Why IVF is done

In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less-invasive treatment options before attempting IVF, including fertility drugs to increase the production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in your uterus near the time of ovulation.

Sometimes, IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

• Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
• Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus, and fallopian tubes.
• Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with the implantation of the fertilized egg.
• Previous tubal sterilization or removal. If you've had a tubal ligation — a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy — and want to conceive, IVF may be an alternative to tubal ligation reversal.
• Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist determine if there are correctable problems or underlying health concerns.
• Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
• A genetic disorder. If you or your partner are at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.
• Fertility preservation for cancer or other health conditions. If you're about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.

Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman's eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier's uterus.

Why IVF is done

how to make ivf successful

 In vitro fertilization or IVF, effectively treats many causes of male and female infertility. IVF can be an excellent option for many patients who have struggled to get pregnant with other fertility treatments. It is an especially successful treatment for women with tubal issues, endometriosis, or polycystic ovarian syndrome. For women of advancing maternal age, IVF is also very successful with the use of donor eggs. Men with low sperm counts and couples with inherited diseases also benefit from IVF.

IVF has been around since the mid-1980s to treat couples experiencing infertility. Back then, the chances of bringing home a baby after IVF was a dismal 10%, less than what you would expect from Mother Nature at about 20%. Today, over 190,000 IVF cycles are conducted in the U.S., with average live birth rates of over 32% for women of all ages. Younger women with younger eggs have even better success, with live birth rates approaching 50%.

What has accounted for this incredible increase in success with IVF? Most notably are the new techniques that have arisen over the last several years that offer the possibility of improving a patient’s odds of having a baby through IVF. Let’s take a look at some of these success-boosting techniques.

 

Assisted Hatching

Sometimes viable embryos do not implant in the uterine wall simply because they are unable to break free from their surrounding “jelly coat,” called the zona pellucida. We perform assisted hatching in the lab right before embryo transfer using a laser to create a hole in the zona. This allows the embryo to “hatch” and make contact with the lining of the uterus and implant.

Intracytoplasmic Sperm Injection

We first used ICSI, or intracytoplasmic sperm injection, to treat cases of severe male factor infertility. In this technique, a single sperm is injected into the cytoplasm (interior) of the egg. Today, the use of ICSI is now routinely applied to a wide range of clinical situations whenever there is a possibility that fertilization may not occur. Such situations may include unexplained infertility or when frozen sperm samples survive their thaw poorly. Further, ICSI is used in any case where there is an extreme need to maximize normal fertilization, such as when a woman has only a few eggs retrieved.

“Freeze All Embryos” IVF Cycle

In the past, we preferred to perform fresh embryo transfers for most patients because the embryos had a better chance of implanting and developing into a baby than frozen embryos did. However, over the past several years, vitrification techniques for freezing and thawing embryos have improved so much that frozen embryos now have an equal or perhaps better chance of implanting than fresh embryos.

When there is a planned “freeze all embryos” IVF cycle, the developing embryos are frozen via vitrification and stored until they are transferred at a later time. This technique is especially beneficial for women at risk of hyper ovarian stimulation caused by the medications used to produce multiple eggs during the cycle. We have found that high hormone levels associated with ovarian stimulation might affect the lining of the uterus, making it less likely for the transferred embryos to implant. We see this particularly in patients who develop higher progesterone levels earlier in the ovarian stimulation cycle.

Preimplantation Genetic Screening (PGS)

PGS helps us answer the question of which embryos have the greatest potential to become a healthy pregnancy and baby. Humans have 23 pairs of chromosomes, inheriting one copy of each chromosome from either parent. When sperm fertilizes an egg, it creates an embryo which should consist of 23 chromosomes from the mother and 23 chromosomes from the father. But often, embryos are created with too many or too few chromosomes. This is a major cause of miscarriage and increases dramatically with maternal age. One of the most common examples is Down Syndrome, or Trisomy 21, which is caused by the presence of a third copy of chromosome 21.

PGS gives the patient two advantages. First, it allows us to be 99% certain the embryo has the correct number of chromosomes thereby increasing the chance for a healthy pregnancy. Second, it allows the patient to transfer only ONE embryo thereby decreasing the chance of twins (which have a much higher rate of complications). The pregnancy rate of transferring just one embryo that has undergone PGS and is deemed chromosomally normal is the same as transferring two embryos that are not tested.

 

how to make ivf successful

Gender selection with IVF

As Dr. Elena Trukhacheva, president and medical director of the Chicago-based Reproductive Medicine Institute, explains, once embryos are created in vitro, they are sometimes screened in order to choose the healthiest ones to implant into the mother's womb. Called Preimplantation Genetic Diagnosis (PGD), it's a complete chromosomal analysis of each embryo.

 

 

"The screening is in response to medical indications, such as multiple miscarriages or failed past IVF cycles, or advanced maternal age [over 35]," Trukhacheva says. "With a regular cycle, about 40 to 50 percent of implanted embryos will result in a healthy pregnancy. Using a screened embryo increases those chances to about 60 to 70 percent."

Trukhacheva says that if screening indicates that there are healthy embryos of both genders, about half of patients ask to choose the gender to implant. Trukhacheva doesn't have an ethical issue with gender selection at this stage, particularly because she has not seen a pattern of discrimination against one gender. "It's usually an issue of balance, that the couple has two boys and would like a girl, or vice versa."

 

gender selection with IVF

IVF success factors

Considering in IVF Then it’s important to learn about IVF success factors that can help or hinder your getting pregnant.

 

 

IVF Success Factor 1 – Age

Your age and using your own eggs are important IVF success factors to consider. While younger women have higher chances of IVF success, factors that reduce the chances of IVF success include being an older womanwith fewer eggs and the lower quality of an older woman’s eggs.

In fact, the live birth IVF success rate for women under 35 who start an IVF cycle is 40 percent. However, women over age 42 have a 4 percent success rate.

 

IVF Success Factor 2 – Previous pregnancy

 

More IVF success factors to think about include whether or not you were pregnant previously and if it was with the same partner.

If you were pregnant previously with the same partner that’s currently undergoing IVF treatment, there is a greater probability of IVF success. Factors such as a history of recurrent miscarriage or a different partner may reduce the chances of IVF success.

 

 

IVF Success Factor 3 – Type of fertility problems

While some male infertility problems do impact IVF success, factors like uterine abnormalities, exposure to DES or fibroid tumors also decrease the likelihood of success with IVF.

Very important to know: IVF success factors are dependent on ovulation. Ovarian dysfunction, like high FSH levels which indicate a low ovarian reserve, may reduce the chances of IVF success.  Factors that may lower pregnancy rates and reduce success with IVF include needing large amounts of ovulation stimulation drugs.

When both partners are infertile with lower chances for IVF success, factors such as the length of time you have been infertile is important to consider. The chances of IVF success decrease with the amount of time a couple has been infertile.

 

 

IVF Success Factor 4 – Use of donor eggs

Donor eggs are a significant consideration, especially if you are over 35-40, as there may be a higher rate of IVF success. Factors such as egg quality and age of donor are important. Using donor eggs from younger women may increase the chances of pregnancy for women over 40. 2011 findings show a 55 percent live birth success rate with a fresh donor egg/embryo transfer.

 

 

IVF Success Factor 5 – Lifestyle habits

Stop smoking if you want to improve your chance of having a baby. In fact, many times the woman is required to stop smoking at least 3 months before starting IVF treatment.

• Smokers require higher dosages of fertility drugs to stimulate their ovaries
• Smokers have lower implantation rates than nonsmokers
• Women who smoke require almost twice as many IVF attempts
• Women who smoke experience more failed fertilization cycles

More IVF success factors to mull over include losing weight if you are overweight or obese. Women who are overweight have an increased risk of infertility as well as miscarriage. Overweight women also have less IVF success with fertility treatments than women of normal weight. Underweight women are also at greater risk of having success with IVF. Bottom line: aim to stay within a healthy weight range.

 

 

IVF Success Factor 6 – Fertility clinic

The center you choose to perform the IVF treatment can greatly affect your IVF success. Factors to think about when reviewing the success rate of fertility centers include:

• The training and experience of the IVF clinic and staff
• The live birth rate per IVF cycles started
• The rate of patients pregnant with multiples (twins, triplets or more)
• The laboratory used by the clinic and the qualifications of their staff
• The types of patients accepted at the clinic, more specifically their age and fertility problem

Keep in mind that some clinics are more willing to accept patients with a lower chance of IVF success or they may specialize in particular treatments.

 

 

Know  your IVF success factors as you plan to get pregnant

Remember, just as with any chronic illness, knowledge is power with infertility. The more you learn about specific IVF success factors, the more control you will feel about high-tech treatments that help you get pregnant and start a family.

 

IVF Success factors

WHO NEEDS IVF?

Although its original intention was to treat women with tubal disease, in-vitro fertilization (IVF) can help couples overcome various types of infertility. For some diagnoses or conditions, such as tubal factor, IVF may be the first-line treatment. In other cases, IVF may be recommended only if simpler treatment fails. Below is a list of common indications for IVF treatment:

Tubal Factor (Damage to Fallopian Tubes) / Pelvic Adhesions

There are two options to treat patients with significant tubal damage and/or pelvic adhesive disease. The first option is to surgically repair the tubes and either get pregnant naturally or use Artificial Insemination or IUI to get pregnant. In many cases, however, surgery is not a good option as it may be very difficult to surgically fix the damaged tube(s) and/or the surgery may cause a high risk of an ectopic pregnancy. In these instances where the surgical option does not pose a high chance for success, the second option is to by-pass the tubes completely by using IVF as the treatment plan. Advanced Fertility Care Physicians will individualize the treatment plan for each patient or couple at our Mesa, Scottsdale and Glendale AZ offices, and if you have tubal damage, they will provide you detailed information on each option so that you can make an informed decision.

Endometriosis

Current scientific data about endometriosis shows that mild to moderate forms of endometriosis may be effectively treated with a combination of surgical and medical therapy. For more stages of endometriosis, including the presence of endometriomas, IVF is the optimal first line treatment and offers the highest pregnancy success rates.

Male Factor Infertility

One of the most significant advances in the treatment of infertility has been the ability for men with severe sperm abnormalities to achieve fertilization of the egg and successful pregnancy. IVF with addition of ICSI (Intracytoplasmic Sperm Injection) has enabled couples suffering from abnormal sperm, who would not otherwise be able to conceive, to be able to start a family. ICSI is often recommended if there is any suggestion of a sperm problem, if sperm are obtained surgically, or if there has been a prior failure of fertilization.

Diminished Ovarian Function & Age Related Infertility

During the course of woman’s normal reproductive life, her ovarian function decreases with age. In many cases, this reduced function can be overcome through the use of IVF alone, or in conjunction with techniques such as Assisted Hatching and ICSI. For some women, this decrease in ovarian function may start at earlier ages and requires aggressive treatment with IVF sooner rather than later.

Anovulation & Polycystic Ovarian Syndrome (PCOS)

The majority of patients with an ovulation and/or PCOS often conceive using less aggressive treatments such as ovulation induction with IUI. For some patients who are “high responders” to gonadotropin therapy, IVF offers an excellent prognosis and reduces some of the risks of higher order multiples.

Unexplained Infertility

Approximately 20% of couples will have no identifiable cause of infertility after completing a comprehensive evaluation. IVF is often successful even if more conservative treatments have failed, especially since some of these couples may have yet unidentifiable causes of infertility or sub-fertility.

Family Balancing (also known as Gender or Sex Selection)

For families that wish to have additional children of a particular gender after already having a previous child, PGD allows for selection of embryos to transfer based on gender. While not perfect, embryo biopsy with genetic chromosome determination prior to transfer of embryos can allow families choice in how they expand the family. Read more about PGD.

Genetic Diseases / Preimplantation Genetic Screening or Diagnosis (PGS or PGD)

One additional indication for IVF is to provide genetic testing on embryos prior to implantation. PGD or PGS is used for patients who are at risk for passing on genetic disorders to their offspring as a result of one or both of the partners being carriers for the disease. Diseases such as Cystic fibrosis and Thalassemia are 2 examples of the hundreds of diseases that can be tested for prior to embryo implantation. In addition, IVF with PGS is indicated for women with recurrent pregnancy loss related to chromosomal abnormalities or repeated failed IVF attempts. Learn more about PGD.

What is In Vitro Fertilization

In Vitro Fertilization (IVF) is a form of assisted reproductive technology (ART) that helps couples dealing with infertility conceive. The process involves extracting a woman’s eggs, collecting a sperm sample and combining the egg and sperm manually. After the egg and sperm have been combined in the laboratory, the embryo or embryos are transferred to the uterus. Although more costly, time consuming, and invasive than artificial insemination, IVF has excellent success rates for overcoming various types of infertility. Some of these include tubal factor, endometriosis, male factor infertility, age related infertility, diminished ovarian function, polycystic ovarian syndrome and unexplained infertility. Other implications for IVF are gender selection and preimplantation genetic screening for parents at risk for passing down genetic disorders.

 

There are additional options for IVF, like ICSI, PGD, assisted hatching, donor sperm, and a gestational carrier. Our goal is help you have a healthy baby, the least invasive, most cost effective way. The Advanced Fertility Clinic physicians will go over every possible option with you to guide you in making a more informed decision about the process that is right for you.

 

What is IVF?

IVF for male infertility

Sometimes, IVF for male infertility is the best treatment option. When the semen analysis is abnormal and identifies a male factor, it’s important to look for the cause. If the low sperm count appears to hormone-related, caused by an infection or related to a male anatomic abnormality, basic treatments may be used. If these do not work, or if it is a more severe case of male infertility, IVF is usually the treatment of choice.

Options other than IVF for male infertility

For hormonal imbalances like a low testosterone level, Doctor may choose medications like Clomid or fertility shots. The partners of men with decreased sperm counts and normal hormone levels will often undergo IUI. This is a simple and relatively inexpensive treatment for mild cases of male infertility.

Anatomical abnormalities that contribute to male infertility often require further evaluation by a urologist. Urologists are specialists regarding the male reproductive system. They will work with Doctor to determine what treatment is necessary.

If the sperm count is too low for IUI, IVF for male infertility may be the best treatment option. This treatment is a very successful option for couples with male factor infertility.

When do we recommend IVF for male infertility?

If a semen analysis reveals a very low concentration of normal sperm, Doctor often will recommend IVF for male infertility. This is because the chances of success are much better than with timed intercourse or IUI.

IVF is also a good option when there are multiple fertility factors, such as a low sperm count in combination with a blocked tube, difficulty in ovulation or advanced age of the woman. IVF can be the most effective treatment for couples in these situations by increasing the chance for fertilization of the egg.

The reason why is as follows:

How to Increase Chances of IVF Success

If you are looking to increase your chances of conceiving during IVF, here are 8 tips from 5 different fertility doctors.

 

1. Maintain a healthy weight.
"Maintaining a healthy weight is extremely important in fertility and IVF," says Linnea Goodman, MD, Assistant Professor of Obstetrics and Gynecology at the UNC School of Medicine. "We know that being obese (BMI >35) and underweight (BMI <19) increases time of conception by 2 and 4 times respectively, and negatively effects IVF success rates. Being overweight also makes monitoring the ovaries during IVF more difficult and increases the chance of complications during egg retrievals."

This is best implemented with changes in diet and activity with professional help.

"Working with dietitian, and in some programs enrolling in a cardio metabolic weight loss program can help achieve these goals," says Zaraq Khan, MD, reproductive endocrinologist at Mayo Clinic in Rochester, MN.

What are the risks of IVF?

IVF doesn't always result in pregnancy, and it can be both physically and emotionally demanding. You should be offered counselling to help you through the process.

There are also a number of health risks involved, including:

• side effects from the medications used during treatment, such as hot flushes and headaches
• multiple births (such as twins or triplets) – this can be dangerous for both the mother and the children
• an ectopic pregnancy – where the embryo implants in the fallopian tubes, rather than in the womb
• ovarian hyperstimulation syndrome (OHSS) – where too many eggs develop in the ovaries

Read more about  risks of IVF.

What happens during IVF

IVF treatment involves 6 main stages:

1. suppressing your natural cycle – the menstrual cycle is suppressed with medication
2. boosting your egg supply – medication is used to encourage the ovaries to produce more eggs than usual
3. monitoring your progress and maturing your eggs – an ultrasound scan is carried out to check the development of the eggs, and medication is used to help them mature
4. collecting the eggs – a needle is inserted into the ovaries, via the vagina, to remove the eggs
5. fertilising the eggs – the eggs are mixed with the sperm for a few days to allow them to be fertilised
6. transferring the embryo(s) – 1 or 2 fertilised eggs (embryos) are placed into the womb

Once the embryo(s) has been transferred into your womb, you'll need to wait 2 weeks before taking a pregnancy test to see if the treatment has worked.

 

What happens during IVF