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IVF Series, part III: When should IVF be done? Why would IVF be recommended?

IVF Series, part III: When should IVF be done? Why would IVF be recommended?

Catherine Poslusny | February 18, 2020 | trying to conceive

Deciding whether or not to pursue in vitro fertilization (IVF) is one of the biggest choices that you’ll make when you’re trying to conceive (TTC). For some people, it’s only recommended after at home fertility tracking and less-invasive fertility treatments, such as intrauterine insemination or fertility drugs, have failed. 

Since its invention in the 1970s, IVF has helped couples overcome infertility (whatever the cause), but the step isn’t one to be taken lightly. The process can be trying, both emotionally and financially, and there’s no way to guarantee success. Still, IVF represents hope for many who are TTC. In this post, we’ll take a look at some of the top reasons that doctors recommend IVF.

 

Fallopian tube damage or blockage

Your fallopian tubes are like your eggs’ private highway to your uterus. If they’re blocked or damaged, that makes the journey difficult, if not impossible, for the egg. If an egg is fertilized in the fallopian tube and cannot get to the uterus, it can lead to a dangerous condition called ectopic pregnancy (1).

Fallopian tube damage can be caused by factors including:

  • Abdominal or pelvic infections 
  • Surgery in the abdomen or pelvis
  • STIs, such as gonorrhea or chlamydia
  • Endometriosis

Some women may be eligible for surgery to repair damaged fallopian tubes but, for others, IVF may be the best option to help them get pregnant (1).

 

Ovulation disorders

Irregular or absent ovulation is one of the most common causes of infertility in women (2). If you don’t ovulate every cycle that cycle is anovulatory, and it means there’s no egg in the fallopian tubes for the sperm to fertilize. If you do ovulate, just on an irregular schedule, you may have a hard time pinpointing your fertile window accurately during each menstrual cycle.

 

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Ovulation is regulated by your hypothalamus (a part of your brain), ovaries, and glands, including your pituitary gland, thyroid gland, and adrenal glands. Sometimes, your doctor may recommend medication to regulate your ovulation and help you conceive. Other times, IVF may be your best bet (3).

 

Male-factor infertility

Male-factor infertility contributes to an estimated two-thirds of all infertility cases (4). For men, fertility is dependent on sperm quality and quantity, so infertility is mainly evaluated and diagnosed using semen analysis. It can be hard for couples to conceive naturally if:

  • Sperm counts are low
  • Sperm has low motility (movement)
  • Sperm morphology (shape) is abnormal
  • Sperm is unable to penetrate an egg
  • Sperm is absent from a man’s ejaculation (azoospermia) 
  • There is a history of a vasectomy

IVF can give couples with male-factor infertility a chance to get pregnant that they wouldn’t have otherwise. Sometimes, a process called intracytoplasmic sperm injection (ICSI) may be needed in conjunction with IVF procedures. During this procedure, a doctor uses a tiny needle to inject a single sperm into eggs harvested for IVF (5).

 

Endometriosis

Over 11% of American women between the ages of 15 and 44 are affected by endometriosis, a condition in which tissue similar to the endometrium (uterine lining) starts to grow outside of the uterus. Endometriosis can be painful, and it may affect the function of the ovaries, uterus, and fallopian tubes (6). Researchers are still trying to figure out exactly why endometriosis causes infertility. Some existing theories suggest that this condition may:

  • Cause the immune system to attack the embryo
  • Keep the endometrium (where a fertilized egg is implanted) from developing correctly
  • Cause changes to the shape of reproductive organs that make it harder for a sperm to find an egg 

Endometriosis is thought to be a contributing factor in half of all women that experience infertility (7). For some women, surgery to remove endometrial growths may increase the chances of conception. For others, IVF may be the best option (6).

 

Limited egg supply and poor egg vitality

As you get older, it’s perfectly normal for your eggs to decline in number and quality. That’s why you hear so much about it being harder to get pregnant in your thirties. Though a limited supply of quality eggs is usually more of a concern for women in their mid- to late-thirties, it can affect younger women as well. At any age, women with poor ovarian reserves often turn to IVF for their best chances of conceiving (8).

 

Uterine fibroids

Over 75% of women of reproductive age experience some form of uterine fibroids, or benign growths in the uterine wall (9). Not all fibroids affect a woman’s fertility. However, some can change the shape and characteristics of the endometrium, making it difficult for a fertilized egg to implant in the uterine lining. Some women may need to have their uterine fibroids surgically removed before IVF to increase their chances of success (9). 

 

Unexplained infertility

Sometimes it’s difficult to determine why you can’t conceive. Everything can look and feel normal, but you still find yourself unable to get pregnant. About 15 to 30% of couples that are diagnosed with infertility will have no identifiable cause (10). Fortunately, the specific factors behind you or your partner’s infertility don’t have to be fully understood before you begin fertility treatments. 

 

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IVF may be recommended for couples with unexplained infertility if other, less-invasive fertility treatments have failed, as it is the most successful (but most expensive) treatment for unexplained infertility (10).

 

How to tell if you’re a good candidate for IVF

Ultimately, it will be up to you, your partner, and your doctor to decide whether you should go forward with IVF, or if you should try other fertility treatments first. IVF is usually recommended for couples that have:

IVF is a complicated process that can take a toll on your mental health as well as your bank account. If your doctor thinks that you have a chance of becoming pregnant using other fertility treatment methods, they will probably recommend trying those first. Help from support groups, like our Kindara community, can be an extremely valuable resource throughout this process.

 

IVF Series

Part I: The Basics of the IVF Process

Part II: What should I try before IVF?

Part III: When should IVF be done? Why would IVF be recommended? (you are here)

Part IV: Will IVF work for me?

Part V: What are benefits and risks? What can I expect in IVF process?

 

References:

  1. American Society for Reproductive Medicine. (2014). What Do I Need to Know About Conceiving After Tubal Surgery?
  2. U.S. Department of Health & Human Services. (2019, March). Female Infertility.
  3. Merck Manual. (2019, February). Problems With Ovulation.
  4. Stephens, S. M., Arnett, D. M., & Meacham, R. B. (2013). The use of in vitro fertilization in the management of male infertility: what the urologist needs to know. Reviews in urology, 15(4), 154–160.
  5. American Pregnancy Association. (2019, October). Intracytoplasmic Sperm Injection (ICSI).
  6. Office on Women’s Health. (2019, April). Endometriosis.
  7. Macer, M. L., & Taylor, H. S. (2012). Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and gynecology clinics of North America, 39(4), 535–549.
  8. Jirge, P. R. (2016). Poor ovarian reserve. Journal of human reproductive sciences, 9(2), 63–69.
  9. Taylor, H. S. (2018, May). Fibroids: when should they be removed to improve in vitro fertilization success? Fertility and Sterility, 109(5), 784–785.
  10. Quaas, A., & Dokras, A. (2008). Diagnosis and treatment of unexplained infertility. Reviews in obstetrics & gynecology, 1(2), 69–76.