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During embryo transfer, the doctor uses a soft rubber tube to transfer the embryos into your uterus. You will have to stay in bed for 1 to 4 hours after the procedure, possibly in a position in which your lower body is elevated above your head. You will need to take the hormone progesterone to help stabilize the lining of your uterus for implantation of the embryo. You will have a pregnancy test 10 to 14 days after the transfer. If you are pregnant, you will continue to take progesterone for up to 12 weeks. The average success rate for IVF is about 38 percent per attempt, but the rate is much lower for women over age 40.

Because up to four or more embryos are transferred during each attempt, IVF carries the risk of a multiple pregnancy. Most multiple pregnancies result in twins, but triplets, quadruplets, and even higher numbers of fetuses can occur. The decision about how many embryos to transfer is made by you and your doctor. The more embryos that are transferred, the greater the chances of having a multiple pregnancy with three or more fetuses. For this reason, many countries limit the number of embryos that can be transferred. In the general population, the risk of multiple pregnancy is only 1 to 2 percent.

Multiple pregnancies carry risks to both the woman and the fetuses. Fetuses are at risk of miscarriage, premature birth, birth defects, and mental or physical problems such as cerebral palsy (see page 409) that can occur from a preterm delivery (see page 529). Risks to the woman include pregnancy-induced high blood pressure (preeclampsia; page 526), gestational diabetes (see page 521), anemia (see page 610), and vaginal or uterine hemorrhage.

In vitro fertilization

In vitro fertilization is a process in which a needle is inserted through the wall of the vagina along the outside of the uterus to retrieve eggs from the woman’s ovaries (top). Fluid from the follicles is removed along with the eggs. The eggs are fertilized in a plastic dish in the laboratory with sperm from the male partner (center). After a few days, the embryos are transferred to the woman’s uterus with a soft rubber tube (bottom).

To ensure the pregnant woman’s health and to improve the survival of some of the fetuses, doctors sometimes recommend multifetal pregnancy reduction, in which one or more of the fetuses is aborted. Deciding whether to undergo this procedure is an emotionally difficult process that may be made easier with professional counseling.

Egg donation

If a woman’s ovaries have stopped functioning prematurely, she is over age 40, or she has a genetic disorder that could be passed on to children, she and her partner may explore using donated eggs to achieve a pregnancy using IVF. The donor may be a person the couple knows, such as a sister, or may be anonymous. Either way, each donor is carefully screened for infectious and genetic diseases and must undergo a psychological evaluation. The donor should be between ages 21 and 35 and must have blood tests to show that her ovaries are still producing eggs.

If you are considering using egg donation, you will need to have a thorough physical examination to make sure that your health would not be endangered by pregnancy. Your partner also will be screened for infertility. Before the egg donation takes place, you will receive IVF drugs so that your monthly cycle will conform to that of the donor, whose cycle will be controlled with other drugs.

After the eggs are retrieved, fertilized in vitro, and one or more embryos have been transferred to your uterus, you will need to take estrogen and progesterone until your pregnancy test on the 28th day of your cycle. If you are pregnant, the hormones will be continued until about the 10th week of pregnancy. Egg donation increases the success rate of IVF to about 40 percent per attempt.

Embryo donation

Couples who have a successful in vitro fertilization usually have some unused embryos left over, which are frozen. An increasing number of couples are choosing to donate their embryos