In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less-invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in the uterus near the time of ovulation.
Sometimes, IVF is offered as a primary treatment for infertility in women over age 40. IVFcan also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:
In vitro fertilization (IVF) helps with fertilization, embryo development, and implantation, so you can get pregnant.
IVF stands for in vitro fertilization. It’s one of the more widely known types of assisted reproductive technology (ART). IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in your uterus.
IVF has many steps, and it takes several months to complete the whole process. It sometimes works on the first try, but many people need more than 1 round of IVF to get pregnant. IVF definitely increases your chances of pregnancy if you’re having fertility problems, but there’s no guarantee — everyone’s body is different and IVF won’t work for everyone.
The first step in IVF is taking fertility medications for several months to help your ovaries produce several eggs that are mature and ready for fertilization. This is called ovulation induction. You may get regular ultrasounds or blood tests to measure your hormone levels and keep track of your egg production.
Pregnancy happens if any of the embryos attach to the lining of your uterus. Embryo transfer is done at your doctor’s office or at a fertility clinic, and it’s usually not painful.
In today’s society, age-related infertility is becoming more common because, for a variety of reasons, many women wait until their 30s to begin their families. Even though women today are healthier and taking better care of themselves than ever before, improved health in later life does not offset the natural age-related decline in fertility. It is important to understand that fertility declines as a woman ages due to the normal age-related decrease in the number of eggs that remain in her ovaries. This decline may take place much sooner than most women expect.
During an intrauterine insemination (IUI) procedure, sperm is placed directly into the uterus using a small catheter. The goal of this treatment is to improve the chances of fertilization by increasing the number of healthy sperm that reach the fallopian tubes when the woman is most fertile.
IUI can be helpful for:
IUI is a widely used treatment option because it is a minimally invasive, lower-cost alternative to in vitro fertilization (IVF), and it can be conveniently performed in our clinic.
At your initial consultation, you will meet with one of our fertility specialists to review your medical history and your family building goals. We will then order diagnostic tests, such as a saline infusion sonogram (SIS) or a hysterosalpingogram (HSG), to make sure your fallopian tubes are open and your uterus appears normal. This information is important to help us to know what fertility treatment will be most beneficial for you.
Two weeks following IUI, you will take a pregnancy test to see if the procedure was successful. If you are pregnant, we will monitor your pregnancy closely via bloodwork and ultrasound. If your test is negative, we will prepare for a new treatment cycle or consider other treatment options.
Couples who are having trouble conceiving may be wondering if they should undergo fertility treatments and what type of treatment they would be candidates for.
Two procedures are commonly used to help couples who need fertility assistance:
Your fertility specialist will run some tests and then advise you on potential treatment options based on the results of those tests. Your fertility specialist can also provide you with an estimated chance of conception success, either naturally or with each type of treatment.
There are key differences between IUI and IVF treatment. Comparing both options can help you determine which approach might be best for you and your partner.
Couples with infertility often start treatment with IUI, which is much less invasive than IVF. IUI involves placing a washed sperm directly into the woman’s uterus during the fertile window. This can be done as part of a natural cycle or, more often, in combination with medications (like clomiphene citrate or letrozole).
It is important to note that many women undergoing IUI are given hormones or medication in order to induce ovulation or to increase the number of eggs that are ovulated each month. This increases a couple’s chances of having twins or multiples. Although many couples undergoing fertility treatment welcome the idea of having twins or even more babies, in reality, having multiples will introduce complications for the mother and the babies.
IUI can be a good starting point for couples facing issues involving ovulation or unexplained infertility. However, IUI may not be the most suitable fertility treatment for a couple.
IVF is usually recommended for couples facing the following situations:
Pre-implantation genetic testing is an advanced scientific procedure that can be performed before IVF. This procedure can be used to identify genetic disorders or chromosomal abnormalities in embryos, and can help identify the best embryo to transfer.
During their reproductive years, women have regular monthly menstrual periods because they ovulate regularly each month. Eggs mature inside of fluid-filled spheres called “follicles.” Ultimately, periods become increasingly infrequent until they cease completely. When a woman has not had a menstrual period for 1 full year, she is said to be in menopause.
The majority of follicles are not used up by ovulation, but through an ongoing gradual process of loss called atresia. Atresia is a degenerative process that occurs regardless of whether you are pregnant, have normal menstrual cycles, use birth control, or are undergoing infertility treatment. Smokers appear to experience menopause about 1 year earlier than non-smokers.
Ovulation tests measure ovulation, the time when an egg is released from one of the ovaries. This egg can be fertilized by sperm, leading to pregnancy.
Most ovulation tests assess a hormone made by the pituitary gland called luteinizing hormone (LH).
“LH is a signal that’s sent to the ovaries to tell them to ovulate an egg,” Sekhon says. “The hormone signal circulates in [the] bloodstream, gets filtered by the kidneys, and ends up in the urine. When it’s detectable in urine, it means ovulation will likely take place in the next 12 to 36 hours.”
Because of this, all ovulation tests use a urine sample to determine whether ovulation is happening soon.
To select the best ovulation tests on the market, we spoke with medical professionals about what to look for in an ovulation test. Experts agreed that the top factors to consider are:
Ovulation is the process of final maturation of the egg (oocyte). At ovulation, the mature egg exits the ovary and enters the Fallopian tube. Conception occurs when that egg is fertilized by sperm in the middle of the Fallopian tube. Because the life span of the mature egg is limited to approximately 18 hours after ovulation, the arrival of the sperm must be precisely coordinated.
Ovulation can be detected by several methods: ovulation predictor test, basal body temperature (BBT) chart, ultrasound, blood progesterone level, and endometrial biopsy. The first two methods are most commonly used.
A woman’s best reproductive years are in her 20s. Fertility gradually declines in the 30s, particularly after age 35. Each month that she tries, a healthy, fertile 30-year-old woman has a 20% chance of getting pregnant. That means that for every 100 fertile 30-year-old women trying to get pregnant in 1 cycle, 20 will be successful and the other 80 will have to try again.
Women do not remain fertile until menopause. The average age for menopause is 51, but most women become unable to have a successful pregnancy sometime in their mid-40s. The age-related loss of female fertility happens because both the quality and the quantity of eggs gradually decline.
Unlike the early fertility decline seen in women, a man’s decrease in sperm characteristics occurs much later. Sperm quality deteriorates somewhat as men get older, but it generally does not become a problem before a man is in his 60s. As men age, their testes tend to get smaller and softer, and sperm morphology (shape) and motility (movement) tend to decline. In addition, there is a slightly higher risk of gene defects in their sperm. If a man does have problems with libido or erections, he should seek treatment through his primary care provider and/or urologist. Decreased libido may be related to low levels of testosterone.
To become pregnant, the following steps must occur:
Although Mother Nature has a hand in the timing, there are some things you can do — or not do — to help increase your chances of getting pregnant ASAP. Read on for seven expert-approved tips for getting pregnant.
Before you officially start trying, get a checkup. Ask your doctor about prenatal vitamins that have folic acid, which helps protect against some birth defects, such as spina bifida. Folic acid works during the early stages of pregnancy, so that’s why it’s important to make sure you’re getting enough folic acid even before you get pregnant.
How much do you know about your menstrual cycle? Really understanding helps you know when you’re most fertile, says Hillard. Ovulation is the best time to get pregnant. “This is the time to focus on having sex,” Hillard says.
Myths abound about the best positions for getting pregnant, but they are just that — myths. There is really no scientific evidence saying that the missionary position is better than the woman being on top when it comes to maximizing your chances of making a baby.
You have probably heard this one — lie in bed with your feet in the air after having sex to increase your chances of getting pregnant. The verdict? Not (totally) true.
Having sex every day even during ovulation will not necessarily increase your chances of getting pregnant. Sperm can live up to 5 days inside your body. The best suggestion is to have sex regularly — when you’re ovulating, and when you’re not.
Try not to get stressed out about starting a family. You may roll your eyes if someone says, “Just relax and it will happen,” but stress can actually interfere with ovulation. So the more relaxed you are, the better!
Exercising is a healthy habit — especially if it helps keep you at your ideal weight. Just like anything else, though, you can get too much of a good thing. “Too much exercise can cause you not to ovulate,” Goldfarb says.
Most people will have the strong desire to conceive a child at some point during their lifetime. Understanding what defines normal fertility is crucial to helping a person, or couple, know when it is time to seek help. Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months. Only an additional 7% of couples will conceive in the second year. We generally recommend seeking the help of a reproductive endocrinologist if conception has not occurred within 12 months. However, there are various scenarios where one may be advised to seek help earlier. These include:
Alexis and James got married when they were both 30 years old, and they weren’t in a rush to have a family. “We wanted to have some time as a couple and enjoy ourselves,” Alexis said. So they used birth control and were kind of relieved every month when her period came around.
After they’d been married a few years, they began to think about starting a family. “My friends were having babies, and I started to really want one,” Alexis said. “I thought the time was right,” James said. “My job was going well, and so was hers. I felt like we could afford a baby, and it would be great.” Alexis’s mother started dropping hints that she’d like to be a grandmother. “We’re working on it!” James told her.
They both knew what to do to make a baby—have unprotected sex, often. James was enthusiastic about that, especially at first. Neither one of them really knew how long it might take for Alexis to get pregnant, but they thought it wouldn’t take long. After the first three months of TTC and not getting pregnant, Alexis did some researching. She was shocked to find out that even fertile couples who don’t have any fertility problems have only a 20 percent chance of getting pregnant in any given month.
“I was determined to beat those odds!” Alexis said. She began using an ovulation calendar to help figure out when her fertile periods were so she and James could be sure to have sex at the optimal time to get pregnant. James quit smoking and switched to boxer shorts (“I figured it couldn’t hurt,” he said), and they both ate healthy foods and cut back on drinking.
But Alexis began to get worried that something was wrong. Each month she was filled with grief when her period happened, and she started to envy her friends who had gotten pregnant easily. James tried to comfort her, but she began to feel depressed. Why was it so easy for her friends to get pregnant, and so hard for her? Alexis dreaded going to baby showers and family gatherings where someone was bound to ask, “When are you two going to start your family?” James began to feel angry about the thoughtless comments and questions. And he felt ashamed, as well. What kind of man was he, that he couldn’t get his wife pregnant? They both started to feel isolated from their friends. “I feel like I don’t have control of my own body,” Alexis said. “How can this be happening to me?”
Alexis felt that knowing more about fertility problems would help her get some control over the situation, so she did much more research on the internet. She shared some links with James about fertility treatment, and they had a long talk. “I don’t want to wait and see if this gets better,” she said. “I want to do something now!” James agreed they should look into why they were having trouble TTC. Then Alexis went to her gynecologist and told her she wanted a referral to a fertility specialist. “I think the best thing is for you and James both to get some testing done,” the gynecologist said. “I want you to see a reproductive endocrinologist.” She explained that a reproductive endocrinologist has extensive training in finding the issues that cause fertility problems and helping people have a baby.
Alexis felt strongly that she and James needed to find out what the problem or problems might be, so she could get pregnant. They made an appointment at the fertility clinic, gave their medical histories and went for testing. James’s tests were a semen analysis to determine the quality and quantity of his sperm, and a physical exam. Alexis had a physical exam, an ultrasound and a number of blood tests to determine her hormone levels and whether she was ovulating. Alexis told her mom they were going for testing but asked her to keep it to herself. “I couldn’t bear for my family to know yet, until I know we have an answer,” she said.
When the test results were ready, Alexis and James had an appointment together with the fertility specialist. They were both nervous but hopeful. Maybe there would be a problem with an easy fix, although they weren’t exactly sure what that would be. The answer they got was both good news and bad news.
About one in five of those couples who come to a fertility specialist are diagnosed with unexplained infertility. As the fertility specialist explained to Alexis and James, this means the available testing did not find a reason they were not getting pregnant. “This is good news,” she said, “because it means neither of you has any major, obvious reasons for infertility.” However, people diagnosed with unexplained infertility may have other, more subtle issues which the current diagnostic testing can’t detect, such as poor egg quality, she said. “We can try IUI for a few rounds, with and without Clomid, and if that is not successful, you can consider IVF,” the specialist said. “Many times, problems can be found and treated through the IVF process.” She told them about a recent study of couples with unexplained infertility, called FASTT (The Fast Track and Standard Treatment), which showed that couples who are unsuccessful after three cycles of Clomid and intrauterine insemination (IUI) should then try in vitro fertilization (IVF). This study showed a higher success rate at lower cost with IVF after three cycles than with continuing for more cycles of Clomid and IUI.
“It was really hard to see this as good news,” James said. “If we don’t have major problems, why can’t we have a baby without treatment?” “I don’t know what to do,” Alexis said. “I feel the clock ticking and we still don’t have a baby. I never expected this to happen.” She felt depressed and guilty that maybe this was her fault, because James’s test results were fine. James was upset that she felt that way. They actually had an argument about it, and Alexis cried. “Look, we’re in this together,” James said. “The doctor says we have to have treatment, so let’s get on with it. Let’s make this baby happen.” Alexis began to feel a little more hopeful. They agreed to meet with the fertility clinic’s financial counselor and figure out how they could afford treatment.
The couple met with the financial counselor and reviewed their health insurance, savings, and available discounted treatment plans and financing if they should need to go on to IVF treatment. After a lot of discussion, they decided they could afford treatment, and they decided to begin. “We held hands and jumped in to it together,” Alexis said. “Here we go!”
Alexis went through three cycles of IUI with James’s sperm, one without stimulating her ovaries with Clomid, and two cycles with Clomid. Clomid made her produce multiple eggs, but none of those cycles resulted in a pregnancy.
Alexis and James were on a roller coaster of emotion with each cycle, filled with hope and excitement and then sad and grieving when she didn’t get pregnant. Alexis’s mother tried very hard to be supportive but couldn’t hide her disappointment. Alexis began to feel very depressed and withdrew from James. James was angry and frustrated. “Having a baby has taken over our lives,” he said. Their fertility specialist saw their tension and suggested that they get counseling. They met with a counselor at the fertility clinic who helped them feel they weren’t alone with their emotions and supported them as they made treatment decisions. Alexis reached out to her closest friends and told them what she was going through. Their warmth and kindness made her feel less alone.
The fertility specialist talked to them about moving on to IVF treatment with PGS, preimplantation genetic screening. “We will fertilize your eggs with the sperm in the lab,” she said. “When the embryos start to develop, we will test a few cells from the embryos to make sure they have the correct number of chromosomes, and transfer only the best ones. About half of failure to implant and most miscarriages are caused by chromosomal abnormalities. PGS improves your chance of success with IVF.”
After much thought and some heartfelt discussion, Alexis and James agreed to have an IVF cycle with PGS. “I was afraid to hope, but the doctor said the odds were in our favor with IVF, so we went ahead,” Alexis said. “I read about the research on unexplained infertility, and IVF was the next step.”
After about two weeks of hormone injections, harvesting of her eggs, and fertilization of the eggs in the lab, their embryos were tested and the best ones were transferred to Alexis’s uterus. Then began two weeks of anxious waiting (and progesterone injections to help an embryo or embryos implant). Alexis went to the fertility clinic for the pregnancy test and came home to await the results with James.
“I was so scared,” she said. “When they called with the good news, it was the happiest day of my life!” Alexis was pregnant. James was thrilled. They both cried a little bit. Their dream was going to come true. Alexis carried the baby to term and delivered a healthy baby girl.
“All the waiting, all the effort, all the worry was worth it to have our daughter,” James said.
We were engaged to be married in December of 2018. We knew we wanted children and that it wouldn’t happen “naturally” on our own, so we decided to start building our family the October before we got married.
We went to a different fertility center, and we did all of the pre-screening testing that needed to happen before starting IUI treatment, and we picked a sperm donor.
Selecting sperm was a wild process, and honestly, one that both my wife and I loved because it felt like our future baby was getting closer to being a reality but also found very stressful because we put a lot of pressure on ourselves to pick the “right” donor- whatever that even means!
What we wanted in a donor evolved, and we ended up with who we thought would be perfect. But, how much to buy?? If you’ve never bought sperm before, well, it sells like hotcakes if you choose specific donors, and we felt like we had to buy enough for all the “what ifs.” So, we purchased what we thought would certainly be enough, and we were ready to go!
Fast forward to after our wedding in December 2018 and honeymoon in February 2019; we were ready to start our first IUI in March 2019!
We were ecstatic (and also naive), thinking that we would get pregnant in the first or second round of IUI. Not the case. After two rounds with our first fertility clinic and not feeling optimistic about how the treatment plan was executed, we sought out Boston IVF.
This was the best decision we made during our fertility journey. We met with Dr. Cardone in Stoneham, and he immediately put our minds at ease. He added some medication to my cycles and some additional tracking to ensure we were catching my surge at the correct times.
His experience, expertise, and kind manner were such a welcome change from our previous doctor, and we felt like this was the place we needed to be. We completed four additional rounds of IUI with Dr. Cardone, none of which were successful.
The nurses in Waltham were extraordinary during my IUIs- so supportive, kind, and upbeat each time I went in for yet another IUI. After completing six IUIs total (and yes, paying for them all out of pocket because we hadn’t yet “proved” infertility for insurance purposes), we moved on to IVF.
During our meeting with Dr. Cardone about IVF, he couldn’t have been more positive. He was so sure that it would work and that nothing was telling him that we didn’t have a great chance of getting pregnant. His line was something like- “you have to play the percentages.”
It wasn’t necessarily going to happen the first time, but over each round, the odds got better we’d have success. My first round of IVF was in October 2019. We successfully harvested five eggs, and three fertilized them. It was decided to transfer two day five embryos.
We waited (im)patiently for the two-week wait window, and then I went in for my blood test, and… nothing. Another unsuccessful round (in my mind). But, good ol’ Dr. Cardone was the voice of optimism once again. He said, “We now know that we can get your eggs to fertilize. And, we still have one that is frozen that looks ‘beautiful’”.
He suggested trying to do another fresh IVF cycle and, trusting him completely, we went for it! My second round of IVF was in December 2019. We successfully harvested four eggs and two fertilized them. So, once again, we went with transferring two days five embryos.
My transfer was on Christmas Eve. Dr. Kim Thornton was the doctor who did my transfer that day. I remember being SO grateful that Dr. Thornton and her team were working on Christmas Eve, helping us to grow our family potentially. We thanked them all profusely for being there on a day that they easily could have been with their own families. The IVF team is just so wonderful, and I was acutely reminded of this fact during this transfer.
We, once again, waited the two weeks and- AHHH!! PREGNANT! My HCG came back at 50, and I couldn’t believe it. It worked- our very own Christmas Miracle! I just thought that it would be smooth sailing from there on out. I had my positive pregnancy test. It worked! But now, as I quickly found out, we had to make sure it “stuck.”
I returned for my next blood test a few days later and found out that my HCG didn’t multiply the way that they like to see, and I had to come back in a few days for another test. Subsequent blood tests didn’t bring better news, and I was scheduled to go in for an ultrasound to see what was going on. It could have been everything from a miscarriage to an ectopic pregnancy to a very slow developer… only an ultrasound would give us more information. We were nervous and sad going into the ultrasound.
But, my favorite ultrasound tech at Dr. Cardone’s office made our ultrasound (side note- I forget her name, but she is seriously amazing, and if you need her name, I’ll call the office and find it out for you!). She told me that both embryos implanted and were in my uterus, but she couldn’t find a heartbeat in either. I was both shocked and devastated.
Of all the scenarios I had imagined, miscarrying twins was not one of them. I needed a D&C to remove the embryos and ensure that my uterus was clear to try again.
After all of this, Dr. Cardone was, once again, the picture of optimism. “Well, now we know you can get pregnant. We just need a healthy embryo to implant.” He also said that, given my profile, he expected it to take anywhere from 5-7 embryos for it to work, and we had tried 4. We had one frozen embryo left. He strongly urged us to use it for this round. During my third round of IVF, it was different. We used different medications, and it was much less invasive because we didn’t need to stimulate my follicles for an egg retrieval. No shots in the tummy or rear end. It felt like a much more relaxed cycle until…the coronavirus.
On March 13th, our workplace closed, people were being told to stay home, and the world was seemingly shutting down around us. We were worried I wasn’t going to be able to get in for my next transfer, which was due to take place any day. On March 19, 2020, I was lucky enough to get in for my third embryo transfer. We had one frozen embryo left, and it was our last chance before having to start all over again. Dr. Thornton performed this transfer as well, and I felt like it was good luck that we had her again as our doctor for this procedure.
Two weeks after my transfer, I took a blood test, and I literally couldn’t believe my ears when the nurse, Maryanne, called me and told me I was pregnant again! My HCG was much higher than the last time, and it felt like she was just as excited to tell me the news as I was to hear it. By that point, the Stoneham office was closed, and I was going to Waltham for all my follow up blood tests and my ultrasound. I’ll never forget the first time I saw my baby on the ultrasound screen. Her heart beating, her little body developing. It was a miracle. A miracle that Boston IVF helped create.
A miracle my wife and I will always be eternally grateful for.
Throughout our entire fertility journey, we were never a novelty being the same sex couple. Everyone from the phlebotomist Claudine to Colleen in accounting, Dr. Cardone, Dr. Thornton, and all the nurses we met with always treated us with respect. We felt like our fertility struggle was just as valid as anyone else’s, regardless of why we needed reproductive medicine. We would recommend Boston IVF wholeheartedly to anyone looking to grow their family and needing medical intervention, especially those in same-sex couples. It was a safe and supportive experience from start to finish.