1) After repeated attempts, which are also costly, many couples drop out of in-vitro fertilization (IVF) treatment, losing their chances of pregnancy. Can pregnancy be successful even after several unsuccessful IVF attempts?
IVF cycles can fail due to a few reasons – improper diagnosis of the cause of infertility, improper treatment, chromosomal abnormalities in the embryo and failure of implantation/endometrial receptivity. One of the first things to do for IVF is that both the male and female partners undergo certain tests, including blood tests and ultrasounds, to determine the root cause of infertility. A treatment chart can be prepared only after a thorough examination of each unique patient case. In many cases, the couple needs to take medication to treat underlying health conditions or even other procedures, such as the removal of uterine fibroids.
Once the egg and sperm are fertilized and an embryo is formed, pre-implantation genetic testing (or PGT) is performed to check for any genetic anomalies in the embryo; These anomalies can act as a barrier to conception or cause a miscarriage. Thus, PGT helps in two ways-a) transfer of the best graded embryos in the uterus, and b) single embryo transfer (multiple embryo transfers can be done in some cases to increase the chances of pregnancy but complications may occur later) can). The technology used – which includes subtle details such as temperature and humidity at which gametes are handled – can also make a significant difference to the success of an IVF cycle. In most cases, the gap is bridged by understanding the patient’s history, taking a unique approach to the case and choosing the right technique.
2) You had a patient who got pregnant after the 14th attempt. Can you share the details?
After repeated cycles of unsuccessful in-vitro fertilization (IVF), Nashik couple Vibha and Abhi (names changed) were successful with twin pregnancy in their 15th attempt. Married for 15 years, the couple exhibited secondary infertility as they already had an older child. In hopes of completing her family with more children, she tried to conceive naturally as well as using assisted reproductive technology (ART). Then he opted for IVF.
Vibha (36) reported having chronic hypertension and hypothyroidism. On testing of fertility parameters, it was found that the lining of the uterus, the endometrium, had developed into the uterus (called adenomyosis). Additionally, the left fallopian tube was blocked with fluid (left terminal hydrosalpinx) and contained a low number of viable eggs (poor antral follicular count). On analyzing Abhi’s semen sample, it was found that he had severe oligosthenoteratozoospermia or OAT. This condition is marked by three specific defects in spermatozoa – low sperm count, poor sperm motility and abnormal shape.
The couple attempted ART 12 times with their own eggs, all of which failed. Given the healthy egg stock and the couple’s compromised level of sperm, the best option was to select a donor embryo. Donor embryos are genetically and physically healthy and have a better chance of implantation in the uterus, and a subsequent live birth.
To prepare Vibha’s uterus for implantation, she was given platelet-rich plasma (PRP) 10 days before embryo transfer. Laser assisted hatching also helped prepare her womb. Two donor embryos were transferred. Human chorionic gonadotropin (hCG) levels and an ultrasound confirmed the presence of two growing fetuses. But they didn’t last full term. This is called recurrent implantation failure. This is a complex problem that arises for many reasons. Treatment plans vary depending on the source of the problem. In such cases, the best solution that provides light at the end of the tunnel is individualized treatment, depending on the unique nature of each case.
3) What is the IVF success rate per cycle as per the age of the couples?
Age has a number of effects on fertility and the efficacy of IVF in general. According to the Centers for Disease Control and Prevention (CDC), the average percentage of ART cycles that lead to a live birth is:
– 31 percent of women under 35 years old
– 24 percent in women aged 35 to 37
– 16 percent of women between the ages of 38 and 40
– 8 percent in women aged 41 to 44
– 3 percent in women age 43 and older
These success rates have historically been linked to women’s biological clock and their limited reproductive window. However, new studies on the relationship between age and male infertility have shown that men have a similar threshold. Decreased sperm quality and fertility have been found in men over the age of 40.
4) It is observed that young couples in the age group of 25 and 35 also face infertility and are now opting for IVF treatment. What are the reasons behind early infertility?
Young couples in their mid-20s and 30s are having difficulty conceiving. This can be attributed to the emergence of lifestyle diseases such as diabetes, obesity, high blood pressure and thyroid disease. Other lifestyle triggers are work-related stress at work, poor eating habits, increased alcohol and tobacco consumption, and lack of regular exercise. Pandemic-induced lockdowns and work-from-home formats have meant prolonged sedentary life, which has disturbed the hormone patterns of young people. Medical conditions such as endometriosis, endometrial tuberculosis and polycystic ovarian syndrome (PCOS) are also to blame.
However, it is imperative to mention that awareness about infertility has increased. Easy access to information on IVF and openness to accept a medical solution for infertility has played a significant role in changing the mindset. This also applies to people who are born with genetic diseases or congenital limitations.
5) What kind of fertility problems are most common in young couples nowadays?
There has been an increase in cases among couples experiencing infertility, with women being diagnosed with polycystic ovarian syndrome (PCOS) and men with azoospermia. It has also been observed that many young men experience infertility, with the exposure of the pelvic region to constant heat (such as a laptop or engine) being a contributor. It is known that the testicles need to be a few degrees cooler than the rest of the body. Exposure to sources of heat affects sperm production.
In addition, with six percent of the adult Indian population living with one or more sexually transmitted diseases (STDs) that can affect reproductive organs and function, it is essential that those who have multiple sexual partners undergo regular STD testing so that they can be treated. early enough. In women, other reproductive health issues may include endometriosis, pelvic inflammatory disease and uterine fibroids. In men, other fertility challenges may include erectile dysfunction, retrograde ejaculation and varicoceles.
6. In view of the changing lifestyle of today’s young generation, what are your tips for late marriages?
You should get married or start a family only when you are ready to do so. For young people, especially in urban centres, it has become common for both partners to be financially independent before committing to a family. Those who envision having a family in the future can plan their fertility journey ahead of time.
With the help of cryopreservation techniques, they can freeze their eggs and sperm in their early 20s to 30s and use them up to 10 years later when they are ready to marry and/or start a family. Even for young couples who are married but want to focus on their careers or explore the world before they bring on a new life, freezing embryos is a technique that will help them later. Can help in getting pregnant. This ensures that the eggs, sperm and embryos are harvested at a time when they are genetically and morphologically strong.
Additionally, young individuals should also take care of their health to avoid complications. Simple things one can do is to include a balanced diet, be physically active, maintain a healthy weight, avoid alcohol and tobacco use, take proactive measures to deal with stress and anxiety, and go for regular health checkups. .
7. Is There a Right Age for IVF?
Even with technology, age remains a major determinant of pregnancy outcomes. Women using IVF in their 20s and early 30s have a higher chance of conception and a single live birth. However, after reaching the mid-30s, the success rate slowly begins to decline. Aging eggs are unable to fertilize with sperm or have genetic anomalies, reducing the chances of a full-term baby. By age 30, women have about 12 percent of the 300,000 eggs they produce. By the age of 40, only 9,000 of them remain. As women reach the age of menopause (50–55), there are very few eggs left in the ovaries and their viability is questionable. Patients are advised to take eggs from young egg donors once they reach the age of 43.
According to the Assisted Reproductive Technology (Regulation) Act, 2021, the legal age of marriage for men and women to seek treatment should be between 55 and 55 respectively. This is necessary as conceiving at an older age can lead to many other complications for both the mother and the baby.
Despite the demands of the complete process of IVF, young couples as well as single men and women have the option of freezing their sperm and eggs respectively. This ensures that these gametes are collected early in their lives and can be used when they are ready to have children in the future.
(Why this doctor? Dr. Kshitij Mardia has fellowship in Infertility from Singapore. She has experience of doing more than 15,000 IVF cases)