Is It Time to Consider IVF?

You have “tried” too long

There is no distinction between having unprotected intercourse and “trying” to conceive. They both represent “exposure” to conception. With each passing cycle without a pregnancy, the probability of conception rapidly decreases.

A young couple who just stopped using contraception has a 20% to 25% likelihood of conception during the first cycle (month) of “exposure.” After a year, during the 13th month, the probability decreases to approximately 1.5%. After two years, it becomes approximately 0.1% (1 out of 1,000 couples) during the next cycle.

Based on the length of infertility alone, most patients should consider IVF treatment after a year and a half to two years of infertility.

Advancing age of the female partner

For most women, their fertility peaks in their mid-twenties. Starting around the age of 32, the quality of the remaining eggs within the ovaries begins to decline. By the age of 39, for most women, the quality of their remaining eggs will make it difficult or even impossible to conceive on their own or with “low tech” (oral medications, IUIs, etc.) fertility treatments.

Based on the female age alone, most patients should consider IVF treatment once they reach the age of 37. Most women older than 43 will require Donor Egg IVF to conceive successfully.

Male infertility

It is estimated that approximately 10% to 15% of all men are born with some degree of male infertility, and nearly one-third of the time, a couple’s infertility can be solely attributed to male factor infertility.

For most men, there is no completely reliable test to assess male fertility. Diagnosing male infertility is often facilitated by excluding all possible female infertility factors.

Most couples diagnosed with male infertility will either be lucky and conceive on their own or will require In Vitro Fertilization. Intrauterine insemination (IUI) is typically no more effective than intercourse for male factor infertility.

Pelvic adhesions

In the past, pelvic adhesions (scars) and blockages of the Fallopian tubes used to be treated surgically (laparoscopy, laparotomy). Many such surgeries were unsuccessful, and there is an increased risk of an ectopic (tubal) pregnancy afterward.

In Vitro Fertilization is now considered to be the most appropriate treatment for pelvic adhesions and tubal blockages.

Endometriosis

There is a lack of consistent scientific evidence that surgical or medical removal of endometriosis increases the probability of pregnancy. This has led some clinicians to believe that endometriosis is merely a sign of another underlining cause of infertility.

The most appropriate treatment for endometriosis depends on the underlying cause and the length of infertility. If you are 39 or younger (female partner) and have been sexually active without contraception for 18 months or more, you may need In Vitro Fertilization to conceive. Women 39 years and older should consider IVF treatment after only three months of no contraception.

Polycystic Ovary Syndrome (PCOS)

Polycystic ovaries are by far the most common cause of irregular menstrual periods and the lack of ovulation (anovulation).

The term “polycystic” refers to the increased number of ovarian follicles (not cysts) present within the ovaries of most women with PCOS.

In Vitro Fertilization is the recommended treatment for women with moderate and moderately severe degrees of PCOS. It allows for precise modulation of ovarian stimulation and minimizes the risk of multiple pregnancy by limiting the number of transferred embryos.

Multiple miscarriages

In Vitro Fertilization, possibly with the addition of preimplantation embryo genetic testing (PGT), may be considered by patients with a history of recurrent miscarriages (three or more).

Unsuccessful ovarian stimulation and IUIs

If such treatment is recommended, there should be no more than 3 to 6 ovarian stimulation cycles with oral medications with or without intrauterine inseminations. In Vitro Fertilization should be considered a better alternative if this treatment is unsuccessful.

Unexplained infertility

Up to 25% of all infertile patients will be diagnosed with unexplained (idiopathic) infertility. This diagnosis means that, in spite of exhaustive fertility evaluation, there is no apparent cause of infertility.

Most of these patients have infertility factor(s) involving the eggs, sperm, and Fallopian tubes, but their testing has not uncovered this information. Infertility related to the egg quality factor represents the most “unexplained” infertility since it is the most difficult to diagnose.

In Vitro Fertilization is the most common treatment for patients with unexplained infertility.