As Election Day approaches, reproductive health care is receiving national attention. This includes a medical process that hopeful parents undergo to expand their families, called in vitro fertilization.

After the Alabama Supreme Court governed (PDF) earlier this year that embryos created through in vitro fertilization, or IVF, have the same legal rights as children, the legislators and medical providers continue to fight with the fate of reproductive health procedures involving embryos and fertilized eggs. Since 2022, when Roe v. Wade was overturnedWhether infertility procedures will remain available has become less certain depending on state laws.

IVF is the process of fertilizing an egg with sperm in a medical laboratory then implant the resulting embryo into someone’s uterus, in the hopes that it will continue to develop into a successful pregnancy and baby.

About 2% of all babies born in the United States each year are conceived through IVF, according to the U.S. Centers for Disease Control and Prevention, and their use has “more than doubled” in the past decade. But despite its growing popularity, IVF remains a complicated procedure, fraught with financial and sometimes emotional burdens for hopeful parents. It also sheds light on the nuances of human reproduction, whether it’s fertilization in a fallopian tube or conception aided by a little science.

“I think it’s important for people to understand that we as humans are not very efficient at reproduction,” said Dr. Asima Ahmad, chief medical officer of Fertility of carrotswrote in an email to CNET earlier this year. Many embryos created through IVF will not achieve a live birth because they will not continue to grow, or fail to implant in the uterus and continue as a pregnancy, for example.

Early Embryo losses are also common in “natural” conceptions, even before implantation, but unlike IVF, they often go unnoticed and can pass through the body even before the pregnancy is detected.

“There are a lot of things that have to align in the right way for a live birth to take place,” Ahmad said.

Learn more: For these personal finance influencers, infertility wasn’t part of the plan

People use IVF for many different reasons. These include cases of medical problems that make a natural pregnancy difficult, preserving childbearing at an age when pregnancy becomes more difficult, and the need for donor eggs or sperm to have a child.

In other cases, people may resort to IVF or freezing embryos to preserve their fertility if they are undergoing a medical procedure that may affect it, such as cancer treatment, or if they are having gender affirmation surgery.

How does IVF work?

Many steps go into IVF treatment – one of the reasons why is it so expensive – but essentially it is about spreading to the world a process that traditionally takes place in the fallopian tube, with additional reproductive assistance from doctors and embryologists when the patient or doctor performing the IVF procedure l ‘required.

Here’s how the process works, according to information from NYU Langone, Johns Hopkins Medicine And Penn Medicine.

Step 1: Collect the eggs

During the month before a natural conception, a single egg is released (sometimes two) during ovulation for possible fertilization and pregnancy. But when conception occurs outside the body, you need more eggs to work with, so you will need to do egg retrieval.

Egg retrieval requires the person using their eggs during pregnancy to receive a hormone injection that causes multiple eggs to mature instead of just one. (Many people who use IVF will use their own eggs to get pregnant, but some patients can find an egg donor or even a surrogate mother to carry the pregnancy through.)

To extract mature eggs from the ovary, you will go through a process called follicular aspiration, in which a very fine needle is guided through the vagina during an ultrasound. The device will suck up the eggs. You will receive medication for this part. (Fun fact: Human eggs are gigantic compared to other cells in our body.)

The number of times a person will need to undergo egg retrieval depends on several factors, including the reasons for their infertility and their age. The number of healthy eggs your body releases decreases with age, so an IVF patient in her 40s, for example, may need more eggs and cycles to have any chance of a successful pregnancy . But some people have higher or lower egg quality and quantity due to medical history or individual biology, as is the case with sperm, or step #2.

Step 2: Collect the sperm

Since much of the sperm production during conception takes place outside the body, obtaining sperm for IVF is less medically involved than egg retrieval. The person using sperm during pregnancy will likely be asked to refrain from ejaculating for a few days before collection to ensure a higher sperm count, and most clinics prefer your sample be returned to the office.

For those who do not produce sperm when they ejaculate, thus contributing to a case of infertility, sperm can sometimes be recovered during a minor surgical procedure, similar in theory to egg retrieval. Whether you donate sperm before or after egg donation will depend on you and your doctor.

Step 3: The lab fertilizes the egg

Once you have eggs and sperm, the next step in IVF (and where the procedure gets its name) is fertilization of the egg in the laboratory.

Shortly after the eggs are retrieved, an embryologist will fertilize the eggs, either by letting a sperm find its own way to the egg or by injecting a sperm directly into the egg (a process called intracytoplasmic sperm injection). The method used for you will depend on your reasons for using IVF or your laboratory.

Then everyone waits. It takes about 18 hours to determine if an egg has been successfully fertilized, then a few more days to see if the embryo is developing properly. In many cases, genetic testing of embryos is done to determine their health or their likelihood of giving birth to a baby.

Regardless of fertility status, not all fertilized eggs will result in a healthy embryo. Estimates of the number of people lost during natural conception seems to varybut up to half of fertilized eggs are lost quickly after conception. During IVF, these early losses and failure to conceive are literally put under a microscope.

According to Ahmad, the chances of getting pregnant, even in “the most fertile age group,” are about 25 to 30 percent per cycle.

Step 4: Healthy embryo implanted in the uterus

Once an embryo is selected and begins to develop, it will be transferred to a uterus so that the pregnancy continues normally during a period of the menstrual cycle where the uterine lining can successfully receive it. This is a relatively short procedure in which the embryo is released directly into the uterus through the cervix.

After some timepatients will know if the embryo was able to successfully pass the “hatching” process of integration into the uterine lining, which then triggers someone’s body to enter into pregnancy fashionhopefully resulting in a baby nine months later.

Step 5: Remaining embryos stored if requested

The Alabama trial from earlier this year centered on embryos stored by patients at a fertility clinic.

People often have “extra” embryos if they went through the early parts of the IVF procedure and were able to get pregnant. If someone wants to have more children in the future, they can keep these embryos. frozen in protective liquid with the use of liquid nitrogen whenever they are ready to try to get pregnant again. The cost of embryo storage varies depending on the clinic, but can costs at least a few hundred dollars per year, according to an estimate by ReproTech.

People may find themselves with stored or extra embryos that they do not know what to do with, have more embryos than originally planned, be unable to achieve pregnancy again for medical reasons, or decide not to implant embryos that tests deemed genetically abnormal or those that do not have a good chance of resulting in a healthy pregnancy.

If the embryos are not used or frozen, they are thrown away as medical wasteor they are transferred into someone’s uterus at a time in the menstrual cycle when pregnancy would not be possible. They can also be donated to science for research, and even to another person.

Whatever the choice, decide the fate of the remaining embryos created during IVF can be difficult for patients for a variety of reasons. The American Society for Reproductive Medicine, an organization in the field of reproductive science and medical practice, recognizes the “ethical concerns” that unused embryos pose to patients and the clinics that store them. The ASRM considers patient choice a “core value” of reproductive medicine and patients’ wishes regarding their embryos should be “respected where practical and within legal bounds.” The legal limits of what you can do as a patient depend on state laws, as well as individual fertility clinic protocols.

In general, patients have the power to decide how to proceed with their IVF journey, according to Ahmad, which involves transferring only “fresh” embryos and not storing any (frozen embryo transfer may be recommended by providers). doctors for different reasons, including a greater chance of pregnancy), and the need or not to do genetic testing. She notes that some fertility clinics may have individual protocols for freezing all embryos for testing or any other reason, but IVF choices should involve a benefit-risk discussion between patients and their doctors.

“Ultimately,” Ahmad said, “the goal is to achieve the best possible outcome for the patient.”