Chapter 5: Overview of the IVF Process

IVF is a complicated process — here's a quick breakdown to help you understand it better, as well as some questions to keep in mind throughout  the process. 


During the in vitro fertilization process (more commonly referred to by its acronym “IVF”), a fertility clinic will fertilize an egg with sperm in order to create the embryos that will be transferred to your gestational carrier. Below is a breakdown of IVF, as well as some considerations intended parents should keep in mind before starting the process.

Egg donation

The first step in the process will be to select an egg donor. After you have selected your egg donor, and she is screened, she will then be given stimulation medication to produce multiple eggs which are contained in follicles in the ovary. After the follicles have grown to a specific and appropriate size the egg is ready to be retrieved.

“These are the same hormones that women produce throughout their cycle to make them ovulate,” said Dr. Daniel Skora, Reproductive Endocrinologist at Fertility Specialists of Texas. “We give them much higher doses to get all the eggs that are available in their ovaries that month to grow together so that we can then extract them.” Most egg donors are between the ages of 21 and 30, and produce a high quantity of eggs — anywhere between 15 to 40.

Semen analysis

You and your partner, if you have one, will also need to supply a sperm sample or samples that will be used in IVF. Your fertility clinic will first conduct a semen analysis to determine whether your sperm is in the best condition possible for the creation of embryos. While roughly 98% of men will have viable sperm, the remaining 2% may need to seek the aid of a urologist for further analysis. There are certain lifestyle choices that impact sperm quality, which include things like: smoking, excessive drinking, certain medications, and testosterone usage. The good news is that semen quality can be improved with certain lifestyle changes.

Deciding whose sperm to use

A single sperm is used to fertilize a single egg — which can pose a problem for a couple made up of two men. The solution to this problem will not be to mix the sperm together — the IVF lab will not do this. However, you can elect to both provide sperm samples, and have half the eggs fertilized with one partner’s sperm and half with the other. “This is the most common option our same-sex intended parents choose,” said Dr. Skora of Fertility Specialists of Texas. This allows couples to both implant an embryo, though this raises the prospect of a twins pregnancy, which increases costs and complications. If only one embryo is transferred, couples can also freeze and store the embryos of the second father for use in a future sibling journey.

Once you’ve decided on a sperm source, you will provide a specimen and blood work, both of which will be used to gain clearance with the FDA to use your sperm in the surrogacy process. Your specimen will then be “frozen” or cryopreserved. “That specimen is good for years upon years upon years,” said Dr. Mark Leondires, Founder and Medical Director of RMA of Connecticut and Gay Parents To Be.  “And that’s the specimen that we are going to use to create embryos that’s hopefully going to create your family.”

Embryo creation

Once both the eggs and sperm are screened and secured, your fertility clinic will fertilize the eggs from your donor with your sperm source, and then observe them as they grow into a healthy embryo, a 150 to 300 cell called a blastocyst. Most of the time, these embryos will be cryopreserved for use once your gestational carrier is properly screened and prepared. Eventually, the embryos will be thawed and placed into the uterus of the gestational carrier. After transfer, any remaining, viable blastocysts can be frozen for later use if desired by the intended parents. A pregnancy can be detected 11 to 12 days after the embryo transfer.

Preimplantation genetic testing

Some embryos have a higher chance of a successful pregnancy than others. Choosing the embryo that has normal chromosomes — meaning 23 pairs of chromosomes, for a total of 46 — will have the highest likelihood of a successful pregnancy, which is of course the ultimate goal. By conducting Preimplantation Genetic Testing (PGT), your fertility clinic can identify embryos with chromosomal errors, such as Down’s Syndrome, and other errors that lead to miscarriage or difficulty conceiving. This process can also be used to reveal the sex of the embryo. Other forms of embryo testing can screen for familial genetic diseases including cystic fibrosis and breast cancer genes.

Experts interviewed for this article:

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