For some couples IVF is the first-line treatment while in other couples IVF may be recommended only other infertility treatments fail.
IVF treatment was first used in 1978 in England to treat a woman whose tubes were closed and Louise Brown was the first baby born with this method. In the first years, IVF was developed and used to treat women with blocked, damaged, or absent fallopian tubes.
Tubal infertility is a common cause of infertility, affecting between 15 and 25 percent of women who try to become pregnant. The role of the fallopian tubes is to transport a fertilized zygote to the uterus for implantation, and this is an important step in the conception process. Because tubal problems are often asymptomatic, most women don't realize they suffer from this condition until they have difficulty conceiving. IVF treatment helps many women to conceive with fallopian tube problems, as fertilization of the egg and transportation of the zygote to the uterus is bypassed completely by IVF procedures.
Today, we use IVF as the first-line treatment in women whose fallopian tube is blocked, damaged, injured, blocked due to previous pelvic infections, a prior ectopic pregnancy (in which the embryo implants within the tube),adhesions from a previous surgery or severe endometriosis or hydrosalpinx (is a condition that occurs when a tube blocked and fills with serous or clear fluid near the ovary). Some women may also have congenital malformations or missing fallopian tubes.
Some man have very low sperm count, or low motility or abnormally shaped sperm may make fertilization difficult.
If a man have no sperm in his semen (azoospermia) IVF is the first-line treatment. In these couples we collect the eggs from woman and we take sperm from man by aspiration or surgery that is named as “PESA/TESA or TESE” procedure.
Or a male partner may have ejeculary problem. In these cases we take sperm from the testis and use these sperms in IVF.
In male factor infertility, such as low sperm count or other sperm abnormality, or in cases where sperm retrieved by TESA/TESE, intracytoplasmic sperm injection (ICSI) fertility technique is preferred, just one healthy sperm directly inserted in an egg during IVF.
When women age, the number and also quality of their eggs diminish, making conception difficult, if she is 41 years or older IVF is the best choice.
During the course of a woman’s normal reproductive life, her ovarian function gradually decreases with age. For some women, this reduction in ovarian function may begin at an earlier age. In younger women who has diminished ovarian reserve successful pregnancy rates are very low, it is best to have IVF immediately without wasting time.
Endometriosis is associated with an increased risk of having difficulty becoming pregnant, or infertility. Minimal to mild endometriosis is common and it is far more likely that most women have no difficulty conceiving naturally. With increasing severity of endometriosis (Grade III and Grade IV),scar tissue (adhesions) around the ovaries and fallopian tubes becomes more common and the chance of natural conception decreases
Women with endometriomas (endometriosis in ovary) have higher FSH levels, their anti-mullerian hormone levels (AMH),and antral follicle count (AFC) levels are lower suggesting impairment of ovarian reserve. IVF treatment offers the highest pregnancy success rates in the presence of endometriomas.
Preimplantation Genetic Diagnosis (PGD) is used for patients who are at risk for passing on genetic disorders to their offspring as a result of one or both of the partners being carriers for the disease. These are:
Monogenic/single gene defects (PGT-M), is used to identified embryos that have a specific genetic disease. PGT-M for essentially any single gene disorder for which the mutation is known, including very rare conditions. Diseases such as Cystic fibrosis and Thalassemia are 2 examples of the hundreds of diseases and after diagnosis that can be tested for prior to embryo implantation only healthy embryos are transferred to the womb.
Chromosomal structural rearrangements (PGT-SR): Balanced structural chromosome rearrangements such as reciprocal translocations, Robertsonian translocations and inversions are the most frequent chromosomal abnormalities in the general population. Although these individuals are phenotypically normal, they have an increased risk of fertility problems, recurrent miscarriages and producing offspring with congenital abnormalities and cognitive impairment.
Preimplantation Genetic Screening (PGS) is also reffered as PGT-A is recommended for parents who have no known genetic abnormalities, as well as patients who meet any of the following conditions:
In vitro fertilisation treatment is considered as a third-line treatment option for anovulatory PCOS with no other cause of infertility, if first- or second-line ovulation induction treatments are unsuccessful. IVF is a highly effective treatment with pregnancy rates reaching up to 70% from a single treatment cycle, especially in young women with a good ovarian reserve, and a 60% chance of a successful live birth there remain significant challenges with this treatment modality. The high risk of OHSS, multiple births and accelerated endometrial maturation are disadvantages of IVF.
Couples who have had difficulty becoming pregnant through natural means combined with fertility medications or intrauterine insemination (IUI) are often good candidates for in vitro fertilization. IVF is the most effective (and most expensive) treatment for unexplained infertility.
In world class IVF programs, women under age 35 transferring a single embryo can expect an IVF implantation rate (seeing a sac in the uterus with ultrasound after embryo transfer) of 55%. A recent important study showed that in women aged 38-42 with good egg quality, initial treatment with in vitro fertilization is the most cost effective and successful approach.