did not report any significant differences in symptoms of anxiety and depression than fertile women. The further into treatment a patient goes, the more often they display symptoms of depression and anxiety. Patients with one treatment failure had significantly higher levels of anxiety, and patients with two failures experienced more depression when compared with those without a history of treatment. However, it has also been shown that the more depressed the infertile woman, the less likely she is to start infertility treatment and the more likely she is to drop out after only one cycle. Researchers have also shown that despite a good prognosis and having the finances available to pay for treatment, discontinuation is most often due to psychological reasons.[16]

Egg retrieval and sperm collection – Egg retrieval happens 35 hours after the trigger shot. It is done under light anesthesia and takes just 5-10 minutes. During retrieval, a tiny hollow needle is pierced through the vaginal wall towards an ovary. At this point, the fluid that contains the developed eggs is drained from the follicles and immediately taken to the IVF laboratory, where they will be fertilized and developed. Sperm is collected the same day as the procedure by ejaculation into a sterile specimen container, frozen ahead of time, via a donor, or through more advanced sperm retrieval procedures. Next, the sperm is washed, placed in a solution similar to the fallopian tubes, and used for fertilization.


Odds of multiples. Because more than one embryo may be placed in your uterus, your chance of having twins or more is about 20 percent. Though many couples consider this a blessing, multiple fetuses increase your risk of miscarriage and other complications, such as preterm labor. Some doctors will advise you to consider selective reduction if three or more embryos implant successfully. This is a serious decision with major emotional and psychological consequences. IVF researchers are working on techniques to prevent multiple fetuses.

Most women over 40 who try to get pregnant will have difficulty, and fertility over age 44 is rare - even in women who are ovulating regularly every month. The point is that the older the female partner, the more likely that there is an egg related issue causing the fertility problem. Unfortunately, there is currently no specific test for "egg quality".
Obviously, if the same couple decides to have more children at age 38, the chances won't be 25% anymore; it is likely that they are about 10%, which translates into a reduced pregnancy chance. This does not mean the couple has become infertile. Since they weren't absolutely fertile at age 32, it is only logical that their pregnancy chances at 38 are so low.
^ Jump up to: a b Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BW, Broekmans FJ (2012). "Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach". Human Reproduction Update. 19 (1): 26–36. doi:10.1093/humupd/dms041. PMID 23188168.
Headaches and mood swings: Headaches and mood swings are common IVF treatment side effects. Over-the-counter medications can ease headaches, and while no medication can help with mood swings, knowing that they’re a normal part of IVF treatment helps. If you find mood swings are disrupting your day, be sure to seek out self-care practices such as enjoying alone time, reading a book, taking a nice bath, or sharing feelings with a friend or loved one.
Repeated failed rounds of IVF can help identify causes of infertility. For example, if sperm and egg quality are normal, then the conception issue may be rooted at the embryonic or implantation level. In other words, if IVF fails to result in pregnancy despite successful fertilization, embryonic development or implantation may be to blame. Still this is a very expensive way to start getting answers.
IUI is a procedure during which processed and concentrated motile sperm are inserted directly into a woman’s uterus. This procedure is timed according to a woman’s ovulation, and may be performed one to two times in the days immediately following the detection of ovulation. After ovulation a woman’s egg is picked up by the fallopian tube and waits there for the sperm. Since the IUI procedure deposits higher concentrations of good quality sperm close to where the egg is waiting, the chances that the egg and sperm will find one another are increased.

Availability of IVF in England is determined by Clinical commissioning groups. The National Institute for Health and Care Excellence recommends up to 3 cycles of treatment for women under 40 years old with minimal success conceiving after 2 years of unprotected sex. Cycles will not be continued for women who are older than 40 years old.[156] CCGs in Essex, Bedfordshire and Somerset have reduced funding to one cycle, or none, and it is expected that reductions will become more widespread. Funding may be available in "exceptional circumstances" – for example if a male partner has a transmittable infection or one partner is affected by cancer treatment. According to the campaign group Fertility Fairness at the end of 2014 every CCG in England was funding at least one cycle of IVF".[157] Prices paid by the NHS in England varied between under £3,000 to more than £6,000 in 2014/5.[158] In February 2013, the cost of implementing the NICE guidelines for IVF along with other treatments for infertility was projected to be £236,000 per year per 100,000 members of the population.[159]


Dr. Gorka Barrenetxea provides us with a practical case of secondary infertility that occurs more commonly than one may think. A couple, throughout their lifetime, can have children with 20, 25, 30 and 35 years, but when they decide to have a second or third child, they may encounter trouble conceiving due to the passage of time itself, Dr. Barrenetxea states.

For women, intake of antioxidants (such as N-acetyl-cysteine, melatonin, vitamin A, vitamin C, vitamin E, folic acid, myo-inositol, zinc or selenium) has not been associated with a significantly increased live birth rate or clinical pregnancy rate in IVF according to Cochrane reviews.[30] The review found that oral antioxidants given to men in couples with male factor or unexplained subfertility may improve live birth rates, but more evidence is needed.[30]
Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle into the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization. 

Egg Development – This step is either part of the woman’s natural egg development or stimulated with medications and lasts roughly 5-14 days. Once your follicles are optimal size, a trigger medication may be given to finalize egg maturation and trigger ovulation. This phase of egg development may or may not be accompanied by ultrasound and bloodwork monitoring.
Repeated failed rounds of IVF can help identify causes of infertility. For example, if sperm and egg quality are normal, then the conception issue may be rooted at the embryonic or implantation level. In other words, if IVF fails to result in pregnancy despite successful fertilization, embryonic development or implantation may be to blame. Still this is a very expensive way to start getting answers.
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