Uploaded on August 10, 2014
New York City IVF – Individualization of IVF Treatment
So now you and your reproductive endocrinologist have decided that In Vitro Fertilization carries the best chance for achieving a pregnancy, and now that you understand why you are doing In Vitro Fertilization, either because the tubes are blocked or because your partner has few number of sperm or you are testing the embryos to avoid a genetic problem, and so on, it is very important for you and your physician to sit together and discuss how treatment is being conducted. Individualization of all aspect of treatment is key for success.
One aspect of that is crafting the best ovarian stimulation protocol that will produce the optimal number of eggs. The optimal number of eggs is not necessarily a large number of eggs. It could be just seven or eight eggs that are mature and of good quality. That would be much better than having twenty or thirty eggs and the majority of them are not mature and of lower quality. Also the protocol should avoid excessive exposure to gonadotropins and give you just enough. A small amount of gonadotropin that will get you to where you want and that is in strong relation to the studying of ovarian reserve before you even start. For some women that have a predicted low response to stimulation because we think that the number of eggs in the ovary is small also requires special attention of how to optimize the number of eggs in the ovary whether that might be synchronizing of their follicles in the luteal phase before they start injectible medications or using oral medications or some of the many other methods or employing mild stimulation. This is also a key for optimizing the number of eggs that are produced.
Sperm analysis and other indications would point to the need of injecting the sperm into the egg otherwise known as intracytoplasmic sperm injection or ICSI or do conventional insemination where the eggs are surrounded by sperm and left to fertilize alone. Other points of individualization could be related to the quality of the lining of the uterus. Also the number of embryos to be transferred. The appropriate number of embryos to be transferred is directly related to our perception of the implantation potential of the embryo. This is related to the female’s age and the quality of the embryos in the lab. The best approach is minimize the number of embryos to be transferred to avoid the risk of multiple pregnancies. So your reproductive endocrinologist may decide to place one embryo sometimes, or a large number of embryos as it is needed. This individualization of treatment is key and no treatment plan should proceed without being tailored to the various intricate male and female factors so that the best chance for success is achieved.