Is it time for IVF?

There is no one standard answer to this question for all patients because individual circumstances determine the best family building option.

What we do know however is that ultimately the single most important predictor of success when using assisted reproduction is the age of the egg provider.

The standard definition of infertility is 12 months of unprotected intercourse without a pregnancy. This is generally the definition used when recommending that people seek the help of their primary physician or gynecologist. This may well be a good recommendation when the egg provider is young, under 35, and there are no obvious factors already known like low sperm parameters, damaged fallopian tubes or endometriosis. With everything normal as in open tubes, normal sperm parameters and regular ovulation with age of eggs under 35, the monthly pregnancy chance of natural conception is approximately 16 percent per month for the first six to eight months of trying.

If however you are over the age of 35, time becomes a major factor, and moving on to assisted reproduction becomes imperative.

The steady decline in the number of eggs from approximately 6 million in the fetus to 300,000 at the onset of puberty, coupled with the increase in the incidence of chromosomal abnormalities with increasing age of the egg after 35, explains scientifically why fertility potential declines as rapidly as it does with increasing age.

Unlike sperm which continues to be produced anew every three months well into old age, a woman is born with all the eggs that she will ever have. By the time the eggs reach age 35, there is a clear measurable decrease in the chance of a successful birth which is mirrored by an increase in chromosomal abnormalities.

The following situations should prompt more rapid consideration of assisted reproductive techniques like IVF. The reason for accelerating the process relates directly to the decreasing success as the eggs become older. For example, if there are already known factors that decrease the natural chance of pregnancy like low sperm or damaged fallopian tubes, continuing on with a treatment that carries a very low chance of success just postpones the time at which IVF is performed. This may decrease the overall chance of having a baby together with one’s own eggs and sperm. These following factors should prompt early evaluation of IVF as the best option for treatment:

  • Age of egg provider > 35 years
  • Known factors like damaged tubes, low sperm parameters, endometriosis or Polycystic Ovarian Syndrome (PCOS)
  • No known factors but trying for more than one year.
  • More than 3 failed ovulation inductions with clomiphene citrate/injectable medications with IUI.
  • Recurrent pregnancy loss after correction of immunological factors.
  • Known single gene genetic factors within the family like cystic fibrosis, Tay-Sachs or thalassemia.
  • Known genetic problem like translocation causing recurrent pregnancy loss.

If any of the above factors apply to your situation, then you may be better going directly to IVF sooner rather than later.

Patients on ovulation induction using clomiphene citrate or injectable fertility medications with intra-uterine insemination (IUI), often ask when it is time to move on to IVF. Eighty five percent of pregnancies that result from IUI, happen within the first three cycles, and whether it is with clomiphene citrate or injectable fertility medication, we do not recommend more than three cycles of each before moving on to IVF.

If you are over 35, you may want to wait no longer than 6 months before seeking fertility advice.

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