Monday, May 25, 2015

IVF is much more than just a treatment - making the most of an IVF cycle



For most patients, IVF is primarily a  treatment which can help them to have a baby. After all, the primary goal of IVF is a successful pregnancy, and when the IVF treatment results in a baby, everyone is happy. However, we do need to remember that the outcome is always uncertain – and that even if the IVF cycle does not result in a baby, it can still give us invaluable diagnostic and prognostic medical information, which we would never be able to get otherwise.

Thus, when we label a couple as having unexplained infertility , the reason we call it unexplained is because we do not have the technology or tools to be able to determine why she is not getting pregnant in her bedroom . Now, if we do IVF for this couple , we may find they have total fertilization failure – that his sperm are not able to fertilise her eggs, even though his semen analysis report is completely normal, and his sperm count, motility and morphology are all normal. This means that as a result of doing IVF, we can conclude that the so-called unexplained infertility was actually male factor infertility  because of sperm dysfunction; and we can treat this successfully by doing ICSI. We  would never have been able to make this diagnosis without doing IVF !

Even more important, each IVF cycle gives us very useful prognostic information. Thus, every 38 year old woman knows that her chances of getting pregnant are reduced, as compared to a 25 year old, because of her age. However, she wants a more precise estimate. Doctor, are my chances 5% ? or 25 % ? Now this is a hard question to answer for the individual patient, because even we do not know her ovarian age – how good the quality of her eggs is. While we can test her AMH level and her antral follicle count, both of which allow us to estimate her ovarian reserve, we will never know how good her ovarian response will be until we actually start her IVF treatment and superovulate her – after all, the proof of the pudding is in the eating.  We have all seen women with a low AMH level get pregnant – and those with a normal AMH level who grow poor quality eggs. After all, these tests all have their own limitations when applied to individual patients.

However, at the end of the IVF cycle, we have a lot more data based on which we can counsel her much more intelligently. We can see how many eggs she grows; how good their quality it; and we can see the quality of the embryos her eggs form. Based on this, even if her IVF cycle fails, we can then advice her whether it’s worth trying another IVF cycle with her own eggs, or whether she should move on to considering using donor eggs.

This is why it’s important for patients to understand that IVF is much more than just a treatment – it’s a great diagnostic and prognostic tool as well, which gives us information we can never get from any other test available today.

Want help in maximising the value of your IVF cycle ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !




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