When to start thinking about IVF

Posted on 3 January 2019

Infertility problem with marriage couple concept. A fertility doctor or reproductive endocrinologist with man and women holding hand together in therapy consult session of inability to pregnant.

One in 6 Australian couples need help to conceive. Many ultimately turn to IVF. Success rates in IVF are at their best when performed in the best hands (ultimately by a CREI subspecialist) in the best laboratory (yes the IVF lab quality, and investment in staff training, equipment, technology and materials can make a huge difference).

IVF is amazing but the best results can be delivered to those who don’t come to realise that they need IVF too late. Age related egg quality decline is our biggest challenge as IVF practitioners. We can deliver great outcomes much more easily with younger healthier eggs.

You have been trying for 6 months and are over 35

If you are over 35 and haven’t been able to conceive after 6 months of trying, you owe it to yourself to be fully investigated as a couple. At least 50% of infertility is either partly or solely due to a male factor. Seeking help from a CREI qualified fertility subspecialist means a) all the right tests will more likely be done from the beginning and b) all possible treatment options will be made available to you, including but not limited to IVF.

You have been trying for 12 months and have unexplained infertility.

Unexplained infertility is not the same as everything being ok. Most couples with normal fertility conceive relatively quickly, over 80% will be pregnant after 6 months of trying. After 12 months in most couples there is clearly a problem. “Unexplained infertility” is infertility of long duration, where all usual tests appear normal but a couple is still not getting pregnant. To have a true diagnosis of unexplained infertility, a woman has to have had a laparoscopic pelvic assessment as a significant number will have “silent” endometriosis where the main symptom is failure to conceive and not pain.

We think vast majority of true unexplained infertility are due to rare problems occurring in the hundreds of protein interactions that need to occur between sperm and eggs in the body. IVF and ICSI is able to get around these problems for > 80% of couples with no clear label for their real fertility problem.

You carry a genetic condition you don’t want to pass on to your baby

Couples with normal fertility where one or both partners carries a genetic disease can choose to have IVF to get pregnant. Because no specific sperm, egg or receptivity problems are present, couples in this situation usually have very positive IVF outcomes. By creating embryos in the lab and testing them, we can ensure only healthy embryos are implanted to make babies. Lot’s of serious conditions can be avoided in this way. Examples include cystic fibrosis, muscular dystrophy, Tay-Sach’s disease, achondroplasia and conditions like Lynch syndrome and BRCA which incur a high lifetime cancer risk. As long as we know the details of the gene problem you carry, we can test for it.

You have severe endometriosis

Women with severe endometriosis often need subspecialist IVF care to conceive, even after surgery. Seeking help at an earlier age will improve their prognosis for success. Young women with severe endometriosis should seriously consider freezing their eggs.

Your partner has had a vasectomy

While vasectomy reversal is possible, IVF has much better success rates. This is especially true if the vasectomy was performed a long time ago as men are more likely to have formed autoimmune antibodies against sperm in this scenario.

You are over 35, pregnancy is not happening naturally and you want to have more than one baby

If you are starting your family later in life, the age at which you may not be able to have more than one baby naturally. IVF offers the unique opportunity of embryo banking. By proactively putting healthy IVF embryos in the freezer while you still can, you may greatly enhance your chance of having the number of children you ideally want. Genetic testing of embryos prior to embryo banking (by pre-implantation genetic screening for aneuploidy or PGT-A) allows you to know your true probability of future pregnancy success realistically. Pre-implantation genetic screening of embryos also reduces your chance of miscarriage or having a baby with a serious abnormality like down syndrome.


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