Wednesday, July 13, 2016

IVF is much more than just an infertility treatment.

Most people think of IVF as being a treatment option which maximizes their chances of getting pregnant. However, the reality is that IVF can be a lot more. Thus while the primary purpose of an IVF cycle is of course to give the couple a baby, it also provides a  lot of diagnostic information as well as prognostic information.

We often diagnose infertile couples as having unexplained infertility . This means we are telling them we don't know why they're not getting pregnant in their bedroom, and many find this lack of a diagnosis very frustrating, because they are worried that if we don't know what the problem is, how will we be able to find a solution ? When we do IVF , we actually get a chance to see what the eggs look like ;  whether they are mature ; and whether the sperm are capable of fertilising the eggs . Thus, some couples with unexplained infertility will have sperm dysfunction , which means that even though their sperm count, motility and morphology are completely normal, their sperm are not able to fertilise the eggs. The only way of making this diagnosis is by documenting total fertilisation failure in the IVF lab. This is invaluable information which we really can't get any other way.  While this does mean that we will not have any embryos to transfer in the IVF cycle, it also means that we can now tell them why they have not been able to get their wife pregnant in the bedroom.  We can use this diagnostic data to do ICSI for them in the next cycle, so that we can help their sperm to make embryos in the lab.

Similarly , the prognostic information IVF provides can be vital as well. Thus, we know that older women have a reduced chance of getting pregnant , but every older woman is different , and they all have different ovarian reserve. It's not fair to lump all of them in one basket ! Doing an IVF cycle allows us to actually check their ovarian response, and this is the best test for functional ovarian reserve - how well does she respond to superovulation ? Does she make good quality embryos in the lab ? If we can get good quality blastocysts for her, even if she does not get pregnant, we can tell her she has a good chance, and can keep on trying IVF with her own eggs.  On the other hand , if we embryo quality is poor, we can infer that the problem is poor quality eggs , and there's really no point in repeating the IVF cycle , and she would be better off considering third party reproductive options , such as using donor eggs .

IVF can provide priceless information , and this is why it's important that every IVF cycle be properly documented . Embryo photos should be routinely provided to every patient, so that this data can be used for guiding her intelligently in the future. Even if the current IVF cycle fails, we can still extract useful information by analysing it thoughtfully, so we can tweak the treatment plan as needed. You just need an intelligent doctor, who is willing to mine the IVF data to look for the gems hiding there !

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