In vitro fertilization (IVF) 2025: indications, process, evidence, risks & decisions

Author photo
Zappelphilipp Marx•
Embryologist checking embryo culture under a microscope in an IVF lab

In vitro fertilization (IVF) is a standardized procedure in assisted reproduction. After hormonal stimulation, eggs are retrieved, combined with sperm in the lab, and the resulting embryos are transferred to the uterus. This article provides precise, level-headed guidance without hype: indications, realistic success factors, the clinical workflow, safety considerations, the role of add-on procedures, and how IVF differs from ICSI and IUI.

What is IVF?

Under controlled stimulation, multiple follicles mature. Mature eggs are aspirated, incubated with prepared sperm, and cultured further. A suitable embryo is transferred; additional good-quality embryos can be cryopreserved. A clear patient overview is available from the public health portal NHS.

Who is IVF suitable for?

  • Tubal factors (blocked or severely damaged fallopian tubes).
  • Endometriosis with a meaningful impact on fertility.
  • Unexplained infertility after several well-planned IUI cycles.
  • Selected male-factor issues when conventional IVF seems sufficient; with pronounced impairment, often ICSI.
  • Fertility preservation and donor treatments according to local law and medical counseling.

Principle: the method follows the diagnosis. Proceed stepwise, avoid unnecessary complexity, and document decision pathways.

Evidence & success rates

The chance of a live birth per cycle is mainly determined by age and egg quality, the cause of infertility, embryo quality, and the transfer strategy. National guidelines recommend discussing expectations by age and by center; figures vary across centers and cohorts. A sober overview of realistic expectations and avoiding unproven extras is provided by NICE.

Step-by-step process

  • Preparation: History, tests, infection screening; discuss alternatives, chances, and risks.
  • Stimulation & monitoring: Individual dosing, ultrasound and hormone tracking; active OHSS prevention.
  • Follicle retrieval: Collection of mature eggs under ultrasound guidance.
  • Semen collection/preparation: Selection of motile sperm; partner or donor sperm per standards.
  • Fertilization: Conventional IVF (co-incubation) or—when clearly indicated—ICSI.
  • Embryo culture: Assessment of development, possibly culture to the blastocyst stage.
  • Embryo transfer: Transfer of a suitable embryo; number according to guideline, age, and embryo quality.
  • Cryopreservation: Freezing of additional suitable embryos/eggs.
  • Luteal phase & test: Progesterone support; pregnancy test about 10–14 days after transfer.

Patient-friendly step-by-step information is also provided by an NHS center: Guy’s & St Thomas’.

Embryo culture & transfer

The goal is a healthy singleton pregnancy with the lowest possible risk. Where feasible, professional societies recommend single embryo transfer (SET) to avoid multiples. Guidance on embryo number and timing of transfer is provided by the European society ESHRE: Embryo transfer guideline.

Risks & safety

  • Stimulation: Ovarian hyperstimulation syndrome (OHSS)—less common thanks to modern protocols, trigger strategies, and “freeze-all”, but it still requires active prevention.
  • Procedures: Rare bleeding/infection after retrieval; post-transfer discomfort is usually mild and short-lived.
  • Multiple pregnancy: Higher risk when more than one embryo is transferred; hence SET is preferred.
  • Psychological load: Cycle-related stress is common; plan structured counseling and psychosocial support.

Public information bodies such as HFEA and the NHS recommend clear stop criteria when OHSS risk is present and a conservative number of embryos per transfer.

Lab add-ons: what’s supported?

Many add-ons do not reliably increase live-birth rates for most patients. The UK regulator assesses add-ons transparently and advises restraint without a clear indication: HFEA add-ons.

Comparison: ICI · IUI · IVF · ICSI

CriterionICIIUIIVFICSI
PrinciplePlacement of the sample near the cervixWashed sperm into the uterusEgg and many sperm in the labOne sperm is injected into the egg
Typical indicationEntry option without severe factorsUnexplained infertility, mild male factors, donor spermTubal factors, endometriosis, unsuccessful IUIPronounced male factor, fertilization failure
Per-cycle successRather low, timing-dependentModerate; depends on age/diagnosisHigher than IUI; age-dependentSimilar to IVF; advantage mainly with male factor
ComplexityLowLow–mediumMedium–highHigh (micromanipulation)
Main risksSmall; hygiene/testing are keyMultiple-pregnancy risk with stimulationOHSS, procedural risks, multiplesAs in IVF + potential cellular damage

Consequence: use ICSI selectively when clearly indicated; use IUI as a stepwise entry; if success is lacking, transition in a structured way to IVF/ICSI.

Planning & good practice

  • Clarify indication, alternatives, and goals transparently; discuss expectations by age.
  • OHSS prevention: measured stimulation, appropriate trigger strategy, consider “freeze-all” when at risk.
  • Prefer single embryo transfer to minimize the risk of multiples.
  • Assess add-ons critically and use only with a plausible indication; rely on transparent evidence.
  • Define switch criteria: number of cycles, adjustments, and possibly switching methods or pausing.

For guidelines and patient information, the NHS, NICE, and ESHRE are suitable sources. A small set of vetted references in the text is sufficient.

RattleStork – well-prepared decisions around IVF

RattleStork is not a clinic and does not replace medical advice. The platform supports personal organization: verified profiles and secure messaging, private notes on appointments, medications, and questions for the care team, plus simple checklists for conversations and decision-making. This keeps information together—from the first consult to embryo transfer.

RattleStork app showing verified profiles, secure chat, and private notes for IVF planning
RattleStork: Find community, organize information, make well-informed IVF decisions.s

Conclusion

IVF is an effective, well-standardized procedure. The main drivers of success are age, cause, embryo quality, and a cautious transfer strategy. Safety comes from modern stimulation protocols, clear OHSS prevention, single embryo transfer, and a critical approach to add-ons. Informed decisions and structured planning improve the chances—at the lowest possible risk.

Disclaimer: Content on RattleStork is provided for general informational and educational purposes only. It does not constitute medical, legal, or other professional advice; no specific outcome is guaranteed. Use of this information is at your own risk. See our full Disclaimer.

Frequently Asked Questions (FAQ)

The likelihood of success per cycle depends mainly on age, ovarian reserve, the cause of infertility, and embryo quality; lab quality, transfer strategy, and factors such as endometrial thickness and timing also influence outcomes, so centers often report age- and finding-dependent ranges rather than a single percentage.

In IVF, eggs are co-incubated with many sperm, whereas in ICSI a single sperm is injected directly into the egg; ICSI is used primarily for pronounced male-factor issues or prior fertilization failure and typically offers no benefit without such reasons.

In most situations, transferring a single embryo is recommended because it pairs the chance of a live birth with the lowest risk of multiples; multiple pregnancies raise maternal and neonatal risks and are therefore avoided whenever possible.

With blastocyst transfer, embryos are cultured to day 5 or 6 before transfer, allowing more precise selection; whether this improves success depends on the number of eggs, embryo development, and lab performance and is not equally advantageous for everyone.

A frozen embryo transfer can be beneficial when OHSS risk exists or when the uterine lining can be prepared more favorably in a later cycle; with good baseline conditions, a fresh transfer can be equivalent, and the decision depends on findings and the center.

Key risks include ovarian hyperstimulation syndrome, rare complications after retrieval, possible multiples when more than one embryo is transferred, and psychological stress; with a tailored protocol, single-embryo transfer, and close monitoring, risks can be reduced substantially.

Follicle retrieval is usually done under sedation and is generally well tolerated; mild cramping or pressure can last one to three days, and most patients resume daily activities soon if no complications occur.

A mid-course review is often done after two to three well-executed cycles with adequate embryo yield and an optimized luteal phase; depending on age, findings, and results to date, adjustments such as protocol changes, different triggers, embryo number, or moving to adjunct approaches may be considered.

PGT-A can aid selection in specific situations but does not consistently improve live-birth rates across all groups; benefit depends on age, number of embryos, lab quality, and the clinical question and should be weighed individually.

Many add-ons show no consistent benefit on live births in studies; they should be used only with a clear indication and after a transparent benefit–risk discussion, with evidence-based counseling being key.

With increasing age, egg quality declines and embryo aneuploidy rises, reducing fertilization, implantation, and live-birth rates; markers like AMH and antral follicle count estimate expected egg yield but do not reliably predict embryo quality.

Beyond quitting smoking and moderating alcohol, adequate sleep, regular activity, a healthy body weight, balanced nutrition, and stress reduction help; supplements should be targeted and used after medical advice.

With “freeze-all,” all suitable embryos are frozen and transfer is moved to a later cycle—for example to prevent OHSS, with suboptimal endometrial preparation, or when additional testing is planned; this approach can improve safety and ease planning.

Time-lapse systems allow continuous observation and can support embryo assessment, but a general benefit for live-birth rates is not shown for everyone; usefulness depends strongly on lab processes and selection algorithms.