The dream of having children is something almost universally experienced and shared by all human beings. But not everything happens naturally or in the way we have always dreamed, and sometimes medical support can be necessary—such as in the case of in vitro fertilization. In vitro fertilization, also known and recognized by doctors by the acronym IVF, is a human reproduction method developed to help couples who want to have children but cannot do so naturally due to various factors causing infertility. Even though this is an already established technique, it is increasingly being sought out and is now an option available to more couples, becoming more well-known and accessible.

What is IVF?

The in vitro fertilization (IVF) procedure is, essentially, the fertilization of the woman’s eggs by sperm in a fully assisted, laboratory setting. After fertilization, the resulting embryo is transferred to the woman’s uterus so the pregnancy can progress. Explained this way, it might seem simple, but in reality, it requires proper treatment, significant preparation, and the guidance of a fertility specialist who will ensure that the entire process goes as smoothly as possible to achieve a healthy baby.

How In Vitro Fertilization is Performed

The IVF process begins with a medical consultation with a fertility specialist. Before starting any procedure, it’s necessary to perform assessment tests to determine the best course of action and to assess the reproductive health conditions of the couple. Tests such as semen analysis and antimüllerian hormone are performed to evaluate the condition and quality of the genetic material that will be used in the reproduction process. After satisfactory results and once the specialist determines that IVF truly is the best route, treatment to induce ovulation begins. Ovulation induction is used so that the woman produces more and healthier eggs to increase the chances of success. Normally, this medication is given by injection with hormone-based drugs, administered in the abdominal area, and the treatment usually lasts from 5 to 10 days. At the end of the injectable treatment, the development of ovarian follicles will be confirmed, which will soon mature and become the dominant eggs. At this stage, another medication is prescribed, which now helps these follicles mature so that they are ready for retrieval on the precise day. To maximize the chances of success and ensure everything goes as expected, it’s possible to retrieve between 2 and 12 eggs, which are immediately taken to the laboratory for fertilization. Along with the process of ovarian stimulation, the man’s semen is also collected and analyzed. The best and most motile sperm will be chosen for the IVF process. With the selected mature eggs and prepared sperm, the in vitro fertilization is performed in the laboratory. Five days after fertilization, the embryos are analyzed and the most viable ones are transferred to the uterus.

IMPORTANT: Usually, no more than three embryos are selected for each attempt. That’s why it’s very common to see twins in couples who have opted for IVF as their treatment.

After the intrauterine insemination process, the woman continues medication with progesterone, which helps strengthen the endometrium and ensure the healthy development of the pregnancy. After fertilization, it is necessary to wait around 12 days to confirm whether the IVF was successful. A beta HCG test can confirm whether pregnancy has been achieved.

What if Fertilization Doesn’t Succeed?

Unfortunately, it is possible that fertilization may not be successful. However, there is planning for this scenario from the start; when embryos are selected for transfer, the remaining embryos are frozen in case a new attempt becomes necessary. There is no set limit on the number of in vitro fertilization attempts—couples can try as many times as necessary and as long as resources allow. However, after several attempts, it is recommended that the woman’s body be given a break, especially due to the amount of hormones involved in the preparation.

Chances of Successful In Vitro Fertilization

Every couple considered healthy and approved by the fertility specialist has a chance of achieving pregnancy with this method, especially on the first attempt. Women between the ages of 30 and 35 are considered most likely to be successful with IVF on their first try. In contrast, women over 40 require more detailed monitoring as the chances are somewhat lower—generally dropping to 25% of their previous probability—due to a lower ovarian reserve.

Freezing Eggs for Future In Vitro Fertilization

Several factors related to the reproductive conditions of the couple are evaluated to ensure IVF is successful, as already discussed. A woman’s age has a direct impact on egg quality, which is why, as the years pass, the chances of success with in vitro fertilization decrease. For women who want to become mothers in the future—whether due to other current life plans or because they are facing a health issue that will likely lead to infertility—there is an option to keep the dream alive: egg freezing. The recommended age to freeze your eggs is up to 35 years old, when both their quality and production are still considered good. After this age, ovarian reserve starts to decline, reducing egg quality. There is no expiration date for egg freezing. Frozen eggs can be stored for an indefinite period, until the woman is truly ready to become pregnant and begin IVF or artificial insemination treatment. However, in 2013 the Federal Council of Medicine ruled that in vitro fertilization can only be done in women up to age 50, considering that the risk of babies with birth defects, pregnancy losses, and complications during pregnancy is highest at this age. The freeze cycle begins ten days prior to egg collection. As in the in vitro process, the woman will take ovulation-stimulating medications, and once the eggs are confirmed as mature, they may be collected and frozen. The collection, or ovarian puncture as it is called, is performed in a specialized clinic equipped for surgical procedures, as anesthesia will be required and typically lasts about two hours. This collection is performed vaginally and guided by ultrasound, which will help locate the ovarian follicles. The follicles are removed one by one and sent for laboratory analysis, where their maturity will be evaluated to determine freezing conditions.

IMPORTANT: The procedure itself is completely painless due to anesthesia, but mild discomfort or cramping may appear during recovery.

Semen Freezing

Just as women can ensure their dream for the future, men can as well, through a sperm bank. This is also an option for women who wish to pursue motherhood independently, or if the partner cannot be the donor due to infertility. Once the decision for semen freezing has been made, the specialist will request serological screening, followed by collection. Men are required to abstain from sexual activity for at least 3 to 7 days before collection. Three semen samples are recommended to ensure the procedure. The semen is stored in liquid nitrogen at -196°C in specialized clinics and can be preserved for up to 40 years.

Does In Vitro Fertilization Involve Risks?

Like any medical procedure, risks do exist. However, with medical advancements and research in human reproduction, these risks have been drastically reduced. In the past, embryo quality was assessed before fertilization, but it was not possible to be completely certain about potential health issues. Today, there is an innovative new technique in which a biopsy is performed on the embryo for confirmation before transfer to the uterus. For this reason, it is recommended that in vitro fertilization be performed only by specialized, recognized, and approved clinics staffed by fully qualified professionals, ensuring complete safety for the treatment. Before undergoing any procedure, confirm that the doctor is registered with the CRM and specializes in human reproduction, and is a member of the Brazilian Society for Assisted Reproduction, Human Reproduction, and the State Society of Gynecology. See also: Intrauterine Insemination – Advantages and Disadvantages