Repeated IVF failure is a perplexing problem which is extremely disheartening to both patient and physician. Once a decision to proceed to IVF has been made, treatment is undertaken with great enthusiasm and expectations. Proper IVF treatment places huge emotional, financial, and time commitments on the patient as well as her family.  Work and family schedules are disrupted and daily life must be rearranged to accommodate doctor visits, injections, and planned procedures.  Repeated failure to conceive requires a diligent review of all aspects of the patient’s evaluation and treatment to be sure that adjustments in treatment may be made to optimize prospects for future success. This process must be comprehensive and should include a thorough review of the patient file, conferencing with all members of the IVF team and should be followed up with a comprehensive, well thought out consultation with the couple.

Uterine polyps may be discovered during preparation for IVF when the uterus is evaluated by hysterosalpingogram or during routine vaginal ultrasound monitoring.  The question of whether these polyps should be surgically removed prior to in-vitro fertilization treatment has been controversial.  Many reproductive specialists have recommended removal based on data suggesting improved implantation rates following surgical polypectomy.  Several papers have suggested removing only polyps which are greater than 1cm in diameter.  A recent Turkish paper (in press) suggests that removal of polyps measuring less than 1.5cm offers no advantage in terms of pregnancy or live birth rates.  

Because fertility decreases with advancing age it is imperative that the most effective therapies be offered to couples as early in the treatment process as possible.  Physicians who care for infertile couples must make the most of each month to assure that fertility potential is maximized.  Toward this end, data evaluating age specific expectation for successful pregnancy for the various commonly used treatments is essential.  An article in press at this time suggests that in-vitro fertilization is far superior to ovarian stimulation combined with intrauterine insemination.  Live birth rates in this study were more than five times greater for IVF versus ovarian stimulation with intrauterine insemination. 

After a careful infertility evaluation, approximately 15-20% of couples will be classified as having “unexplained” infertility. What this really means is that given our current diagnostic capabilities we are unable to precisely identify the reason for the delay in conceiving.   It seems likely that many couples with “unexplained” infertility actually have unidentified egg or sperm abnormalities in a substantial number of their reproductive cells.

There have been several publications in recent years suggesting that minor trauma to the uterine lining in the menstrual cycle preceding an IVF treatment cycle results in a significant improvement in embryo implantation.  A recent study suggests that obtaining a biopsy from a precise location within the uterine cavity during the IVF treatment cycle significantly improved the prospect of embryo implantation. This study is the first to indicate that location and timing of the biopsy may impact favorably the chances for pregnancy in patients who have had repeated failure of healthy appearing embryos to implant.  

The gender of your child at birth can be affected by a number of different factors. We’d like to take a moment to discuss gender and what considerations you can make when you’re planning to have a family.

Survival rates have improved significantly over the past decade and many patients may be interested in pursuing fertility options after completion of cancer treatment.  For this reason it is important to offer fertility preservation options to patients newly diagnosd with cancer. Some of the available options include embryo cryopreservation, egg cryopreservation, and ovarian tissue cryopreservation. Recent scientific advances have improved the safety and effectiveness of the available strategies for fertility preservation.  Improved understanding of ovarian function has enabled us to perform fertiity preserving procedures without significantly  delaying cancer treatment and without significant risk to the patient.

In vitro fertilization (IVF) is a great way for many couples who cannot conceive a child on their own begin the great adventure of having a family. Let’s look at who the best candidates for IVF are and what the procedure entails.

Because of the large number of follicles often present in patients with polycystic ovarian syndrome (PCOS) as well as the usually observed excellent ovarian response to stimulation with fertility medications in this group of patients, the question arises as to whether reduction in fertility which is known to occur with aging proceeds at a slower rate in PCOS patients.  A recent study from Norway suggests that fertility potential is maintained between the ages of 22 and 41 in a group of PCOS patients compared to a group of non-PCOS patients.

Egg feezing using vitrification  preserves reproductive potential in women undergoing cancer therapy and is a means of preventing age related decline in fertility.