What is IVF, and Is It for You?

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Parenting is a dream for many couples that, when it comes true, often proves deeply fulfilling. Some families may need a little help to bring that dream to fruition, and that's okay.

There are a number of options available to same-sex couples looking to add to their families by becoming parents, including adoption, fostering, surrogacy, and assisted reproductive technology, or ART.

That last option, ART, includes several techniques, including In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI). IUI involves depositing a partner or donor's sperm directly into the uterine cavity – another word for womb, where a fetus grows and develops – at the time of ovulation.

IVF is a little more complex. Dr. Allison Bloom, a reproductive endocrinologist with Main Line Fertility, which is part of The Prelude Network – the largest and fastest-growing network of fertility centers in North America – explains the procedure.

"IVF is the process in which injectable medications are used to stimulate the ovaries," Dr. Bloom says. "Eggs are then extracted during the time of the egg retrieval and exposed to sperm in the lab."

In other words, the actual conception – when the sperm and egg unite, bringing together the genes contained in the sperm and the egg, and initiating the development of a fetus – takes place in laboratory conditions, hence the term "in vitro," Latin for "in glass." When the technique was first pioneered, the use of glass in IVF led to the popular phrase "test tube baby," even though the conception of children through IVF did not take place in test tubes.

"All embryos (also known as blastocysts) that are good quality, have the ability to be biopsied to determine if they are genetic normal or abnormal," Dr. Bloom says. "This is called Pre-implantation genetic testing (PGT). Sex and other known genetic disorders can also be detected with this technique."

A patient or couple may choose to transfer an embryo to the womb of the gestational carrier five days after egg retrieval. However, it is more common to freeze embryos for transfer in a more controlled embryo transfer cycle. This is a decision to be made with the help of your physician. Additional embryos can be created at the same time and frozen – for years, if necessary. As Dr. Bloom notes, "Typically, only one embryo is transferred at a time. Any remaining embryos can be used for future pregnancies."

IVF boosts the odds of successful fertilization of the ova, gives prospective parents control over where sperm or ova are sourced, and can bring genetic testing into the picture from the very first if the parents wish. In some ways, IVF brings together the best aspects from different routes to parenthood. But is it for you?

Many Possibilities

While IVF is a valuable technology for anyone who wants to realize the dream of becoming a parent, it's especially useful for same-sex couples who, though they may be perfectly fertile, still need some help to conceive. Two prospective dads would also need an egg donor and a gestational surrogate. The picture can grow even more complicated when one or both prospective parents are trans or non-binary, but with added complexity come added possibilities.

While no method is guaranteed, IVF offers "optimized success rates" for pregnancy, Dr. Bloom notes, adding that couples wishing to have more than one child often wish for their children to have the same biological donor, strengthening the genetic ties between siblings, which is more easily achieved with IVF. The use of frozen ova or sperm from a single donor – or the preservation of frozen embryos until the time is right for implantation – makes it possible for couples to more easily plan the timing of their children's anticipated arrivals.

During IUI attempts with medications, a patient may ovulate multiple eggs, which increases the rate of multiple pregnancies – that is to say, twins or triplets. That's very uncommon with IVF since the typically only one embryo is transferred at a time. If one embryo is transferred, the only way a twin pregnancy will occur is if the embryo splits in half, which leads to identical twins. A common misconception is that IVF increases the number of twin pregnancies, but that is not the case.

Some couples might opt for the deeply bonding experience of carrying each other's fertilized ova through reciprocal IVF. "For example, if a trans man wants to do an egg retrieval and the partner wants to carry, or two cis women both want to do egg retrievals and carry each other's embryo," Dr. Bloom explains. "I think it gives options for a much more diverse way of creating their family."

Listening to Your Needs

The parenting journey is an emotional and exciting one, and it's enhanced by working with providers who are inclusive, affirming, and attentive to the specific needs of the families that come to them.

"I always ask a couple what they see their family looking like in the future," Dr. Bloom says. Her advice for planning and carrying out pregnancies is tailored to what she hears, with the guidance she provides "depending on the number of children the couple want, who wants to be a biological parent by supplying sperm or ova, and who desires to carry the baby."

Needs, as well as wants, are part of the equation. "Do they need donor eggs? Do they need a gestational carrier?" Dr. Bloom says. "There's so many parts of that initial conversation that really help us guide how someone moves forward.

"So, for example, if a couple comes in and they want one child and they have an otherwise uncomplicated history, they may often choose to do IUI cycles before ever moving to IVF," Dr. Bloom continues, "and then only move to IVF if they fail their IUI cycle. But another couple may say, 'I want three kids,' or, 'You know what, I don't want to carry, but we want to use my eggs.' Then IVF becomes more of a first-line treatment for reciprocal IVF – or, for family building, to create embryos to be used in the future."

Understanding what IVF is and how it can open a path to parenthood is one step on an exciting, fulfilling journey. What comes next is your own choice – but the specialists at the Prelude Network are there to help guide you along the way.