IVF is a reproductive technology in which an egg is removed from a woman and joined with a sperm in a test tube (in vitro). The fertilized egg is then placed in the woman's uterus.

Which infertile couples should consider IVF?

"Women with tubal damage or blockage, endometriosis and unexplained infertility after exhausting alternative therapies are just some of the women IVF can help," says Dr. Carl Herbert, co-director of the San Francisco Fertility Centers in San Francisco, Calif.

Herbert cautions that this procedure is not advisable if pregnancy is contraindicated for any reason. The San Francisco Fertility Centers use detailed guidelines to evaluate which women are likely to conceive using IVF. In many cases, your physician can determine whether in vitro is right for you.

Kathy Anderson, of Park City, Utah, turned to IVF after eight failed attempts at artificial insemination (a procedure in which a small tube is used to place sperm inside the uterus) and a failed adoption. In Anderson's case, her eggs fertilized successfully, but then a chemical imbalance prevented her embryos, or fertilized eggs, from developing. In vitro helped her embryos grow and develop and she soon found herself the thrilled mother of twin boys.

He adds that preparations for IVF are the same as planning for any pregnancy:

• eating a good diet
• decreasing or eliminating caffeine, alcohol or other possibly toxic exposures
• avoiding excessive exercise
• stopping smoking

When couples start the IVF process they give a detailed medical history and then undergo various tests. If the man's semen reveals abnormalities the couple may decide to use donor sperm.

The next step is to medically stimulate the women's ovaries to produce eggs. As soon as the eggs are mature, the initial medication is stopped and another medication is administered to prepare the eggs for ovulation and fertilization. Once the eggs are ready for retrieval, the woman is sedated through a small tube in her arm. She isn't completely asleep but she's comfortable as the eggs are retrieved with the help of ultrasound guidance. Harvested eggs are sent to the IVF lab.

"The procedure takes about 30 minutes and discomfort is generally minimal," Herbert says. He adds that complications are rare due to the use of the ultrasound, and recovery after the procedure is rapid.

This may be an emotional time for the couple and it's also the time for big decisions. The couple and doctor decide how many embryos to transfer since multiple pregnancy may result from multiple embryos.

After this decision is made, the physician introduces a small flexible tube into the woman's uterus and the embryos are released. "No anesthesia is needed for this process and it feels similar to a pap smear," Herbert says. "Although we encourage our patients to rest at home after the embryo transfer, there is no proven advantage to remaining horizontal for that time. Embryos do not fall out of the uterus and lying flat does not enhance implantation."

Two weeks after the egg retrieval procedure the woman undergoes a pregnancy blood test. If she's pregnant the pregnancy is confirmed by ultrasound 2 to 4 weeks later.

Pregnancy rates for IVF vary. "Success rates for IVF, like all fertility treatments, are closely linked to the age of the woman producing the eggs," Herbert says. "Pregnancy rates for women in their 20s, many of which are egg donors, are approximately 50 percent per embryo transfer. Pregnancy rates for women over forty are usually no better than 20 percent per embryo transfer."

At $11,000-plus per try, IVF is expensive and only covered by some insurance companies. If you're considering this procedure, ask for a cost estimate since expenses can vary. For example, IVF medications can cost $1,800 to $6,000.

Anderson encourages couples to look at the big picture: Decide how many times to try in vitro and think up an alternate way to have a family in case it doesn't work. Looking back on her IVF experience and her failed adoption, Anderson recalls that when she first held the baby she hoped to adopt, she felt the same intense love that she felt after giving birth to her boys. The truth is: Parental love begins in many different places. But more often than not, it grows just the same.