21 September 2017

Is In Vitro Fertilization (IVF) The Right Option For Me?

 

Nearly 210,000 In Vitro Fertilization (IVF) cycles were performed in the US in 2015*. Over 5,000 of these cycles were carried out at Reproductive Medicine Associates (RMA) of New Jersey. IVF is a well-established and effective treatment option to help patients build their families. There are a variety of reasons for patients to undergo IVF, including age, blocked Fallopian tubes, male factor infertility, unexplained infertility, genetic disorders, chromosomal factors, ovulation problems, and endometriosis.

Many assume that IVF increases their risk of multiple gestation (twins, triplets, etc.) compared to other fertility treatments like intrauterine insemination (IUI). This assumption is incorrect.  The key factor that determines the risk of multiple pregnancies in IVF is the number of embryos transferred. IVF with single embryo transfer can result in excellent success rates with the lowest risk of multiple pregnancies compared to other treatments.

At RMA of New Jersey, over 80% of our embryo transfers are single embryo transfers. While our single embryo transfer percentage is well above the national average, we continue to have success rates that are among the highest in the US. One of the biggest reasons we achieve great success while transferring fewer embryos is the use of comprehensive chromosomal screening (CCS) to find the embryos most likely to implant and result in a live birth and perform single embryo transfer of the embryo most likely to result in a healthy baby.

When trying to consider whether IVF is the right treatment for your specific circumstance, you should ask yourself a few questions:

Do I (or does my partner) have any conditions that would prevent sperm and egg from being able to meet in my fallopian tube?

Since fertilization normally occurs in the fallopian tube, a tubal blockage would make it impossible for sperm and egg to meet. Blockages could be due to previous infections, including chlamydia and pelvic inflammatory disease (PID). Tubal blockage could also occur due to adhesions from previous surgeries or endometriosis. It could also be the result of bilateral tubal ligation (having your tubes tied).

We see many patients who had their tubes tied in the past but are now in a situation where they want to have children. On the male side, an abnormal amount of functional sperm can prevent fertilization in the fallopian tube. A low sperm count, low motility, or an abnormal amount of normally shaped sperm can result in the inability to have enough sperm reach the tube to successfully fertilize an egg. Men with prior vasectomies who do not wish to have a vasectomy reversal are also candidates for IVF, using surgically extracted sperm.

Do I have time to attempt less successful treatments such as intrauterine insemination (IUI)?

Age is the most important factor that determines success rates in fertility treatment. The time it takes to achieve a successful pregnancy (live-born baby) is extremely important, especially in women over 35. The number of eggs in a woman’s ovaries decreases over time. Also, the quality of the eggs (their ability to result in healthy embryos when fertilized) decreases with advancing age. IVF may shorten the time to a successful outcome in many cases.

Have less aggressive treatments been unsuccessful?

Many patients and physicians prefer to start with less aggressive treatments before considering IVF. For many patients, this is perfectly appropriate. However, if less successful treatments have been unsuccessful it may be time to think about IVF. Women with endometriosis are less likely to conceive with less aggressive treatments than women without endometriosis and should think about IVF early in the treatment process. According to the RESOLVE.org website, endometriosis impacts an estimated three to five million American women of reproductive age.

Women with ovulation problems, including polycystic ovarian syndrome (PCOS) are often treated with oral medications like clomiphene citrate (Clomid) or letrozole (Femara) to help ovulation to occur. While this is a successful strategy for many women, it does not work for everyone. Many of these patients consider the use of injectable fertility medications (like Gonal-F or Follistim) with or without IUI after being unsuccessful with oral medications.

While success rates increase slightly with injectable medications with IUI, the risk of multiple gestations (including triplets or more) increases dramatically. IVF with elective single embryo transfer (eSET) is a more successful treatment option in this setting. An article published on WebMD back in December of 2010 also states that “Women undergoing in vitro fertilization (IVF) are nearly five times more likely to carry a baby to term if they undergo a single embryo transfer instead of a double embryo transfer.” Live birth rates are more than doubled (compared to injectable medications and IUI) and the risk of multiples is greatly reduced.

Do I have a genetic predisposition to have a child with a serious medical condition or a predisposition to have recurrent pregnancy loss?

There are many diseases that occur due to alterations or mutations in one of the more than 20,000 genes in the cells in our bodies. If you and/or your partner are known to be at risk of passing on a mutation to your children, IVF can be used as a strategy to prevent the transmission of that disease. Embryos created via IVF can be biopsied and have testing done to determine whether the embryo inherits the abnormality. Selective transfer of embryos that test negative for the abnormality greatly reduces the risk of having a child affected by the condition.

The doctors at RMA of New Jersey excel at recognizing patients who would benefit from IVF. We would be happy to discuss IVF with you if you think that it may be a good option for you, or if you would like additional information feel free to contact us by phone 973-656-2089 or email PServices@rmanj.com.

*SART – 2015 Preliminary CSR National data for 2015 based on 209,336 total cycles. For more information visit Sart.org.

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