IVF and other Assisted Reproductive Technologies

Your treatment depends on your diagnosis. In women with regular cycles and open healthy tubes, the couple may need nothing more than well-timed intercourse if the husband has adequate sperm. Timing of ovulation can be done using a urine test kit at home, but ultrasound and blood tests around mid-cycle will provide the most reliable indicators.

In women with irregular cycles who have open healthy tubes, ovulation induction with fertility drugs (tablets or injections) may be tried if the husband has adequate sperm. Ultrasound and blood tests are useful to monitor response to the medication and can document that ovulation has occurred. Chances of conceiving with well-timed intercourse are enhanced if the fertility drugs produce regular cycles.

Artificial insemination, with or without ovulating-enhancing medication, may be a treatment option when sperm quality is border-line, provided the wife’s tubes are open. Again, ultrasound and blood tests will aid in timing the insemination.

Usually, a treatment may be tried for 3-6 cycles before going on to a more advanced option. For the past 25 years, in-vitro fertilization (IVF) and other Assisted Reproductive Technologies (ART) have been used successfully to overcome multiple fertility problems. IVF was originally devised for women with blocked or damaged tubes. IVF bypasses the tubes since  the mature eggs are taken from the ovaries, fertilized in the laboratory with the partner’s sperm, and cultured to embryos which are placed into the uterus 3-5 days after the eggs are taken out.  Fertility drugs are used to develop multiple mature eggs during the cycle, thus improving the chances for pregnancy.

Today, IVF also helps overcome male-factor  problems, ovulation dysfunction, endometriosis and unexplained infertility. It may be the best and most cost-effective option for many women trying to conceive after the age of 35, or for younger women who have diminished ovarian function (baseline FSH >15 over several cycles) and sub-optimal egg quality.

Experience with IVF has shown that a woman’s age is the single most critical factor in the treatment of infertility. In general, a woman’s reproductive capacity is greatly diminished after age 37, even in those who have not had fertility problems. Not only is it much more difficult for older women to conceive; they are also at increased risk to miscarry. Both problems arise  because their eggs are more likely to have abnormalities resulting in chromosomal defects which will produce defective embryos. Donor-egg IVF offers excellent chances of pregnancy and carrying to term for women between 40-45 who want to bear a child, or younger women who have premature ovarian failure or greatly diminished ovarian function.

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