The Wild World of IVF, Explained

Shortly after her 40th birthday, Sarah Chamberlin and her husband Julio interviewed reproductive endocrinologists at four different clinics in Brooklyn and Manhattan. They had already gone through five unsuccessful rounds of intrauterine insemination, also known as IUI, and had graduated to the big leagues: in vitro fertilization, or IVF.

At first, Chamberlin was prescribed a 10-day round of injections with three medications, including a follicle stimulating hormone to spark as much egg growth as possible. There were lab visits with transvaginal ultrasounds to check on her ovaries’ response to the drugs and regular blood draws.

When that first IVF cycle didn’t work, Chamberlin tried again. And again. And again. By her fifth round of IVF, Chamberlin’s fertility cocktail included a combination of 14 injectables, pills, intravenous drips, and suppositories. She and her husband had created 24 embryos. Every single one failed to stick. Three weeks before her 42nd birthday, Chamberlin learned that her fifth IVF cycle was unsuccessful. In total, she and her husband had spent $77,000.

Chamberlin is just one of thousands of women who expended a significant amount of time, emotional energy, and money in her quest to have a baby. In 2015, 464 clinics performed 231,936 cycles, compared to 146,244 at 441 clinics in 2009. Despite the major uptick, the information out there about IVF—who gets it, how much it costs, what it actually feels like, and what the risks are—is muddled.

“I'm not the world’s most academic person, but I'm not a slouch either,” says Chamberlin. “It amazes me now how clueless I was going into it—but I can't hold myself totally accountable, because the narrative about assisted reproductive technology is so overly optimistic.”

She's right. To combat that, Marie Claire talked to fertility experts, doctors, and more than 20 women who underwent IVF to get to the truth about the much-discussed yet entirely confusing procedure.

Forty years ago, IVF was a genuine breakthrough.

The procedure was originally invented to help women with fallopian tube diseases and, in July 1978, the first IVF-conceived child, Louise Brown, was born in Britain. Three years later, the U.S. birthed its first IVF baby. These seemingly miraculous deliveries gave women with troubled tubes hope that they could have their own children. Celebrities have since expanded the treatment’s appeal—Jane Seymour, Christie Brinkley, Celine Dion, Brooke Shields, Courtney Cox, and Chrissy Teigen, to name a few—and there’s been a massive increase in the number of women receiving the treatment.

In its early days, the IVF success rate was 9 percent. Today, the reported success rate of a live birth after using assisted reproductive technology and your own eggs is 33 percent for women under 35; 26 percent for those ages 3537; 17 percent for women ages 3840; eight percent at 4142; and 1 percent for women over 44.

IVF is marketed to treat a series of fertility conditions.

Estimates vary, but infertility—the failure to get pregnant naturally after 12 months—affects more than 7 million women in the U.S. Patients seeking IVF services include heterosexual couples struggling to conceive, same-sex couples, as well as single mothers and single fathers.

Clinics today sell IVF to address age-related infertility, low sperm count, endometriosis, and unexplained infertility, though it’s important to note that scientists haven't concluded that IVF can solve for all the aforementioned conditions. (Women with diminished ovarian reserve appear to have the most success with IVF.)

The average IVF cycle starts at $10,000.

If you’re using your own eggs and your partner’s sperm, an IVF cycle typically ranges from $10,000 to $12,000 but can go higher, depending on drug protocols and add-ons (many of which have questionable efficacy). Using someone else’s eggs can cost significantly more: Couples have paid up to $100,000 for the “perfect” egg. Donor sperm costs much less— about $300 to $4,000 . Depending on your healthcare provider, you may be able to get help covering the costs of IVF; there are currently 16 states with infertility insurance laws.

If you’re undergoing IVF, expect a physical and emotional rollercoaster.

A typical IVF cycle includes several steps over the course of four to six weeks. The Society for Assisted Reproductive Technology offers a comprehensive (super scientific) guide to ART. The experience itself—what you’ll actually feel—varies from patient-to-patient, but there are a few things to expect:

Injections: You’ll stick your stomach or thighs with hormones twice a day. It’s often painful, and bruising and swelling is expected. Even if you’re uncomfortable wielding needles and mixing medications from vials, you get used to it; you’ll use about 30 or more syringes in one cycle. Some clinics have you practice on an orange to experience the thickness of your skin.

Ultrasounds: Prepare to scramble to accommodate clinic openings for transvaginal ultrasounds, captured by a wand that many IVF patients mockingly call the “dildo cam.”

Side Effects: Fertility hormones exacerbate mood swings, cause bloating, and can make you toss and turn in your sleep. Essentially, your ovaries feel like two swollen bar-bells, each potentially harboring a half-dozen-plus eggs. You’ll be grumpy, tired, and stressed out—but forget about caffeine, alcohol, or exercise. All are forbidden.

Egg Retrieval: There’s a 36-hour window to administer your last and most complex hormone injection (with the biggest needle), called the “trigger shot,” before the retrieval appointment. That then takes place at a surgical center, where you’ll be put under general anesthesia or conscious sedation. Everyone responds differently to anesthesia—from nausea to foggy brain—but you can count on cramping as your ovaries recover.

Embryo Transfer: Several agonizing days after retrieval, wondering and worrying whether your eggs fertilized and became embryos, you’ll go back to your clinic and take a mild sedative. A clinician will carefully deposit one or more embryos into your uterus via a long flexible tube (which feels like a very narrow straw) inserted through your vagina and cervix. The sedative is to keep you still, as this procedure is meant to give the embryos the best possible landing.

The Two Week Wait: Despite the needles and swollen ovaries and parade of doctors and nurses exploring your uterus with wands, the infamous Two Week Wait is the worst part of IVF. This is the time period when you hope an embryo implants in your uterine wall and turns into a big fat positive (known as a BFP in Internet circles). It’s torturous and often weepy—so distractions of any kind (we have some binge-worthy suggestions) are welcome.

The way fertility clinics measure success rates varies.

The Fertility Clinic Success Rate and Certification Act, passed by Congress in 1992, requires all U.S. clinics to report the number of IVF cycles they administered versus the number of live births, but the clinics defer to either the patient or the patient’s obstetrician to provide birth information and many do not. In short, there are no enforcement mechanisms in the statute , so it is anyone’s guess which clinics remain in compliance or how many live births occurred. There’s also no law that requires clinics to market their rates accordingly.

Some clinics, for instance, will jigger their denominator—the pool of candidates who actually underwent IVF—to create higher, more marketable success rates. They may do this by, say, only pursuing embryo transfers with patients who produce high-quality embryos, says Dr. Mark Sauer, Chair of Obstetrics, Gynecology and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School.

Though dense, the CDC’s Assisted Reproductive Technology Fertility Clinic Success Rates Report has the most comprehensive, unedited data about every registered clinic in the U.S.

Before starting treatment, clinics require patients to sign an “informed consent” form.

This states that the patient understands the potential benefits and risks of treatment and would like to move forward with the procedure. Though it’s called “informed consent,” most women have little idea what they’re really signing. Julia Leigh, a writer and filmmaker who documented her fertility struggles in her 2016 memoir Avalanche, wrote, “With those consents, I felt the same sense of empowerment, fair bargaining, ability to discuss and negotiate a document, as I did when I signed off blindly on the terms and conditions of the latest Adobe update.”

Indiana University law professor Jody Lyneé Madeira specializes in helping patients navigate the reproductive industry and recently wrote about the lack of universal informed consent requirements for reproductive medicine. “Many reproductive endocrinologists, health psychologists, and attorneys have expressed concern over whether patients understand the balance of ART's risks, benefits, and alternatives,” she explains. “Strong, collective effort in our field to promote understanding has not eradicated the concern that many women and their partners undergo ART without truly knowing or appreciating the implications of ART for personal health and the health of children born through the process.”

Essentially, it’s on individual doctors to outline all the risks. Yet, “if a doctor doesn’t explain it well,” says Sauer, “the patient is not really informed.”

Like any medical procedure, there are risks to consider.

About 3 to 6 percent of ART patients experience ovarian hyperstimulation syndrome (OHSS) and .01 to 3 percent experience severe OHSS. Essentially, OHSS happens when your body goes into overdrive, producing north of 20 eggs. (You know that heavy feeling you have mid-cycle? Imagine that, on steroids.) In extreme cases, OHSS can be life threatening.

The more embryos transferred, the higher the potential for delivering multiples (we all remember ‘Octomom,’ who delivered eight babies in 2009). Singletons account for about 55 percent of all IVF births; 42 percent are twins, and 3 percent are triplets, according to George Annas, the Director of the Center for Health Law, Ethics Human Rights at Boston University School of Public Health. Any multiple pregnancy, IVF-created or not, is considered high risk; the mother will be monitored for high blood pressure, gestational diabetes, maternal hemorrhage, and has a higher chance of delivering via C-section, and the babies may be born premature and are more prone to lung development problems, intestinal infections, cerebral palsy, learning disabilities, and behavioral problems. The “One At a Time” campaign, which advocates for single embryo transfer, launched in the U.K. in 2007 and recently made its way to the U.S. The goal of any responsible IVF physician it to transfer the fewest number of embryos possible that will result in a single live birth. That said, the number of embryos transferred will likely increase with maternal age.

Politics is why the information above—the success rates and the risks—feels opaque.

Medical research is typically funded by federal grants, but the government shies away from funding research in the field of reproductive medicine because of its historical relationship with embryo research—and embryo research’s association with abortion. (Yes, seriously. Read Marie Claire’s investigation into the unregulated fertility clinic industry.)

Deciding if IVF is right for you is a complex process.

Decisions about expanding your family are personal, and biology varies wildly from individual to individual. But before spending tens of thousands of dollars

• Find an ob-gyn or primary care physician you feel you can trust.
• Get to know the characteristics of your ovulation and menstrual patterns. (There are tons of apps for that.)
• If anything seems off, ask for basic screenings like measuring your FSH level (a normal FSH level indicates you have a good supply of eggs or ovarian reserve) to establish a baseline, or a hysterosalpingography to make sure your Fallopian tubes are functioning properly. And get your partner checked out, too. Men account for up to half of all infertility factors.
• Seek out other women who have undergone fertility procedures to have frank discussions about what to expect.
• The medicalization of treatment often makes patients feel like lab experiments. Don’t underestimate or feel bad about the emotional toll and mental anguish that accompanies IVF. Here are some tips from a clinical psychologist on how to make the process less stressful.
• Above all, be an advocate for yourself and don’t be afraid to ask questions or pushback if you’re not comfortable with what’s being prescribed.

Pamela Mahoney Tsigdinos is the author of Silent Sorority and Finally Heard. She is also the co-founder of ReproTech Truths.

Editors’ note: We use the terms “woman” and “female” in this article to refer to people with internal reproductive organs; however we understand that not everyone with internal reproductive organs identifies as a woman or a female. We use the terms “man” and “male” to refer to people with external reproductive organs; however we understand that not everyone with external reproductive organs identifies as a man or a male.