By Francis Polansky, M.D.
Of all fertility treatments, In Vitro Fertilization provides the highest probability of conceiving with your eggs and sperm.
If you have not been able to conceive on your own and need fertility treatment, you may not require In Vitro Fertilization. On the other hand, if one or more of the following IVF indications apply to you, In Vitro Fertilization should likely be your next step.
- 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 likelihood of conception rapidly decreases.
A young couple who just stopped using contraception has between 20% and 25% probability 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% during the next cycle.
Most patients, based on the length of infertility alone, should consider IVF treatment after a year and a half to two years of infertility.
- Advancing age of the female partner
For most women, 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.
Most patients, based on the female age alone, should consider IVF treatment once they reach the age of 39. A large majority of women older than 43 will require donor egg IVF to conceive successfully.
- Presence of male infertility
It is believed that approximately 10% to 15% of all men are born with some degree of male infertility, and approximately 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. The diagnosis of male infertility is often facilitated by first excluding all possible female infertility factors.
Most couples with the diagnosis of male infertility will either be lucky and conceive on their own or will require In Vitro Fertilization. Intrauterine insemination (IUI) is typically no more successful than intercourse.
Most couples, based on the presence of male infertility alone, should consider IVF treatment.
- Presence of pelvic adhesions
In the past, pelvic adhesions (scars) and blockages of the Fallopian tubes used to be treated surgically (laparoscopy, laparotomy). Many of such surgeries were not successful, 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.
- Diagnosis of 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 underlining 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.
- Diagnosis of Polycystic Ovary Syndrome (PCOS)
Polycystic ovaries are by far the most common cause of 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 a multiple pregnancy by limiting the number of transferred embryos.
- History of multiple miscarriages
In Vitro Fertilization, possibly together with genetic testing of embryos, can be considered by patients with a history of recurrent miscarriages (three or more).
- History of unsuccessful ovarian stimulation and IUIs
If such treatment is recommended, there should be no more than 3 to 6 cycles of ovarian stimulation with oral medications with or without intrauterine inseminations. If such treatment was not successful, In Vitro Fertilization should be considered as a better alternative.
- History of unexplained infertility
Up to 25% of all infertile patients will have a diagnosis of unexplained (idiopathic) infertility. This diagnosis means that, in spite of exhaustive fertility evaluation, there is no apparent cause of infertility.
The majority of these patients do have infertility factor(s) involving the eggs, sperm, and the Fallopian tubes, but their testing has not yet uncovered this information. Infertility related to the egg quality factor represents most of the "unexplained" infertility since it is the most difficult one to diagnose.
In Vitro Fertilization is the most common treatment for patients with unexplained infertility.