Everyone experiences infertility differently, but it’s no secret that it can be daunting at times. For men in particular, undergoing fertility treatment as a couple may leave you feeling somewhat sidelined or even helpless. In this article, we’ll cover the basics and all of the steps in the IVF process to inform and support you during this time.
Let’s start with the technical definition: In vitro fertilization (IVF) is a medical infertility procedure which involves the combination of an egg with sperm in a laboratory setting. The fertilized eggs (embryos) are then transferred into your partner’s uterus (or a gestational carrier’s if you’re doing surrogacy), where it will hopefully implant in the uterine lining and continue to develop. Excess embryos may be frozen for future use.
Since IVF bypasses the fallopian tubes, this treatment option is ideal for women with blocked, damaged or absent fallopian tubes, or in cases where endometriosis is preventing conception. It’s also a solution in case of male factor infertility (infertility caused by a problem in the male partner, for example, a low sperm count or an inability to ejaculate) and where no explanation has been found for a couple’s infertility.
IVF is also necessary when a donor egg is needed, and as mentioned, in the case of surrogacy.
The IVF process may vary from clinic to clinic but it generally follows these steps:
Fertility testing begins before the start of the cycle and involves you and your partner. You will be asked to provide a sperm sample for the lab to evaluate – ideally, the test is performed twice, on separate days, to confirm the result. Depending on your specific case, further testing may be required, including a specialized semen analysis (that includes genetic testing of the sperm), and blood work to check hormone levels. More intensive testing, such as a testicular biopsy or vasography (an X-ray that looks for obstructions in the male reproductive organs), may be advised.
During this time, your partner will undergo ovarian reserve testing to check the size and quality of the eggs. This involves blood tests to check three main hormones: FSH, AMH, and estradiol. A saline sonogram is also done, which will check whether the uterine cavity is healthy.
Other common pre-IVF tests include a comprehensive blood panel to check if immunization boosters are needed, genetic carrier screening and screenings for infectious diseases.
Time Frame: 30 Days
Your partner will be given injectable medication to suppress the normal menstrual cycle. This helps the next treatment stage be more effective.
Time Frame: 2 Weeks
Medications, commonly known as ‘fertility drugs’, are prescribed to boost egg supply. A 2013 study by the University of Birmingham found that for women under 34, the ideal number of eggs is 15: at this number, the live birth rate stood at 40%.
The medication comes in the form of an injectable follicle stimulating hormone (FSH) that should be self-injected for 10-12 days.
[Note: A good way to be involved and supportive at this point is to help your partner with the injections!]
During treatment, the ovaries are evaluated via ultrasound to see that the ovarian follicles are developing – at this point, a blood test is also done to measure response to ovarian stimulation medication. This determines if the follicles are ready for egg retrieval. A final hormone injection is given to help the eggs mature: the eggs are then collected after 34–36 hours.
While 80% of IVF cycles proceed normally, a smaller percentage end up canceled at this stage due to poor medication response and an insufficient amount of follicles. Unfortunately, the chance of an IVF cycle being canceled increases with the age of your female partner, but there are so many IVF success stories out there so do try to stay positive and supportive along the way.
Time Frame: 10 – 12 Days
Using ultrasound for guidance, a needle is passed through the vagina and into each ovary. This minor procedure is performed in the physician’s office or an outpatient center, and takes around 30 minutes. Most women find the procedure straightforward (a light sedative is used to help relax and feel minimal to no pain). However, it wouldn’t hurt to keep in mind that some report lower abdominal cramping and light spotting, but recovery is generally quick.
[Note: You will be asked to provide a sperm sample on the same day, if it hasn’t already been collected ahead of time and frozen. A lot of clinics will recommend that you abstain from sex for at least two days prior to the IVF procedure. Each doctor will have their own requirements, so make sure to check with your clinic.]
Time Frame: 90 Minutes
Details: 30-minute procedure, followed by 5-10 minutes for your partner to come out of sedation and an additional 30 minutes for recovery.
Following retrieval, the eggs are examined for maturity and quality. Mature eggs are mixed with sperm and left to fertilize for the next 16-20 hours.
Around 60% of assisted reproductive technology (ART) cycles utilize intracytoplasmic sperm injection (ICSI). In this procedure, a single sperm is directly injected into a mature egg. ICSI is performed in cases of poor sperm quality and/or failed fertilization in a previous IVF cycle. ICSI is also a must when frozen (vs. fresh) donor eggs are used: the freezing and thawing process makes the shell surrounding the egg hard for the sperm to penetrate on its own. If you’re interested in more details on fresh vs. frozen eggs overall, check out this helpful article: The Egg Question: Fresh vs Frozen Donor Eggs?
The fertilized eggs are then allowed to grow in the laboratory for up to 6 days.
Time Frame: About 6 Days
The embryo is monitored to ensure it’s growing well. At this stage, a number of tests may be offered, including:
For couples who are carriers of genetic diseases, these second two tests help reduce the risk to your child. Our article Maximizing the Chances of IVF Success: Genetic Testing provides more information on this option.
Moving along with the process… the best embryo(s) are then chosen for transfer! In the meantime, your partner or a gestational carrier is given medication to help prepare the lining of the womb for the embryo transfer.
Time Frame: 6 Days*
Details: Embryo transfer takes place approximately 6 days following egg retrieval. If you choose to do genetic testing, the embryos are frozen and transferred at a later stage.
The embryo is transferred into the womb using a thin catheter. The procedure is more straightforward than egg retrieval: no sedative is necessary and many women say it’s like a pap smear. The reproductive endocrinologist (RE) or embryologist will discuss the number of embryos that should be transferred – the decision will be based on your partner’s or the gestational carrier’s age, and specific patient and embryo characteristics.
The American Society for Reproductive Medicine (ASRM) provides guidelines for the number of embryos to be transferred. These can be viewed here.
The Centers for Disease Control and Prevention (CDC), too, have their own recommendations when it comes to embryo transfer: “for women who are good candidates for single embryo transfer, transferring one fresh embryo followed by one frozen embryo, if a second transfer is needed, offers the best chance of having a baby without increasing the chance for twins.” The reason that the CDC recommends the transfer of only one embryo is because twin pregnancies are more risky, for both mother and babies.
With this part complete, the remaining embryos can be frozen (cryopreserved) for future transfers. This makes future IVF cycles less expensive and less invasive.
Time Frame: About 2 Hours Details: The embryo transfer procedure itself takes around 20-30 minutes – considering checking in and rest time, you and your partner may be at the fertility clinic for around 2 hours.
Total Time Frame for Steps 2-7:
Once the embryo(s) are transferred, what’s commonly known as ‘the two week wait’ ensues. It can be a difficult time for you and your partner: you may feel a roller coaster of emotions, from hope, to fear to exhaustion. This is normal and the National Infertility Association RESOLVE offers some emotional coping strategies to help see you through this time. To better understand a woman’s perspective of the two week wait, check out fertility advocate and IVF mom @mybeautifulblunder Erin Bulcao’s essay detailing the emotions of this stage of the IVF cycle.
If the cycle has been successful, ultrasound scans will be carried out in the following weeks, after which you’ll follow regular antenatal care (appointments with a midwife or an obstetrician to monitor the pregnancy and ensure that your partner and the baby are both doing well).
IVF success rates vary according to age, the specific case in question, and from one clinic to another. Unfortunately, not all cycles are successful – most physicians tell RESOLVE that patients see success with 2-3 cycles – so you should prepare yourself also for this possibility. Make sure you have a good support system around you to help deal with any outcome – counseling, fertility support groups, and online communities are helpful during this time.
Time Frame: 2 Weeks (no surprise there!)
Unfortunately, some men note that they sometimes feel like not much more than a sperm donor during the process. Psychologist Narelle Dickinson encourages men to attend as many appointments as they can so as to feel more involved in the process. She also suggests planning questions for your RE together with your partner, in advance of appointments, and to not be afraid to speak up, ask questions, and help take note of the answers – which you two will want to save. Many fertility patients say to bring a notebook with all of your questions written out – and with space to take your own notes. Learn more about preparing for your first IVF appointment and what to ask in our article.
As Marc Sherman, Co-Founder and CEO of Organic Conceptions notes, men and women experience the emotions related to infertility differently. However, “when men are given the tools and support they can play a critical role in easing the burden that often sits entirely on their significant other. Men can emotionally engage at a deeper level to create a level of trust and safety that releases some of the frustration and loneliness women experience on this journey. This deeper bond has a profound effect on quality of life and the reproductive journey.” In this guest article, he offers five suggestions to help future dads navigate IVF together with their partner.
Alex Kornswiet, mom of three boys – one through IVF, one via surrogacy and one a surprise natural pregnancy – details the emotions she and her husband experienced when they had to move from IVF to surrogacy. After years of being the patient, she became a bystander, similar to how her husband felt during their first pregnancy through IVF: “I don’t mean that he hasn’t gone through every aspect of infertility right alongside me – he absolutely has – but he’s never been the actual patient”. She goes on to explain that “something unique about being an intended parent, as a woman who experienced infertility, is that my husband and I experienced this pregnancy together, in the same way”. Reading through other family building stories, such as this one by Alex, will help you realize that you’re not alone navigating the many feelings and emotions that come with infertility.
Therapy, either individually or as a couple, or both is also a great source of support. Erin Bulcao, says that infertility brought up issues she and her husband never talked about together, noting that “I don’t think we could have gone through everything, as a couple and individually, without therapy”. Dr. Grill and Dr. Domar, co-founders of FertiCalm, consider it essential to see a therapist who specializes in infertility and knows the implications of the medical aspects – you want someone who can match your medical knowledge as you’ll be experiencing the process in real time, and even go above that. In the US, there are 600 therapists specialized in counseling couples and individuals going through infertility.
Recent advances in reproductive technology have made it possible for many couples and single persons to experience parenthood. IVF is one such option. The process requires patience and determination and can sometimes be grueling, both for you and your partner. But, with a positive attitude, being prepared, having a good understanding of the process, and support along the way, it is manageable.
At GoStork, we’re here to support you as you research your family-building options, connect with fertility providers that may be your ideal match, and make informed decisions about which to move forwards with. Join us today to keep learning about your fertility options, and to find the ideal providers to help you on your journey. Start by creating your free account here.