Typically we associate in-vitro fertilization (IVF) with infertility, a means to help couples who have trouble getting or staying pregnant grow their families. But with all the recent advancements in assisted reproductive technology (ART), that’s not always the case; IVF has many different purposes and has helped so many different types of couples and individuals become parents. Let’s review!

IVF for infertility

You’ll likely be diagnosed with infertility after a year of trying to conceive unsuccessfully if you’re 35 or under, according to the American Society of Reproductive Medicine (ASRM). The timing changes to six months if you’re over the age of 35. In 2023, the ASRM updated its definition to be more inclusive, referring to infertility as the “inability to achieve a successful pregnancy based on a your medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.”

We know that age of the female partner plays a huge role in our fertility (UGH!), and your physician can assess where you are on your own timeline with preliminary testing. This testing usually includes:

  • a transvaginal ultrasound to count how many follicles (they house your eggs) you have on each ovary
  • a hysterosalpingogram (HSG), an x-ray test that examines the uterine cavity and fallopian tubes
  • bloodwork to check your fertility hormones, namely your anti-müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels

IVF for genetic reasons

Some patients may go straight to IVF not because they have trouble getting or maintaining a pregnancy, but because they or their partner are carriers for a condition that they don’t want to pass down to their kids. That’s because in addition to testing embryos for the correct number of chromosomes, preimplantation genetic testing (PGT) can also test for specific genetic conditions that run in your family or that you have a personal history of.

PGT-M, or preimplantation genetic testing for monogenic orders, has become more commonplace, and therefore we see more people turning to IVF to prevent passing down serious conditions such as cystic fibrosis or BRCA. The genetic screening itself is done via bloodwork, ideally before you plan to get pregnant; there are a variety of tests available depending on which your physician offers. 

The goal of this blood test is to make sure you and your partner or donor aren’t carriers of the same genetic conditions. If you are (or if you’re a carrier of an X-linked condition that you can pass on even if the male partner isn’t a carrier), IVF can be used to test embryos for that specific condition via PGT-M. You can then avoid transferring an embryo that carries that gene.

IVF for LGBTQ+ couples and single parents by choice

Many same-sex couples will require IVF to grow their families if they want biological children; two women will need a sperm donor to fertilize their eggs (many may start with IUI and then move onto IVF if treatment is unsuccessful), and two men will use their sperm to inseminate eggs from a donor. They’ll also need a gestational carrier to carry the pregnancy.

Single moms by choice and single dads by choice will turn to IVF too as this also requires third-party reproduction, which uses eggs, sperm, or embryos that have been donated by a third person to hopefully make a baby.

IVF for uterine abnormalities/surrogacy

Uterine abnormalities can be congenital, meaning present at birth, or due to surgery/trauma to the area at any point in life. If a uterine abnormality means you can’t carry a pregnancy, you may want to consider a gestational carrier. You’ll do IVF to create embryos using your eggs and your partner’s or a donor’s sperm, and the embryo will be transferred into the carrier’s uterus. 

It’s important to note the difference between a gestational carrier and a traditional surrogate. The latter is when a female is inseminated directly and therefore using her own eggs so she is genetically related to the child. A gestational carrier carries someone else’s embryo, which she is not genetically related to.

How does IVF work for surrogacy?

The first part of the IVF process involves follicle stimulation; daily injections to grow the follicles, and then a quick procedure involving anesthesia where the eggs are removed and then inseminated with partner or donor sperm to create embryos.

The retrieval procedure itself is minimally invasive, short, and has a relatively speedy recovery depending on the number of eggs retrieved. Most people go back to work the next day.

If you’re creating embryos with your male partner, he will provide a semen sample/sperm collection the same day as your egg retrieval or provide a frozen sample ahead of time. If you’re using donor sperm, then a frozen sample will be used.

Once the eggs are retrieved, embryologists fertilize the mature eggs with sperm to hopefully create embryos that can later be implanted into the carrier’s uterus to attempt pregnancy.

Keep in mind that a tested and chromosomally normal embryo has a success rate of about 50-60 percent when using a surrogate or when transferring to yourself; an untested embryo’s success depends on your age. Embryos can also be frozen for use later on— for months or years!

IVF for sex selection

Sometimes people have specific “family plans,” and they turn to IVF to complete their family. Using the PGT-A chromosomal screening test on embryos, they can test and select for the sex of their choosing, and then transfer the embryo of that sex (under their doctor’s guidance, of course). A lot of people are shocked that you can actually do this (and in some countries it’s illegal), but here in the U.S., yes, it’s a thing!

It’s important to note, however, that there are no guarantees with IVF for sex selection (or IVF in general for that matter). You may end up with only healthy male embryos even if you wanted a girl, so there’s certainly risk involved here and it may not be worth it for everyone.

Still, it’s clear that IVF has many benefits beyond just helping male/female couples conceive who otherwise have trouble getting or staying pregnant. Modern medicine is truly amazing.

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