MedifocusHealth

Irrespective of the underlying cause of infertility, the treatment with the highest pregnancy rate per cycle is in vitro fertilization (IVF). Since this method of assistive reproduction technology was first introduced in the late 1970s, it has gained popularity worldwide. Currently, about 1.5% of all live births in the United States are the result of IVF.

In general, the IVF procedure involves the following steps:

• Ovarian stimulation with daily injections of gonadotropin medications to stimulate egg production.
• Retrieval of the eggs using ultrasound-guided transvaginal aspiration of follicular fluid.
• Fertilization of the recovered eggs by either:
  • culturing the eggs with an abundance of motile sperm, OR
  • injecting the eggs with a single sperm by means of a thin glass tube - a technique known as intracytoplasmic sperm injection.
• Culturing the embryos for either 3 days or 5 days
• Transferring the embryos to the uterus to promote growth and development. Extra, good quality embryos that have been cultured are often preserved by freezing (cryopreservation). The frozen embryos may be used at a later time if a successful live birth is not achieved with the initial IVF cycle.

Although IVF is considered to be a very effective treatment for infertility, the likelihood of a live birth per IVF cycle is only about 30%. The success of IVF treatment in women who serve as their own egg donor is influenced to a great extent by the woman's age. In general, the highest success IVF success rates (40% to 49%) are achieved in women who are younger than 35 years of age. After age 35, the live birth rate per embryo transfer drops by about 2% to 6% for each 1-year increase in the woman's chronological age. The likelihood of a successful live birth with non-donor eggs is only about 5% for women who have reached age 43. A woman's age, however, is not as critical for IVF performed with donor eggs obtained from healthy, young women with an average 50% live birth rate per embryo transfer.

Women who are considering IVF as a treatment for infertility should discuss the risks and benefits thoroughly with their OB/GYN prior to undergoing the procedure. Potential risks associated with IVF include:

• Multiple gestations - Women who undergo IVF are much more likely to have multiple gestations as compared to women who conceive naturally. Approximately 30% of pregnancies achieved by IVF result in twin gestations while about 3% result in 3 or more gestations. By way of comparison, the multiple gestation rate for women who conceive naturally is only about 1%.

• Risks for the infant - Regardless of the means for achieving pregnancy (IVF or natural), multiple gestations, in general, are associated with a significantly higher risk (23%) of premature births (<32 weeks of gestation) and a much higher risk (26%) for delivering a very low-weight infant (<1,500 grams). The risk for premature birth and delivering a very low-birth weight infant is also about twice as high for singleton pregnancies achieved by IVF as compared to singleton pregnancies achieved naturally.