When IVF May Be the Right Choice
Most people know at least something about in vitro fertilization (IVF) these days. Maybe someone in your family or someone you work with has had fertility treatment and through IVF was able to have a baby. Many celebrities have had children with the aid of IVF and other fertility treatments, although not all of them are open about their treatment.
According to experts IVF is rarely the first treatment used for infertility, but it is the go-to option for a number of different conditions. Depending on your or your partner’s diagnosis and on your age, IVF may be the best way to be sure you get the family you want. IVF puts the egg and sperm together in a laboratory and then transfers the embryo to the woman’s uterus, getting around a number of different reproductive problems. Let’s look at some of the common diagnoses for which IVF may be recommended.
Female Infertility Issues
For women, it’s all about producing the egg and moving it to the uterus where the sperm can fertilize it. Then if all goes well, the fertilized egg becomes an embryo, is implanted on the wall of the uterus and grows. Anything that interferes with this process is a potential cause of infertility.
In the female partner problems with the uterus or fallopian tubes may cause fertility issues. Endometriosis can cause scar tissue which blocks the fallopian tubes or adheres to your ovaries. It is one of the most common causes of infertility, and 30 to 50 percent of women with fertility problems have endometriosis, according to the American Society for Reproductive Medicine (ASRM.) In other cases the fallopian tubes may not be blocked but they may not be able to move the egg along to the uterus where it can be fertilized. With IVF, eggs are extracted directly from the ovaries and fertilized in the lab, so problems with the fallopian tubes are avoided.
Problems with ovulation are another cause of infertility
Your fertility doctor will schedule blood tests to evaluate your levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) which cause your eggs to ripen and detach from the ovary. Age is a factor in ovulation problems—women 35 or over are more likely to have issues with producing good quality eggs. IVF can help with this, in that the woman’s ovaries are stimulated by fertility drugs to produce multiple eggs, which can then be fertilized in the lab. IVF also gives greater control over the possibility of multiple births than use of fertility drugs alone, since you and your fertility specialist decide how many embryos to implant in your uterus.
IVF also makes it possible to use donor eggs from a younger donor which greatly improves your chance of getting pregnant if you are 40 or over. Polycystic ovary syndrome (PCOS) is a hormone-related condition in which the ovaries are often enlarged and have small cysts, hence the name “polycystic.” Difficulty getting pregnant is often an effect of this condition. There are other treatments for PCOS which your doctor will recommend first, but if they are not effective, IVF may be recommended.
Male Infertility Issues
For men, it’s all about the sperm—producing healthy sperm and getting them into the woman’s uterus so one of them has a shot at fertilizing an egg. A number of things can go wrong with this process and cause infertility.
Low sperm counts, sperm which can’t penetrate the egg or survive in the uterus’s mucus, inability to have intercourse, or blockages in the tubes which allow sperm to mix with the semen are all diagnoses which may make IVF the treatment of choice. If necessary the man’s sperm can be extracted from his testicles, bypassing blockages, and used to fertilize eggs in the lab. In cases where the sperm count is low or there are abnormalities which prevent the sperm from penetrating the egg, IVF with ICSI (intracytoplasmic sperm injection) may be recommended. A single sperm is injected into the egg to fertilize it in the lab.
Fertility Preservation for Women and Men
Hundreds of thousands of people in the U.S. who are of reproductive age are treated for cancer every year. Cancer treatment can affect fertility by destroying eggs and sperm. Of course the first goal is to cure the cancer, but there are steps you can take to preserve your ability to have a family down the road when you are cancer-free.
For women, if time and circumstances allow, you may have IVF treatment and freeze embryos so you can get pregnant later on. If IVF is not optimal for you, it is possible to collect your eggs as if for IVF but freeze the unfertilized eggs for later use. This is a newer procedure which may also be used by young women who are not undergoing cancer treatment but want to be sure they have their own healthy eggs available when they are ready to start a family. The eggs would then be thawed for use with IVF.
For men, sperm samples can be frozen and stored at a sperm bank or fertility center. Sperm samples can be stored for years and used later for artificial insemination or IVF.
Preimplantation Genetic Diagnosis
Couples who have experienced recurrent miscarriage or unsuccessful IVF cycles or who are at risk of carrying inherited genetic diseases may be candidates for IVF with preimplantation genetic diagnosis (PGD.) This state-of-the-art procedure is performed on embryos to select embryos for transfer which are free of any chromosomal abnormalities and certain genetic disorders. These genetic conditions can prevent the embryo from implanting and growing to a healthy baby. PGD can only be performed in the laboratory as part of an IVF cycle. PGD may also be used for sex selection.
What if you and your partner have been through all the testing, and nothing seems to be wrong, but you still can’t get pregnant? A diagnosis of unexplained infertility is not the end of the world. Most of these cases resolve over time with a healthy pregnancy. If you are older and time is a factor, your fertility specialist may discuss how IVF can help.