IVF and Fertility Treatment Options: Risks, Costs, Success Rates

Pregnancy is an exciting and joyful time; however, many women suffer from fertility issues and complications. According to a 2015 study released by the U.S. Society of Reproductive Technology (SART), one million babies have been born using assisted reproductive technologies like IVF.

Infertility can occur for numerous reasons, including difficulties with ovulation, endometriosis, uterine fibroids, polycystic ovary syndrome (PCOS), low sperm count, and structural problems, with your reproductive organs.

When a couple is faced with infertility, the first step is to discover the cause of the fertility issue and create a treatment plan. Doctors and patients can solve some issues through improved diet and exercise, medical procedures, or fertility drugs. However, more extreme treatments and procedures are needed in many infertility situations to produce a successful pregnancy.

In vitro fertilization or IVF is one of the most well-known and successful methods of fertility treatment, but most people don’t know much about the process unless they’ve lived through it.

This article takes an in-depth look at infertility and IVF, possible causes of infertility, when to seek help, risk factors, cost, and success rates, as well as covering a few alternatives to IVF treatment.

Most Common Causes of Infertility

It may, or may not, surprise you to learn that there is quite a long list of reasons a couple may be infertile. Biology set up dozens of roadblocks in an effort to keep the population at sustainable rates. However, doctors and scientists have found ways to overcome many of these hurdles in our modern age. Now, nearly all who want to be, have a chance of becoming parents via infertility treatment.

While not a complete list, below are the most common reasons for female and male infertility, according to the National Institutes of Health (NIH).

Potential Causes for Infertility in Women

• Failure to Ovulate
• Problems with the menstrual cycle
• Structural problems of the reproductive system
• Infections
• Autoimmune disorders
• Failure of an egg to mature
• Implantation failure
• Endometriosis
• Polycystic ovary syndrome
• Primary ovary insufficiency
• Uterine fibroids
• Age
• Obesity
• Being underweight
• Excessive exercise
• Substance abuse
• Radiation therapy
• Idiopathic or unexplained infertility

Potential Causes for Infertility in Men

• Low sperm count
• Complete lack of sperm
• Sperm mobility
• Testicles functioning incorrectly
• Hormonal imbalances
• Absence of reproductive ducts
• Blockages in the reproductive ducts
• Chromosome defects
• Diabetes
• Injury to the testicle
• Thyroid problem
• Idiopathic or unexplained infertility
• Obesity
• Strenuous labor
• Steroids and bodybuilding medications
• Substance abuse
• High blood pressure
• Radiation therapy

When to See a Fertility Specialist

Research shows that roughly 57% of women and 53% of men with fertility complications sought help at some point. However, many younger couples have stated they don’t think of themselves as having fertility issues or that the issues will self-correct because they’re young and therefore never seek treatment.

There are a couple of factors that will determine when and if you should seek help via a fertility specialist. The American Society for Reproductive Medicine says that if a couple has been actively trying for one year, they should seek professional help.

However, if the mother is 35 or older, then it is recommended a couple only wait six months. There are many other reasons you should seek fertility help around six months, even if you’re under the age of 35.

Reason to Seek Fertility After 6 Months of Trying (Or Earlier)

• You are 35 or older
• You have a family history of menopause or premature ovarian failure
• You have a family history of breast cancer or other reproductive cancer
• You have a condition you know may affect fertility
• You have irregular periods, endometriosis, or PCOS
• You’ve had two miscarriages in a row
• You or your partner has a sexually transmitted disease
• You or your partner have any risk factors for infertility

What is IVF?

In vitro fertilization or IVF is a series of procedures that aid in the conception of a baby. IVF requires the collection of mature eggs, which are then fertilized by sperm in a lab. Once the eggs have been fertilized, the doctor will transfer one or more to the uterus. One complete IVF cycle is about three weeks.

Your doctor will use you and your partner's medical history, test results, and conversations to determine if you’re a good candidate for IVF. For example, people who may be eligible for IVF may have blocked fallopian tubes or fallopian tube damage, ovulation disorders, previous tubal ligation or sterilization, impaired sperm production, a genetic disorder, or the mother is over 40.

Leading up to the decision to pursue IVF, your doctor will conduct a series of tests and procedures:

• Ovarian reserve testing
• Semen analysis
• Infectious disease screening
• Practice embryo transfer
• Uterine exam

IVF also includes fertility medications to help promote or control ovulation, build up and prepare your uterus, and help the egg mature. Fertility medications will contain different hormones based on their purpose.

Medications for ovulation stimulation will contain a luteinizing hormone or follicle-stimulating hormones. Medications for oocyte maturation will consist of human chorionic gonadotropins (HCG).

Egg retrieval will occur about 34-36 hours before ovulation, and you will be sedated. After egg retrieval, you may feel cramping or feel fullness or pressure. Sperm retrieval, if using your partner’s sperm, will occur at the fertility clinic the morning of your egg retrieval appointment.

Couples can use their own eggs, or they can use donor eggs. Some couples may also opt to use a surrogate or gestational carrier. Surrogacy is usually an option for same-sex couples, women who cannot carry a baby to full term or may be considered based on the woman’s age.

Once the eggs and sperm have been retrieved or donated, fertilization is next. There are two methods of fertilization: conventional insemination and intracytoplasmic sperm injection (ICSI). ICIS is usually only used if conventional insemination has failed several times.

If your doctor confirms you have a fertilized egg (or two, or three), the next step is embryo transfer. Embryo transfer takes place two to five days after egg retrieval. Your doctor will use a long thin needle, called a catheter, to insert the egg or eggs into your uterus.

If the procedure is successful, an embryo will implant into the uterus in six to ten days.

Side Effects and Risks of IVF

Like all medical procedures, IVF comes with risks and side effects.

Common side effects include:

• Mild cramping
• Mild bloating
• Constipation
• Breast tenderness
• Passing a small amount of clear or bloody fluid shortly after the procedure.

Moderate to severe pain should be evaluated by your ob/gyn to check for complications.

Possible risks of IVF:

• Congenital abnormalities
• Multiple births
• Ectopic pregnancy
• Ovarian cancer
• Miscarriage

Success Rates for IVF

IVF success rates depend on various factors, including but not limited to maternal age, cause of infertility, reproductive history, embryo status, and lifestyle factors.

According to the CDC, the success rate of IVF declines with maternal age. For example, based on data collected in 2019, women under 35 had a 47% success rate while women between 38-40 only had a 22% success rate.

The CDC has a tool parents can use to assess their potential success in having a live birth via IVF.

Costs of IVF

The cost of IVF varies greatly depending on how many cycles you go through, medications needed, and monitoring. On average, one cycle of IVF without medications is usually between $10-$15 thousand. However, keep in mind couples often have to go through several cycles of IVF before they have a successful pregnancy, and it is possible to spend upwards of $100 thousand.

Some insurances will partially cover IVF, and many clinics offer discounts, packages, or refund programs.

Alternatives to IVF

Not everyone is a candidate for IVF, or they may be seeking a less invasive process. The upside is that there are few alternatives to IVF; the downside is that the cost of these treatments is often the same or more than IVF.

The four main alternatives to IVF are Gamete Intrafallopian Transfer (GIFT), Zygote Intrafallopian Transfer, and Tubal Embryo Transfer (ZIFT or TET), and Intrauterine Insemination (IUI).

Gamete Intrafallopian Transfer (GIFT)

Gamete Intrafallopian Transfer is very similar to IVF. The eggs and sperm are harvested; however, instead of fertilization happening in a lab, the eggs and sperm are combined and inserted via a laparoscopic procedure into the woman’s fallopian tubes, where it is hoped conception will happen.

GIFT is a good alternative for couples who, for religious reasons, prefer fertilization to happen in a natural setting. On average, GIFT costs $10-$15 thousand per cycle and has a 35-35% success rate.

Zygote Intrafallopian Transfer, and Tubal Embryo Transfer (ZIFT or TET)

Like other fertility treatments, Zygote Intrafallopian Transfer and Tubal Embryo Transfer both begin with ovarian hyperstimulation in the hopes of producing multiple eggs. ZIFT and TET are both laparoscopic procedures; however, the transfer occurs after fertilization.

With ZIFT, the fertilization and transfer happen the same day; with TET, the embryo is allowed to develop for a few days before being implanted in the fallopian tube. Proponents of ZIFT and TET argue that successful implantation is more likely since the embryos are implanted in the fallopian tubes instead of the women’s uterus.

ZIFT costs between $15-$20 thousand per treatment and has a success rate of about 22%. Unfortunately, we could not discover any reliable statistics on cost or the chance of pregnancy with TET; however, if the option interests you, speak with your ob/gyn or fertility specialist.

Intrauterine Insemination (IUI)

Intrauterine Insemination is when sperm is injected directly into a woman’s uterus when she is due to ovulate. Because the sperm is placed into the uterus and doesn’t need to travel up through the fallopian tubes, it is believed it will be easier for the mother to become pregnant.

IUI is for women whose cervix may create mucus that kills off their partner’s sperm, women with damaged fallopian tubes, and those using frozen or donor sperm. IUI is less invasive than other fertility procedures.

The pregnancy rate for IUI is around 15-20%, and it is the least expensive type of fertility treatment. The price range for IUI is between $450-$1500 per treatment.

Where to Start with Fertility Treatment

At the end of the day, fertility treatment options need to be considered carefully and weighed. Talk with a doctor who specializes in infertility who can refer you to a fertility specialist or medical provider who can discuss the process with you and your partner.