Who needs in vitro fertilization (IVF)?
At the Gundersen Health System Fertility Center, we understand the decision to pursue in vitro fertilization (IVF) is a personal one. There are a number of reasons you may need to explore IVF as an option. IVF is often used only after other forms of fertility treatment have not resulted in pregnancy or other treatments are not an option. Here, you'll find information on the most common types of infertility that can lead to the use of IVF.
Treatment options such as IVF are best explained in greater detail in person. Do not hesitate to contact the Gundersen Fertility Center at (608) 775-2306 or (800) 362-9567, ext. 52306, for more information.
What is IVF?
IVF is the best known assisted reproductive procedure in which eggs collected from the woman's ovaries and sperm collected from the man are joined together in the lab to form embryos. Two, sometimes three, embryos are transferred to the woman's uterus to hopefully establish a pregnancy.
IVF is the treatment of choice when a man has moderate to severe infertility. While other treatments, such as intrauterine insemination (IUI) and gamete intrafallopian tube transfer (GIFT), are available, they are not very effective when it comes to treating moderate to severe cases of male infertility.
With the relatively recent introduction of intracytoplasmic sperm injection (ICSI), the use of IVF for male infertility has become as successful as when used for the treatment of female-related infertility. ICSI involves injecting a single sperm directly into each egg to achieve fertilization.
Post vasectomy, blocked or missing tubes, no ejaculation
Sperm can be surgically retrieved and used in IVF in cases where the man cannot ejaculate sperm, yet sperm production is occurring, such as in cases of a vasectomy or blocked or missing tubes.
A vasectomy reversal can often work when done a relatively short time after the vasectomy. However, many years after a vasectomy, the scarring may have gotten bad enough that it cannot be reversed, and antisperm antibodies are also likely to be an issue. IVF is the treatment of choice in this situation.
For men with congenital absence of the vas deferens, sperm retrieval with ICSI and IVF is also the only treatment.
Tubal damage, pelvic inflammatory disease (PID) and pelvic adhesions
In the early 90s, IVF birthrates began to improve to the point that tubal surgery for the treatment of infertility due to tubal problems rapidly became obsolete. IVF performed in an optimum setting offers more than double the birth rate following a single month of treatment than what can be achieved within two or three years following surgery.
Post tubal ligation
Certain types of tubal ligation are reversible, and some are not. If too much tube has been damaged in the ligation process, the tube cannot be repaired. The woman’s age, as well as how many children the couple would like to have, can also play a factor in the decision to use IVF versus having surgery.
Endometriosis is associated with the presence of "toxins" in the pelvic secretions that surround the fallopian tubes. Regardless of whether fertility drugs are used, or whether IUI is performed, the egg(s) will inevitably become exposed to "toxic" pelvic secretions as they enter the fallopian tube(s). That means these options can be ineffective in the treatment of endometriosis-related infertility. Only IVF and GIFT, where eggs are extracted from the ovary(ies) before they come in contact with pelvic secretions, bypass this problem and, therefore, represent treatments of choice for some patients with endometriosis.
Infertile women approaching menopause need to be proactive. Data reported at the American Society for Reproductive Medicine meeting in 2003 showed that for women 40 years old or older, their fastest method of conception is IVF. The birth rate (with own eggs) in IVF centers of excellence for women between 40 and 43 years can reach 20 percent per cycle of treatment when they can produce enough good quality eggs. Women who are unable to produce enough good quality eggs should consider IVF using an egg donor where the comparable birth rate per cycle can be expected to be above 50 percent, provided the egg donor is under age 35.
Other reasons for IVF
When there is no apparent cause for infertility and the woman is over 35 years of age and/or when the couple has failed to conceive using other types of treatment, IVF becomes the treatment of choice. It is possible that IVF treats yet unknown causes of infertility. IVF may even contribute to the diagnosis of the problem.
Almost 40 percent of infertility (when unrelated to a man's infertility) is associated with one or more immunologic problems that compromise the embryo implanting in the uterus. This requires extensive and often expensive immunotherapy. Because of the cost and extensive nature of immunotherapy, and the fact that some therapies must be repeated in a short amount of time, IVF is a favored method to achieve pregnancy. In these cases, IVF is the most effective form of treatment when looking at per cycle pregnancy rate. The immunotherapy treatment can be given early in the IVF cycle for maximum effectiveness.
Recurrent failure with intrauterine insemination
IVF becomes the treatment of choice if three or more intrauterine insemination (IUI) gonadotropin-stimulated cycles (where ovulation was successfully induced and sperm counts were acceptable) do not result in a viable pregnancy. If sperm counts have been poor during IUIs, IVF is absolutely needed. Even with good sperm counts, there could be more to the male-factor infertility than can be discovered by current testing. The situation can also be much like unexplained infertility or may have an immunological component, both of which can be addressed by IVF.
Couples in need of preimplantation genetic diagnosis
For couples that suffer recurrent pregnancy loss or the inability to conceive due to a genetic abnormality, preimplantation genetic diagnosis (PGD) during IVF can lead to a healthy baby. Other problems that can be addressed by PGD are hereditary diseases such as cystic fibrosis or Tay-Sachs.