In Vitro Fertilization (IVF): What Is It, How Much Does It Cost, and How Reliable Is It?

If you’re exploring fertility treatments, your doctor may have suggested in vitro fertilization (IVF) as an option. Read on to learn all about IVF, from exactly what it is to what your chances of success are.

IVF is a form of assisted reproductive technology (ART) where a doctor fertilizes an egg outside of a woman’s body in a specialized laboratory. They then transfer the resulting fertilized egg (embryo) into the woman’s uterus so she can successfully get pregnant.

Since the first baby was born from IVF in 1978, an estimated 8 million infants have followed worldwide. 1 2

Types of IVF

When you get IVF, you can use either your own eggs or donor eggs. You can also use a partner’s sperm or donor sperm.

In some cases, you may opt for using donated (already fertilized) embryos.

You may also be able to have a gestational carrier (surrogate) carry the pregnancy for you if you’re unable to physically do it yourself.

Fresh vs. frozen embryo transfers

Assuming you carry the pregnancy, your doctor will transfer either a fresh or frozen embryo into your uterus. The main difference between fresh and frozen transfers is how soon your doctor has to insert the embryo: 3

• Fresh transfer: This usually happens 3–5 days after egg retrieval.
• Frozen transfer: This can happen after a delay (potentially years later).

Your doctor may freeze your embryos as part of preimplantation genetic testing (PGT). Doctors use this test to assess the viability of each embryo before transferring it into your uterus.

Since it can take over a week to get the results from PGT, your doctor will need to freeze the embryos to preserve them. 4

Your doctor may suggest IVF if you’re having trouble conceiving and other treatments, like fertility medications or intrauterine insemination (IUI), haven’t been successful.

IVF is also the most effective first-line treatment (e.g., a potential first resort) for certain fertility conditions, such as: 5

• Blocked or damaged fallopian tubes: Because IVF involves fertilizing your egg in a lab, it completely bypasses the fallopian tubes (the tubes that lead to your ovaries).
• Male factor infertility: If you have a male partner, IVF can help with issues like low sperm count, poor sperm shape, or abnormalities in motility. Your doctor will directly introduce your partner’s sperm to your eggs through techniques like intracytoplasmic sperm injection (ICSI).
• Polycystic ovary syndrome (PCOS): While you can sometimes get pregnant with PCOS, it can cause irregular ovulation or stop you from ovulating altogether. IVF often entails taking medication that will stimulate your ovaries to ovulate, counteracting this symptom of PCOS.
• Age-related infertility: As you get older, your fertility naturally declines, which affects both the quantity and quality of your eggs. IVF gives you a higher chance of getting pregnant with your remaining eggs.
• Endometriosis: IVF is a common fertility treatment for women who suffer from endometriosis. This condition can cause tissue similar to your uterine lining to grow elsewhere in your body, which can throw off your menstrual cycle and result in blocked fallopian tubes and scarring. 6
• Uterine fibroids: While these growths are usually benign (non-cancerous), they can sometimes interfere with an embryo’s ability to implant in the uterine wall.
• Unexplained infertility: If your doctor is unable to identify what’s causing your infertility, IVF is one of the most effective treatment options.
• Genetic disorders: If you or your partner are at risk of passing a genetic disorder to your baby, your doctor can combine IVF with preimplantation genetic testing (PGT). This will allow your doctor to screen the embryos before transfer.

IVF also provides an opportunity for both members of female same-sex couples to be physically involved in a pregnancy. One partner can provide the eggs (which can be fertilized with donor sperm), and the other partner can carry the pregnancy.

Generally, there are five stages to an IVF cycle, each of which lasts around 4–6 weeks altogether. While your doctor will come up with a treatment plan that’s tailored to you, here’s more or less what you can expect from your IVF procedure: 5 8

1. Ovarian stimulation

In a natural menstrual cycle, your body usually produces one mature egg. With IVF, your doctor will retrieve multiple mature eggs to give you the best chances of a viable embryo developing.

To make this possible, you’ll self-administer injectable hormone medications, like follicle-stimulating hormone (FSH) and luteinizing hormone (LH), for about 8 to 14 days. These medications stimulate your ovaries to produce multiple follicles (the small sacs where eggs grow).

During the stimulation phase, your doctor will monitor your hormone levels with blood tests and use ultrasounds to measure the growth of your ovarian follicles.

Once your follicles have reached the right size, you’ll take a final injection known as a “trigger shot.” This injection of human chorionic gonadotropin (hCG) or other medication helps the eggs reach final maturity and prepares them for retrieval.

2. Egg retrieval

36 hours after your trigger shot, you’ll have your egg retrieval procedure, also known as follicular aspiration. This is a minor, minimally invasive surgical procedure, but you’ll be given IV sedation or anesthesia, so you won’t feel any discomfort.

Using an ultrasound probe for guidance, your doctor will pass a thin needle through your vagina and into each of your ovaries. They’ll use the needle to gently suction the fluid and mature eggs from each follicle.

Since you’ll be under anesthesia or sedated, you’ll need someone to drive you home after the procedure. Your doctor will probably also recommend that you rest for the remainder of the day.

3. Fertilization

On the same day as the egg retrieval, your doctor will collect your partner or donor’s sperm sample. They’ll then specially prepare the sperm in the lab.

The embryology team will then begin the fertilization process using one of two methods:

• Conventional insemination: They’ll place the retrieved eggs and a sample of sperm (typically 50,000 to 100,000) together in a petri dish so fertilization can occur naturally overnight.
• Intracytoplasmic sperm injection (ICSI): If your doctor is concerned about the sperm quality, an embryologist will inject a single, healthy sperm directly into the center of each mature egg.

4. Embryo culture

Your doctor will place the fertilized eggs (now considered embryos) in a special incubator where they can grow and develop. The embryology team will monitor the eggs closely for the next three to five days.

A healthy embryo will divide and multiply its cells, reaching the “blastocyst” stage by day five. This is when the embryos can also have preimplantation genetic testing (PGT), if you and your doctor decide it’s the right path.

Since IVF can result in multiple embryos developing, your doctor can also freeze (cryopreserve) the ones they don’t transfer for future use.

Can you choose your baby’s sex with IVF?

Yes. It’s possible to choose whether you have a boy or a girl with IVF. Before your doctor transfers the embryos into your uterus, they can analyze their cells for male or female chromosomes.

When you find out your baby’s sex, you can decide whether or not to implant the embryo. Selecting your baby’s sex is somewhat controversial; some people object to it on religious or ethical grounds, and not all practices or clinics provide it as a service. 5

5. Embryo transfer

Around 3 to 5 days after the egg retrieval (if you’re using fresh eggs), your doctor will transfer viable embryos into your uterus.

This is a simple procedure that doesn’t need anesthesia; your doctor will use an ultrasound for guidance as they place one or more of the embryos with a catheter. How many embryos your doctor will transfer depends on your age and medical history.

What to expect after the IVF procedure

After the transfer, you’ll need to take progesterone and estrogen supplements to support your uterine lining and encourage the embryo to implant.

About two weeks later, you’ll go back to the clinic for a blood pregnancy test to determine if the cycle was successful. They will track your hormone levels, and eventually do an ultrasound at about 6 weeks to see if there is a viable pregnancy in your uterus.

Your age is one of the biggest factors in whether you’ll successfully get pregnant with IVF. Women under 35 have about a 50% chance of conceiving when using their own eggs. 9

As you get older, your success rate when using your own eggs decreases:

• 35–37: 36.3%
• 38–40: 23.1%
• Over 40: 7.7%

Egg or embryo condition

Women who use donor eggs or sperm have a slightly higher success rate overall across all ages: 9

What other factors influence your chances of success with IVF?

Outside of your age, there are several other factors, both within and out of your control, that can affect how likely you are to get pregnant with IVF. These include:

What’s causing your infertility

Another big factor that affects your chances of pregnancy success with IVF is what’s causing your infertility. While IVF is very effective for certain infertility factors, others are more complex.

Check out the table below from the Centers for Disease Control and Prevention (CDC), which shows the success rates by age based on the cause of infertility: 9

Your lifestyle

Just like for those trying to conceive naturally, your lifestyle has a big impact on your fertility. For instance, according to a few studies, smoking while trying to conceive with IVF results in lower chances of success. 10

You could also have trouble successfully conceiving with IVF if: 11

• You’re significantly overweight or underweight
• You drink a lot of alcohol
• You’re very stressed

Your doctor can give you lifestyle tips that will improve your chances of getting pregnant with IVF.

Before you undergo IVF, you and your partner (if you have one) will go through medical and fertility exams.

You’ll usually start off with an IVF consultation with your doctor, and you may also: 5

• Have a uterine exam, Pap test, and mammogram (if you’re over 40)
• Be screened for sexually transmitted infections (STIs)
• Have your male partner (if you have one) undergo a semen analysis
• Have ovarian reserve testing
• Have genetic carrier screenings

There’s a good chance they’ll do a study called a hysterosalpingogram to assess your uterus and fallopian tubes.

Your doctor may get you started on those all-important prenatal vitamins, which will help your body gear up for pregnancy.

These initial consultations are also a great chance for you to ask your doctor any burning questions related to the procedure, your lifestyle, and your overall fertility.

IVF is generally safe, but it is more invasive than other fertility treatments like IUI. If you use your own eggs, your doctor will surgically remove them through the back of your vagina using a needle. You may feel a little uncomfortable after the procedure.

Moreover, you could experience temporary side effects as a result of the hormonal medications you’ll take during the stimulation phase. These may include: 5

• Bloating and mild abdominal cramping
• Breast tenderness
• Mood swings
• Headaches
• Bruising or soreness at the injection sites
• Light spotting or cramping after egg retrieval or embryo transfer

Fortunately, most of these symptoms will be mild, though you should let your doctor know if they become more intense.

Potential risks from IVF

Despite IVF being broadly safe, there are a few risks to be aware of, such as: 12

• Ovarian hyperstimulation syndrome (OHSS): In rare cases, your ovaries may overreact to the fertility drugs and become swollen and painful. You could have symptoms like abdominal pain, bloating, nausea, and weight gain. While most cases are mild, severe OHSS requires medical attention.
• Multiple pregnancies: Transferring various embryos increases your chances of having twins, triplets, or more. While this isn’t necessarily a bad thing in and of itself, multiple pregnancies carry higher risks for both you and your babies, including premature delivery and low birth weight.
• Pregnancy complications: IVF also puts you more at risk of pregnancy complications like gestational diabetes and preeclampsia (a dangerous form of high blood pressure during pregnancy).

On top of these potential risks, the IVF process can be emotionally draining, especially if you have to go through multiple cycles before getting pregnant.

Fortunately, your fertility team will help you watch out for these potential health problems. Many clinics will also be willing to refer you to support groups that’ll help you navigate the mental toll of IVF.

Does getting pregnant via IVF increase your risk of miscarriage?

Despite what you may have heard, IVF doesn’t increase your risk of a miscarriage. According to one study, the risk of all types of miscarriages after IVF is no different from that of natural pregnancies. 13

IVF isn’t cheap. A single cycle of IVF in the US usually costs between $15,000 and $25,000, and sometimes more. This figure just represents the average base fee, and you may need to factor additional costs into your total.

Check out the table below for a breakdown of the additional out-of-pocket costs you could incur in the course of undergoing IVF: 14 15 16

These figures are just averages, and you may end up paying a little more or less for your treatment. It can take more than one IVF cycle to successfully get pregnant, so the total costs can grow quite high.

Does insurance usually cover IVF?

Unfortunately, insurance coverage for IVF isn’t universal. Whether or not your insurance covers IVF depends on which state you’re in and your individual policy.

As of writing, only about 22 states have laws requiring insurers to either cover or offer coverage for infertility treatments, and IVF isn’t always included. 17 Make sure you speak with your insurance company to figure out what they’ll cover.

But if you find that your insurance coverage is limited, there are other ways to ease the financial burden of IVF. Look into:

• Health savings accounts (HSA) or flexible spending accounts (FSA): With these accounts, you can use pre-tax dollars to pay for medical expenses.
• Clinic financing plans: Many fertility clinics offer in-house payment plans or partner with lending companies that specialize in financing medical treatments.
• IVF grants: Several non-profit organizations provide grants to help couples and individuals afford fertility treatments.

IVF has given countless couples the chance to finally build families. Although it’s a more invasive and potentially riskier fertility treatment than other options like IUI, IVF is generally safe, and it’s highly effective. Throughout the process, your doctor will be there to guide you.