A Couples Guide: Trying to Conceive

Today, in vitro fertilization (IVF) is practically a household word. But not so long ago it was a mysterious procedure that produced what were then known as "test-tube babies." Louise Brown, born in England in 1978, was the first such baby to be conceived outside her mother's womb.

Unlike the simpler process of artificial insemination -- in which sperm is placed in the uterus but conception precedes otherwise normally -- IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.

What Causes of Infertility Can IVF Treat?

IVF may be an option if you or your partner have been diagnosed with:

• Endometriosis
• Low sperm counts
• Problems with the uterus or fallopian tubes
• Problems with ovulation
• Antibody problems that harm sperm or eggs
• The inability of sperm to penetrate or survive in the cervical mucus
• An unexplained fertility problem

IVF is never the first step in the treatment of infertility. Instead, it's reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven't worked.

If you think that IVF might make sense for you, carefully assess any treatment center before undergoing the procedure. Here are some questions to ask the staff at the fertility clinic:

• What is your pregnancy ratio per embryo transfer?
• What is your pregnancy rate for couples in our age group and with our fertility problem?
• What is the live birth rate for all couples who undergo this procedure each year at your facility?
• How many of those deliveries are twins or other multiple births?
• How much will the procedure cost,including the cost of the hormone treatments?
• How much does it cost to store embryos and how long can we store them?
• Do you participate in an egg donation program?

The CDC maintains a database of all IVF clinics and their success rates. You can find it at http://www.cdc.gov/art/art2003/index.htm?lt;/a>

What You Can Expect

The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one.You will then be tested to determine whether you're ready for egg retrieval.

Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won't develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.