IVF literally means fertilization outside the body. It involves a number of procedures but begins with an evaluation of your fertility potential.

IVF literally means fertilization outside the body. It involves a number of procedures but begins with an evaluation of your fertility potential. Once you have been found to be an appropriate candidate for IVF, after a series of treatments your eggs will be removed from your body by a minor surgical procedure. The eggs will be placed in a dish in a special incubator. Sperm are added to the dish containing the eggs and fertilization takes place in the lab. The resulting embryos are then placed into your uterus by means of a small plastic tube (embryo transfer). If one or more of the transferred embryos implant within the woman's uterus, the cycle then progresses to a clinical pregnancy. Finally, the pregnancy may progress to a live birth with the delivery of one or more infants.

Candidates for IVF include women who have blocked or absent tubes due to infection, endometriosis or tubal surgery done for sterilization.

Candidates for IVF include women who have blocked or absent tubes due to infection, endometriosis or tubal surgery done for sterilization. Women who have had problems with severe endometriosis even with normal tubes may be candidates. Women who do not ovulate regularly and have failed other treatments may undergo IVF. Often men with low sperm counts can be candidates for IVF treatment with their partners. Some couples may be diagnosed with infertility of unknown cause (unexplained) and may also be effectively treated by IVF. Pre-implantation genetic diagnosis (a procedure which tests the chromosomes of the embryo) requires the use of IVF and may be recommended. Lastly, when no other method of infertility treatment is successful, IVF may be used to achieve a successful pregnancy.

Infertility is very common. According to the recent estimates from the National Center for Health Statistics of the Centers for Disease Control and Prevention, 12 percent of women (7.3 million) ages 15 to 44 years were having difficulty becoming pregnant and carrying a baby to term.

Infertility is very common. According to the recent estimates from the National Center for Health Statistics of the Centers for Disease Control and Prevention, 12 percent of women (7.3 million) ages 15 to 44 years were having difficulty becoming pregnant and carrying a baby to term. In more recent years, there has been a slight decline in infertility because of effective treatments and shifting age demographics. Those statistics, however, will probably increase again for demographic reasons.

Infertility is a medical condition afflicting many couples. Approximately one third of the cases are caused by conditions solely afflicting the woman, one third caused by conditions solely afflicting the man, and one third are problems involving both partners.

Infertility is a medical condition afflicting many couples. Approximately one third of the cases are caused by conditions solely afflicting the woman, one third caused by conditions solely afflicting the man, and one third are problems involving both partners. In women, the most common cause of infertility is the irregular or defective release of eggs. The most common symptoms of ovulation disorders are a lack of regular or any menstruation.

Other causes of infertility include blocked fallopian tubes or abnormalities of the uterus. Fallopian tubes can be blocked by adhesions from past pelvic infections, endometriosis, or ectopic (tubal) pregnancy. Abnormalities of the uterus include fibroid tumors, malignancy, or developmental problems. In men, infertility is caused by genetic or environmental factors that impair sperm production. This results in too few sperm or defective sperm that cannot fertilize the woman's eggs. Defective, absent or obstructed ducts also prevent sperm from flowing. The defects can be obvious during childhood, but not always.

Advanced age is the most common factor increasing the risk of a woman being infertile. Although there is considerable variance between women, reproductive efficiency begins to decline rapidly at approximately 35 years of age, has declined considerably by age 40, and is essentially gone by age 44.

Advanced age is the most common factor increasing the risk of a woman being infertile. Although there is considerable variance between women, reproductive efficiency begins to decline rapidly at approximately 35 years of age, has declined considerably by age 40, and is essentially gone by age 44. This decline is aggravated by lifestyle and health issues such as a poor diet, stress, being under- or overweight, smoking, excessive alcohol consumption, sexually transmitted diseases, chemotherapy or radiation, and general health problems.

For men, there is an age-related decline in fertility but it is slower. Lifestyle and environmental issues impact a man's reproductive efficiency as they do a woman's.

Healthy, sexually active couples where the woman is under 30 years of age can usually achieve pregnancy within four to six months.

Healthy, sexually active couples where the woman is under 30 years of age can usually achieve pregnancy within four to six months. For women over 30, it begins to take longer and by age 40 years it can take well over 12 months. Women under 35 with a regular menstrual cycle are advised to try getting pregnant for a year before seeking help. Women over 35 are traditionally advised to try for six months. If the woman has irregular menstrual cycles, the couple should be evaluated with more urgency. In addition, if the woman has a history of gynecologic disease or the man has known reproductive dysfunction, more immediate evaluation is recommended.

The chance of success with IVF is much better than it was 10 years ago. Your individual chance depends on a number of factors including your age and cause of infertility.

The chance of success with IVF is much better than it was 10 years ago. Your individual chance depends on a number of factors including your age and cause of infertility. Overall pregnancy rates range from 20-50% per cycle. The chance of a multiple birth depends on the number of embryos transferred, but in general the chance of twins is about 20-30% of those who conceived and for triplets or more less than 5% on average. In our most recent Women and Infants' experience in Rhode Island, multiples in most years have been less than this.

Treatment of male infertility will depend on the suspected cause. In cases of varicocele, the primary cause of male infertility, surgical repair can be performed which often results in improved sperm count and motility.

Treatment of male infertility will depend on the suspected cause. In cases of varicocele, the primary cause of male infertility, surgical repair can be performed which often results in improved sperm count and motility. Hormonal causes of male infertility can often be treated with exogenous hormones, which often improve sperm count and restores fertility. There are some conditions, however, where medical intervention does not alleviate male infertility. In these cases, more advanced techniques such as Assisted Reproductive Technologies should be used.

We suggest that both partners come together for the visit. In many cases, we can determine the cause of the fertility problem at the initial visit simply by reviewing just the couple's medical history.

We suggest that both partners come together for the visit. In many cases, we can determine the cause of the fertility problem at the initial visit simply by reviewing just the couple's medical history. In other cases, several visits may be required to establish the cause.

During the first visit, a history and physical examination is performed and basic tests are ordered to take place over the coming month. These tests normally include: a semen analysis to look at the number, motion, and shape of sperm; blood hormone tests, which are usually done on the third day of the cycle; pelvic ultrasound; and a hysterosalpingogram, which is an x-ray to view normal uterine anatomy and determine if any tubes are blocked. This is usually enough for us to make a diagnosis leading to treatment. However, more may be required for complex cases. Occasionally, several months are needed to obtain a correct picture of a woman's ovulatory function or to resolve a medical problem that needs attention prior to beginning treatment.

The first step in getting started in the IVF process is to schedule an appointment with one of our specialists. The number in Boston is: 617-636-0053.

Depending on the ages and individual needs of the couple, we begin with the simplest, least invasive, and least risky treatment methods.

Depending on the ages and individual needs of the couple, we begin with the simplest, least invasive, and least risky treatment methods. At the same time, we are very conscious of the sense of urgency couples might feel and are very attentive to this in designing a treatment plan. We consider the length of time the couple has been trying to conceive, their response to previous treatments, the overall health of both partners, the amount of psychological reserve, and test results.

Treatment choices include: educational interactions such as the timing of intercourse during a woman's cycle; medical treatments such as ovulation induction in the woman or treatments to enhance sperm production in the man; the repair of damaged sperm ducts or tubes; artificial insemination; or in vitro fertilization.

It is critical for couples to have realistic expectations about treatment. Overall, most couples who are willing to persist and make any necessary lifestyle adjustments will ultimately be successful.

It is critical for couples to have realistic expectations about treatment. Overall, most couples who are willing to persist and make any necessary lifestyle adjustments will ultimately be successful. However, the beginning of treatment can often be difficult and this must be discussed at the outset. The outcome of treatment depends on the age of the partners and the causes of their infertility. National standards show that most current treatments are successful.

Insurance coverage in the United States differs widely by region. In New England, insurance coverage for infertility tends to be more generous than in other parts of the nation, but is regulated by very strict rules.

Insurance coverage in the United States differs widely by region. In New England, insurance coverage for infertility tends to be more generous than in other parts of the nation, but is regulated by very strict rules. Experienced clinics are able to help their patients navigate these issues before treatment begins so couples can have realistic expectations about the costs.

In vitro fertilization (IVF) is a technique used to treat more difficult forms of infertility and is effective because it bypasses some of the most common causes of infertility such as damaged tubes or inadequate exposure to sperm.

In vitro fertilization (IVF) is a technique used to treat more difficult forms of infertility and is effective because it bypasses some of the most common causes of infertility such as damaged tubes or inadequate exposure to sperm. It is normally reserved for cases in which the woman has blocked oviducts or the man has a serious problem with too few or defective sperm.

Fertilization in vitro means that the oocyte or egg is fertilized in a laboratory dish under highly controlled circumstances. The woman must first inject drugs to cause her body to recruit and mature multiple oocytes at one time. At precisely the correct moment, a slender needle is inserted through the woman's vagina to remove the mature oocytes from her ovarian follicles. The oocytes are then exposed to her partner's sperm cells in the laboratory, fertilized, and cultured for three to five days.

In cases where sperm are defective or few in number, or there are difficulties with the fertilization process, the sperm cells may be injected directly into the oocytes using a process called intracytoplasmic sperm injection (ICSI). The resulting embryos are placed into the women's uterus through the vagina using embryo transfer. For the following three to five days, the embryos float freely in the uterus and then implant onto the uterine walls. The pregnancy hormone human chorionic gonadotropin (HCG) is first detectable in woman's blood about 10 days after fertilization and three to five days before the first missed menstrual cycle.

Medications may be prescribed to the woman or her partner depending on the cause of the infertility. Here is a partial list of some of the most frequently used medications:

Medications may be prescribed to the woman or her partner depending on the cause of the infertility. Here is a partial list of some of the most frequently used medications:

• Clomiphene citrate (Clomid R) - this is an oral medication used to stimulate ovulation. It is most commonly used to treat ovulatory failure associated with polycystic ovarian disease, but can be used for other conditions.
• (Femara R) - this oral medication is used to stimulate ovulation much like clomiphene citrate. Because its mechanisms of action are different than clomiphene, however, it may be successful in inducing ovulation when clomiphene is not.
• Metformin (Glucophage R) - an oral medication, this was historically used to treat diabetes because it enhances the effects of insulin. It is commonly used to facilitate ovulation induction for patients with polycystic ovarian disease when one of the features of the condition is resistance to insulin. Normally it is used in association with other drugs to induce ovulation.
• Human menopausal gonadotropin or hMG (Repronex, Menopur®) - this is an injected drug often used to induce ovulation in women who are unable to ovulate effectively with oral medications. It is also used to induce superovulation for women undergoing IVF treatments.
• Follicle stimulating hormone or FSH (Gonal F, Follistim®, and Bravelle®) - an injected drug, this is often used to induce ovulation for women who are unable to ovulate effectively with oral medications. It is also used to induce superovulation for women undergoing assisted reproductive technology treatments such as IVF.
• Gonadotropin-releasing hormone (GnRH) analogue (antagonist or agonist) - these are injected drugs modified from the natural brain hormone that controls ovulation. They are used in various ways to induce or suppress ovulation.
• Bromocryptine (Parlodel R) - this oral medication is used to induce ovulation in women who have problems with excess pituitary prolactin, the hormone that normally induces lactation.

In many parts of the country there is no insurance coverage for IVF. In Rhode Island and Massachusetts there are state laws mandating insurance coverage.

In many parts of the country there is no insurance coverage for IVF. In Rhode Island and Massachusetts there are state laws mandating insurance coverage. The copay amount will vary from a few hundred dollars to several thousand depending on the plan. Some patients are excluded, such as those who have had a prior sterilization and some companies do not provide this coverage, such as self insured companies and those who are headquartered in other parts of the country.

A standard medical workup for an infertile couple usually involves a semen analysis. A standard semen analysis involves a determination of semen volume, sperm count, sperm motility, sperm morphology, and an evaluation of other characteristics of the semen sample.

A standard medical workup for an infertile couple usually involves a semen analysis. A standard semen analysis involves a determination of semen volume, sperm count, sperm motility, sperm morphology, and an evaluation of other characteristics of the semen sample. Typically, a semen sample with less than 20 million sperm/milliliter and/or less than 40% motility is considered suboptimal and may be a potential cause of a couple's infertility. There are many causes of male infertility, including varicocele, testicular injury, and hormonal abnormalities. Genetic and environmental factors can also play a role in male infertility.

ICSI stands for Intracytoplasmic Sperm Injection, and involves a procedure where a single sperm is isolated from a sample and injected directly into the center of the egg.

ICSI stands for Intracytoplasmic Sperm Injection, and involves a procedure where a single sperm is isolated from a sample and injected directly into the center of the egg. While seemingly very invasive to the egg, this procedure has revolutionized male factor infertility and has given hope to many couples who otherwise would need donor sperm to conceive. Pregnancy rates following the ICSI procedure are similar to, and sometimes exceed those resulting from conventional in vitro fertilization. Data collected thus far on babies produced as a result of ICSI indicate no increase in congenital abnormalities when compared to IVF babies.

Usually male patients with a sperm concentration of less than 3 million/milliliter are counseled to consider the ICSI procedure. Additionally, men with low sperm motility and/or a high percentage of morphologic abnormalities should consider ICSI.

Usually male patients with a sperm concentration of less than 3 million/milliliter are counseled to consider the ICSI procedure. Additionally, men with low sperm motility and/or a high percentage of morphologic abnormalities should consider ICSI. In these cases, use of conventional IVF methods will often result in little or no fertilization of eggs retrieved. There are cases where ICSI is the only possible treatment modality for obtaining fertilization and pregnancy including severely low sperm counts or the complete absence of sperm in the ejaculate. In this latter group, sperm can be extracted surgically from the testis or epididymis and injected into a mature egg. Finally, there is a group of patients that have experienced poor or no fertilization in a previous IVF attempt with no obvious reason. These patients can also be treated with ICSI, although chances of a successful pregnancy are not improved in cases where poor egg quality is a causative factor.

Generally, the only changes in an ICSI cycle involve the laboratory. Initial workups, patient stimulation regimens and the egg retrieval are the same as for IVF patients.

Generally, the only changes in an ICSI cycle involve the laboratory. Initial workups, patient stimulation regimens and the egg retrieval are the same as for IVF patients. Once the eggs are received by the laboratory, they undergo a special preparation for the ICSI procedure. The cells surrounding each egg will be mechanically and enzymatically removed, a necessary step for visualizing the egg during the injection process. Sperm will be isolated, placed in a viscous solution and injected into the cytoplasm of the egg. From this point, all lab procedures for assessing fertilization, embryo quality and performing the embryo transfer are identical to those used for standard IVF.