April 27, 2020
Author Name: Dr. Nagadeepti Naik || Mentor Name: Dr. Lipsa Mishra on April 27, 2020
Experiencing parenthood is the most desirable wish to come true for any couple who have been planning to conceive since a long time. There is a tremendous pressure by the society and family and it also involves a great deal of psychological and financial trauma for those who have failed despite repeated attempts.
In vitro fertilization (IVF) is a boon to many such people who could not conceive with conventional infertility treatments. While successful IVF cycles have fulfilled the dreams of many, a failed cycle can have devastating effects as well, especially in an Indian context where economic conditions and societal pressures play a pivotal role in deciding treatment. Pertinent to this , comes a crucial question i.e., the number of IVF cycles needed for a successful pregnancy, in the minds of every couple visiting a clinic owing to its varied results and the cost involved. Though important but the answer can never be an absolute number as IVF is an individualized treatment program.
1. Age: THE most important factor and it is non-modifiable. As the female age increases, the oocyte quality and quantity changes , indirectly affecting the embryo quality.
2. Cause of infertility:
A. Tubal factor (Bilateral tubal Blockage, hydrosalphinx) : good results
B. PCOD(Polycystic Ovarian Disease) : It is a hormonal disorder and depending on the severity varied results are seen. In case of mild to moderate PCOS without any other factor good results can be expected.
C. Endometrial causes( Thin endometrium, infection):-guarded results if endometrium is unresponsive .
D. Uterine factor : Depending on the condition (polyp, fibroid, anatomical factors ) varied results are seen,
E. Oocyte quality- In women above 35 years of age, oocyte quality decreses thus affecting the results. Donor egg program have increased success rates
F. Male factor- mild to moderate abnormalities have good results whereas severe abnormalities require use advanced techniques like ICSI(Intra cytoplasmic sperm injection), IMSI(intracytoplasmic morphogically selected sperm injection) for good embryos to be formed.
3. Advanced IVF centre with fully equipped Lab: best results always requires competent doctors , embryologists and an advanced lab for good embryos to be formed.
4. Medical illness: presence of morbid obesity, diabetes, hypertension, tuberculosis, addictions like smoking and alcohol, can affect the results if not under control.
Amongst the above, the miracle factor is AGE. The younger the female, the better is the prognosis in the first attempt. Females with age less than 35 years have higher success rate as compared to women with higher age group. But in such advanced age group , donor egg IVF have much better prognosis and higher success rates.
Successful IVF cycles in all age groups in this modern era is attributed to the use of several new technologies available ,such as:
1. Blastocyst or day 5 embryo transfer: compared to day 2 or 3 embryo transfer where success rates are around 30 to 35 % , day 5 embryo transfer results are more than double due to better selection of the embryos.
2. Assisted hatching techniques: It helps in making the embryo shell thin resulting in higher implantation rates.
3. ICSI: in severe male factor abnormalities ICSI helps in better selection of sperms and fertilization.
4. Immunotherapy: highly beneficial for females with immunological abnormality
5. PGT: genetic testing of embryos particularly in elderly females can help selecting euploid embryos.
Thus, accurate diagnosis of the cause of infertility and proper guidance by the clinicianas to the best possible treatment can reduce the treatment to pregnancy time. The couple should be counselled properly regarding the infertility problems, with a thorough understanding of the success involved and the various treatment options available.
Indian data regarding average number of cycles needed in a particular age group is lacking whereas western countries have reported an average of 2 to 3 cycles in any age group. As the demographic conditions vary between continents such results cannot be extrapolated to the entire world.
Thus, the only way to achieve success is targeting the right time and age to come forward and make use of the advanced treatment facilities. The common man should be made aware of the various treatment options available. Also to reduce the odds to success , one should take care of general health, have a complete control of medical problems, have a thorough knowledge of all the possible causes of ones problems and the availability of targeted treatment facilities .
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