13 Things No One Tells You About IVF

It's been a busy few weeks for model Chrissy Teigen. Just before announcing she was pregnant, she spoke up for the first time about the fertility issues she'd been facing and the questions she and musician-husband John Legend have been plagued by. 

She also talked about the insensitive questions well-meaning friends sometimes asked her. "I can't imagine being that nosy to be like, 'So, when are the kids coming?' because who knows what somebody's going through?" she said during an episode of FABLife, which she cohosts. Considering around 10% of American women have some trouble getting pregnant, there's a good chance we really don't know what a friend is going through, even though we've probably all asked the wrong questions. (Guilty!) 

Roughly a third of the time that a hetero couple has trouble conceiving, it's due to problems on the woman's side of things. Another third of the time, it's because of problems concerning the man. The last third comes down to a mixture of complex and frustrating factors concerning both partners. And when it comes to in vitro fertilization (IVF) or another method of assisted reproductive technology (ART), there are still a lot of unknowns.

Here are a few of the lingering questions, and other things no one tells you about IVF. 

 Like, for Example, How It Actually Works

Unless you've investigated IVF, the specifics may surprise you. IVF involves injections or oral meds to stimulate a woman's ovaries to make more than the one egg she usually produces in a given menstrual cycle, explains Wendy Chang, MD, scientific director of the Southern California Reproductive Center and an assistant clinical professor at both UCLA and USC. 

After a few weeks of those shots or meds, the woman undergoes minor outpatient surgery to retrieve her eggs via a superskinny needle. That part of the procedure takes between 15 and 30 minutes. Once handed off to the lab, the egg (or eggs) is exposed to sperm to be fertilized, and an embryo forms.

Even just a few years ago, those embryos were then promptly transferred to the woman's uterus, Chang says. Today, many docs wait a while. There's been considerable advancement in embryo freezing technology, and IVF can result in higher pregnancy rates if embryos are frozen first, she says. Why? Freezing allows time for a woman to have her period and build up a more receptive uterine environment than if she were fresh off her fertility meds, Chang says. 

Nothing's Guaranteed

While IVF and other fertility treatments can be the answer to many women's prayers, they're far from a sure thing. Among women under 35, about 40% of fertility assistance procedures result in live births. Between ages 35 and 37, that success rate drops to 31%. From age 38 to 40, about 1 in 5 procedures are successful, and by ages 40 to 42, the odds are down to 11%. For women older than 42, fewer than 5% of procedures result in live births, according to the Society for Assisted Reproductive Technology, or SART. 
"It's extremely important for people to have a clear idea of what their chances are," Chang says. "We spend a lot of time with our patients managing expectations."

Talking matter of factly about a patient's chances of giving birth helps a woman make the best choices about treatment methods, Chang says. There are less-aggressive options than IVF that might come with lower pregnancy rates, but the tradeoff is they're less invasive and less expensive. 

"We try to guide the patients by giving them the facts so they can be comfortable with the consequences of those choices," Chang adds.

It'll Cost You a Pretty Penny

VF will generally run you between $10,000 and $20,000, Chang says. But depending on your situation and how many additional tests or treatments you need, it could add up to much more. Yowza. On the bright side, insurance coverage for IVF has steadily gotten better. Fifteen states now mandate coverage for fertility treatments, although that still leaves a lot of us scrounging for the requisite cash. (Get A Free Trial of Prevention + 12 Free Gifts)

 You Have Fewer Eggs Than You Think

You probably know you're born with a set number of eggs—about 2 million—and those comprise all the chances you've got at procreating. But the drop-off in egg volume doesn't just happen when you start using them (aka menstruating). Chang says we're already down to about 300,000 by puberty. On top of that, "we enjoy only 300 to 400 ovulated eggs in our lifetime," she says. "The rest are essentially broken down by our ovaries."

You May Not Be Able to Use the Eggs You Have

The older you are, the fewer healthy eggs you have. "Fifteen years ago, we'd say above 42 a woman doesn't have a chance," Chang says. Experts would have recommended these women seek donor eggs. "But depending on a woman's ovaries and embryos, it's not a strict limit," she says. "It's very much dependent on the woman."
Chang says doctors can check the health of a woman's eggs using a blood test and a pelvic ultrasound. Women with weaker ovaries and/or a lower number of eggs might not respond as well to the IVF process, and would want to consider ART earlier than a woman with stronger ovaries, she says.

Your Egg Quality Is (Somewhat) in Your Hands

Finally some good news: A few healthy habits can make the most of what we've each got in our egg reserves. "What you eat and put into your body can affect the quality of your eggs, embryo development, and even your pregnancy rate," Chang says. Aim for a diet rich in veggies and protein and low in sugar, she advises. Also, cut out any alcohol 3 months before starting IVF to help boost egg and embryo quality, she says.

While you're undergoing fertility treatment is also not the time to take on extra responsibilities at the office. "We have a finite amount of mental and physical energy," Chang says. "Give yourself the lowest stress and pressure you can" when you're trying to conceive.

All Sperm Are Not Created Equal

Poor sperm quality can hurt the chances of a successful pregnancy. "If sperm quality is excellent, oftentimes we will simply mix egg and sperm together," Chang says. "But if the sperm is a little suboptimal, each egg will be individually injected with a single sperm."

There May Be Complications

Even the simplest surgical procedures come with risks, Chang says. Because needles are involved in IVF, "there is a risk of that needle puncturing something it should not." Shudder. Luckily, that kind of puncturing is rare. Overall, the procedure isn't too painful either, she says. "Most of the time, women wake up from the light anesthesia and believe we haven't even started yet," 

Hormonal Meds Come with Side Effects

Ovary-stimulating medications up the estrogen in your body. This will tell your liver to bump up its production of compounds that can lead to blood clots, so you do have a slightly higher risk of those during IVF treatment, Chang says. That risk is still lower than if you were actually pregnant, she says, "but it's important to realize the risk while you're on these medications."

Depending on how strongly her ovaries respond, a woman may notice feelings of fullness or bloating, Chang says. In very rare cases, ovaries may respond so strongly that cysts begin to grow and fluid builds up in the abdomen. While this kind of reaction was common 10 to 15 years ago, Chang says experts can now anticipate these issues by monitoring estrogen levels and ovarian responses. They can also ward off these complications by giving at-risk women lower doses of the meds.

Women Who Use IVF May Be at Greater Risk of Postpartum Depression

In a recent Danish study, researchers found women who go on to give birth after any type of assisted reproductive treatment, including IVF, were five times more likely to develop depression than women who underwent treatment but didn't ultimately give birth. Most of us would assume it'd be the other way around, and even the researchers themselves were stumped by the surprising results. 

Acid Reflux Is Another Risk Factor

In a small study, women who gave birth after IVF were three times more likely to develop a long-term form of heartburn called gastroesophageal reflux disease, or GERD, than women who conceived without assistance. More than 13% of women who gave birth after IVF were found to have GERD a year later, compared with 4.5% of women who conceived naturally. It's possible the medications taken during IVF loosen a woman's lower esophageal sphincter, the valve between the stomach and throat that usually keeps stomach juices where they belong. 

Your Chances for Twins Might Not Be as High as You'd Guess

Across the entire US population, women have a 3.4% chance of having twins and a 0.1% chance of having triplets (or more), according to the CDC. But among women 35 or younger who undergo ART, about 28% of live births are twins. Those odds drop slightly among older women undergoing ART, but they're still much higher than among the general population.

However, that's changing. As IVF techniques have improved, doctors are now able to implant one embryo at a time "with much greater confidence," Chang says. "There's a tremendous shift away from multiple births," she says.

A "Third Parent" May Get Involved

Mitochondria are the parts of our cells that generate energy for cellular activity, Chang explains. Defects in our mitochondrial DNA can lead to life-threatening diseases. But using healthy donor mitochondria DNA in women undergoing IVF can prevent the passing down of these conditions, Chang says. "The child is still for the most part genetically the child of the mother and father; only the mitochondrial DNA comes from a donor," she says. This is the so-called "third parent." The procedure is still in its early stages, she emphasizes. But it's another sign reproductive technology is always getting better.

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