It’s natural to have a lot of questions before starting in vitro fertilization (IVF). With everything going on — and trying to balance the appointments with your normal routine — it’s easy to feel overwhelmed. And equally easy to forget to ask an important question in the few minutes you get between appointments with your doctors.
To help guide you along your IVF journey, we answered some of the most commonly asked questions about IVF.
How many eggs will I get?
During your fertility testing, and at the start of your IVF cycle, you will have an ultrasound to measure the number of antral follicles (tiny fluid-filled sacs within the ovary that contain one egg each) you have. This count gives you a rough estimate of how many eggs you may retrieve during your cycle.
The injectable medications you use during IVF will help grow these follicles. Follicles must be at least 12mm for an egg to be retrieved, but doctors typically like to see follicles a lot larger. Research shows follicles between 17-19 mm are the most likely to have a mature egg inside.
It’s normal to not get a lot of eggs from your first round. In fact, most people, especially those over the age of 35, need more than one egg retrieval to bring a baby home.
What happens if an egg isn’t mature?
Eggs need to be mature in order to be fertilized. Sometimes, embryology labs can mature eggs that aren’t quite ready yet in the lab, but this isn’t always the case.
My doctor mentioned ICSI, what is that?
IVF is often used as a catchall to describe egg fertilization done in a lab, but if your partner has male factor infertility, your doctor may offer ICSI, intracytoplasmic sperm injection. The ICSI process looks nearly identical to IVF for you and your partner. You still need an egg retrieval and your partner still needs to provide a sample. The difference between the two happens in the lab. With ICSI, the embryologist picks a sperm to inject directly into an egg, manually fertilizing the egg. Some clinics offer ICSI as an add-on, even without male factor infertility, but research shows it only benefits fertilization rates for couples with male factor infertility.
How many eggs become embryos?
Unfortunately, not all eggs become embryos. While this is disappointing, it’s totally normal. A day after your egg retrieval, you will get a fertilization report. Typically, 80% of the eggs retrieved fertilize. The next report typically comes on day three. Most embryos that fertilize make it to day three. In the past, most embryos transfers occurred on day three, but today most labs have the ability to grow embryos to day five. Most clinics prefer to transfer embryos on day five, especially if you have a lot of day three embryos to choose from. Only 30-50% of embryos make it to day five. Although it may feel disappointing to see your embryo count drop significantly, the embryos that make it to this point are the ones more likely to succeed.
How many embryos can I transfer?
Twin, triplet, and higher-order pregnancies are high-risk pregnancies. To minimize the risk of complications, doctors typically prefer to transfer one or two embryos. If you are older or have had failed transfers, your doctor may be open to transferring two or more embryos depending on your medical history.
Reviewed by the Ovia Health Clinical Team
Sources
- Abbara, Ali, et al. “Follicle size on day of trigger most likely to yield a mature oocyte.” Frontiers in endocrinology 9:193. April 2018. https://www.frontiersin.org/articles/10.3389/fendo.2018.00193/full
- Murdock, Cynthia. “IVF Attrition Rate: Why Don’t All Eggs Create Embryos?” April 2020. https://www.rmact.com/fertility-blog/ivf-attrition-rate
- Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. “Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion“ July 2020. https://www.fertstert.org/article/S0015-0282(20)30523-9/fulltext
- Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. “Guidance on the limits to the number of embryos to transfer: a committee opinion.” July 2021. https://www.fertstert.org/article/S0015-0282(21)00563-X/fulltext
