By Taylor Smith | Images courtesy of shutterstock.com

When people begin to think of fertility treatments, in vitro fertilization (IVF) most likely comes quickly to mind. That’s because the procedure of fertilizing an egg and sperm outside of the body in a petri dish and then placing it inside the uterus has clinically been practiced since 1978.

People pursue IVF for many reasons. According to Mayoclinic.org, some of the most common include advanced maternal age, blocked or damaged fallopian tubes, endometriosis, low sperm count (or other sperm impairments), polycystic ovarian syndrome (commonly referred to as PCOS), uterine fibroids, problems with the uterus, risk of passing on a genetic abnormality, or for the use of an egg donor or a gestational surrogate. Not to be overlooked are the many times that women struggle to conceive even when there is no foreseeable reason.

Sarah, a Princeton native, learned of her infertility issues when she was just 32 years old. “I found out that I needed IVF when I got fertility testing done at age 32 to try to donate eggs to a family member,” she says. “My AMH and FSH showed that I had diminished ovarian reserve and was possibly even perimenopausal. Instead of donating eggs, they recommended that I take steps to preserve my own fertility as soon as possible.”

One of the modern realities of IVF is that single men and women or same sex men and women across the world would like to experience the exceptional love and devotion of being a parent, even if they aren’t in a traditional marriage or relationship.

Area resident Jessie says, “I am in a same sex marriage and wanted to start a family. We are so lucky to live in New Jersey where fertility coverage is mandated if you work in certain jobs. Still, being a same sex couple, insurance is a very gray area. Thankfully for us, our insurance provider covered our entire process.”

These changing demographics and societal norms, combined with people simply having children later in life, means that the IVF process itself has had to adapt and change. Today’s clinics (especially those in metropolitan areas) are now well-versed in aligning the IVF process with an individual patient’s needs and goals.

The Pursuit of Non-Traditional Fertility

The options for single women seeking to grow a family (or “chosen moms” as they are sometimes called), have dramatically grown in recent years. In fact, there are several different routes that they can take. If a woman does not want to begin IVF immediately, but does want a child at some point, she may consider freezing her eggs. It is scientific fact that the quality of a woman’s eggs decreases as she ages.

According to the Fertility Institute of New Jersey & New York, egg quality is paramount to a successful pregnancy. As noted on fertilitynjny.com, “By her mid-30s, her chances of achieving pregnancy decreases, while the rates of miscarriage and abnormalities rise.… Your frozen eggs can give you peace of mind that you can attempt to achieve pregnancy at a time that is right for you.”

The egg freezing process begins with a woman taking hormones for 10 to 12 days, stimulating the ovaries to develop as many mature eggs as possible. For women under the age of 35, most doctors recommend freezing anywhere from 15 to 20 eggs. A surgical procedure with anesthesia is required to retrieve the eggs. Women over the age of 35 will most likely have fewer healthy, mature eggs to freeze, but that is part of the IVF process, which can be repeated as needed (fertilitynjny.com).

Eggs can be kept frozen for many years. Once a person is ready to use the eggs to become pregnant, they must be thawed, fertilized with her partner’s or donor’s sperm, and then the resulting embryos are placed back within the woman’s uterus. This whole process typically takes place over a span of five days.

If a woman becomes pregnant through IVF, but still has leftover frozen embryos she does not want to keep for future IVF attempts, she has the option of donating them to research or to couples or individuals trying to build their own family. A couple or individual may use a donated embryo because they don’t want to pass on genetic traits to their children. Embryo donations may be open (the person’s name and information is known) or anonymous.

Sarah, who went through the IVF process, points out that “embryos can be a little hardier than eggs and are more likely to survive the freeze and thaw. You can also be more assured of their quality and likelihood of resulting in a child since embryos can be graded and tested for chromosomal abnormalities…. We transferred our first embryo in March of 2022 and were very lucky that our first transfer worked. We now have a precious 2-month-old baby girl, and we’re hoping to use our remaining embryos to have one or two more children if our luck holds out.”

A same sex male couple might be interested in the path of using donated eggs, embryos, or the process of finding a gestational carrier. On a somewhat similar note, a lesbian couple may want more information on the IVF process as well as finding a sperm donor. One of the first steps a doctor will take when working with any same sex couple is collecting medical history, discussing the couple’s fertility goals (such as how many children they are ultimately looking to have in their future family), and testing each partner’s fertility. For example, one man or woman may have better fertility indicators than the other. This may result in using one person’s sperm or eggs over their partner’s.

Donor sperm will need to be selected in some cases. Even for a man and wife looking to start a family, using a sperm donor is not unheard of if the husband’s sperm is not able to fertilize a healthy egg. If the sperm donor is not a friend or relation of some sort, a nationally recognized sperm bank is the best option. Similar to frozen egg and embryo donors, sperm donors may choose to remain anonymous.

So, what is the average cost of an IVF cycle? As noted on pennmedicine.org, “the average cost of a single IVF cycle in the U.S. is between $10,000 and $15,000, and is dependent upon insurance coverage, patient characteristics, and the treatment center.”

New Jersey is home to 19 fertility clinics with 39 different locations. Location, doctors, IVF price, and success rates are all important factors to consider when choosing which clinic to work with, chiefly because the patient will have to drive to the location regularly (sometimes multiple times per week) and speak with the doctors and nurses on a very frequent basis as they are guided through the five steps of IVF.

IVF Step-by-Step

The IVF process is very regimented and strategic, but the length of time that it lasts is complicated and depends upon how a woman’s body and psyche react to the process. It’s easy to overlook what kind of emotional toll the act of injecting oneself with hormones can take on a person’s mental health and physical well-being. Moodiness, exhaustion, physical fatigue, constipation, bloating, and weight gain are not uncommon. Also, the anticipation of wanting a perfect outcome can be an emotional waiting game with no final guarantee of conceiving a child. That being said, from the start of the first round of IVF to the end of the first round typically takes four to six weeks, according to rmanetwork.com.

After meeting with her fertility doctor and doing diagnostic testing, a woman will begin the act of ovarian stimulation. Most healthy women have a menstrual cycle between 28 and 35 days. During this time, hormone levels undergo regular changes and one of the ovaries releases a mature egg with the possibility of fertilization. The five days before ovulation, the day of ovulation, and the day after ovulation are the times at which a woman is most likely to get pregnant. Sperm can live for up to three to five days within a woman’s body, so knowing when a person is ovulating is key to understanding fertility. If the egg is not fertilized, it disintegrates and leaves the body (along with blood and tissues from the lining of the uterus). This is what is commonly referred to as menstruation.

During IVF, the woman will take hormone injections (a common injection site is the abdomen) to encourage her body to produce a larger number of eggs with the goal being that they will all mature fully. The ovaries’ response to the medication will be tracked by ultrasounds and monitoring blood hormone levels. The ovarian stimulation process lasts between eight and 14 days. During an ultrasound, the physician will look at the health of the woman’s uterus and ovaries but, most importantly, they are also tracking the growing ovarian follicles. Follicles are small sacs within the ovaries that should each contain a growing egg. The size of each follicle indicates the maturity of each egg. Right before the process of egg retrieval, the woman will give herself a trigger shot. This shot is to be taken exactly 36 hours before the egg retrieval procedure and is the final step in the egg maturation process.

Sarah says, “The hormones affect all women differently. For me, the medications during the IVF retrievals actually made me feel really good, but the come downs in between cycles wreaked havoc on my mental health. The sudden and dramatic drops in estrogen made me depressed and anxious and made my hair fall out in clumps.”

For the egg retrieval, a woman will be placed under sedation as a physician uses an ultrasound to guide a thin needle into the woman’s ovaries through the vagina. The eggs are sucked out through the needle’s retrieval device and placed in a dish containing a special solution. The dish and fully formed eggs will undergo incubation, and the following day the embryologist will attempt to fertilize the eggs by injecting sperm into each egg. Over the next five to seven days, the emerging embryos will be closely monitored. If multiple blastocyst embryos result, the woman or couple may choose to freeze them for a later date. Blastocyst embryos are a specific type of fertilized embryo that only 50 percent of fertilized eggs reach. These are the only type of embryos that will be transferred back into a woman’s body (fertilitynj.com).

A woman will then begin the embryo transfer stage when she will either be given a fresh or frozen embryo transfer. A fresh embryo transfer means that the blastocyst embryos formed in the past three to seven days and were never frozen. A frozen embryo transfer simply means that these embryos were at one time frozen and have now thawed. In preparation for the embryo transfer, a woman will take oral, injectable, transdermal, or vaginal hormones to prepare her uterus. This is usually 14 to 21 days of oral medication followed by a week of injections. Regular bloodwork and doctor’s appointments at this time will monitor the woman’s reactions to the hormones and the health of her uterus. The embryo transfer does not typically require anesthesia. The embryos are injected via a catheter and syringe.

Pregnancy is when the embryo implants itself into the lining of the uterus. A physician will do bloodwork around 10 to 14 days after the transfer to verify pregnancy. If pregnancy did not occur, most doctors will advise that a woman complete one full menstrual cycle before trying again. Keep in mind that the body (and mind) might need to rest and recuperate before undergoing a second round of IVF treatment.

Lifestyle and Environmental Factors to Consider When Pursuing IVF

Beyond the clinical realities of IVF success or failure, there are things that women and men can both do to increase the health of their eggs or sperm in preparation for fertility. On a basic level, this includes avoiding alcohol, refined sugars, and highly processed foods in favor of a Mediterranean diet with lots of fresh fruits, vegetables, whole grains, healthy fats (such as olive oil) and lean proteins. Maintaining a healthy body weight along with adequate sleep and regular exercise (to increase circulation) are also beneficial.

Self-care opportunities abound during an IVF cycle or even between cycles. It’s important that each person takes the opportunity to relax and unwind, whether this is in the form of a massage, walks in nature, socializing with friends, or going to a movie.

Based on her own experiences, Sarah suggests, “Join a community of other people going through IVF. There are tons of groups online, and many clinics organize support groups. Be kind to yourself. You are not to blame for your infertility, and it need not be a badge of shame. Many couples are struggling, but too few are talking about it.”

Jessie adds, “Surround yourself with people you can lean on. Create a [music] playlist, buy some comfy socks, and treat yourself to something after every last round. For us, it was a special visit to Starbucks after every appointment.”

In terms of environmental factors, there are some key chemicals to avoid because they do affect one’s endocrine system (the glands and organs that make hormones and release them into the bloodstream). Nail polish, cosmetics with fragrance, plastic, and food packaging materials should be switched out for more natural alternatives.

It is important for women to review all the medications they take with their physician. Even allergy pills and Tylenol should be discussed in case they may interfere with one’s IVF cycle. A daily prenatal vitamin is almost always suggested along with Vitamin D, which most people do not naturally get enough of due to so much time spent indoors during the winter months.

A Chosen Family

Even the best doctors and the most concentrated efforts of preparation do not guarantee IVF success. Younger eggs correlate to a higher probability of pregnancy, but each person is also unique and different, their genetic makeup being their own.

Society for Assisted Reproductive Technology data from 2020 states that success rates for IVF for women under the age of 35 is 41.6 percent. According to their website, “this is the percentage of live births of a single infant that occurred as a primary or subsequent outcome of one cycle intended for egg retrieval.” For women ages 35-37, this drops to 29.6 percent and at ages 38-40, the percentage of a single live birth is 18.7. For women 41 to 42, the percentage of success is 9.2 (sartcorsonline.com).

Another significant hindrance to success may be financial, as most people do not have endless resources to undergo multiple rounds of IVF.

But while the journey of IVF is often challenging, science and technology will only continue to improve medical understanding of the fertility process and the art of growing a family.

As Sarah says, “Keep your hope, but guard your heart. Chance is a large part of the process. Your luck can always turn. If I’d given up before mine turned for the better, then I wouldn’t have my daughter.”