Women who are about to have IVF mostly fear of short-term adverse drug reactions related with IVF treatment such as ovarian overstimulation, as well as adverse events occurring over time such as cancer. In the first case, anything that might occur -although extremely rare- is most often treated as an outpatient event. In the second case, no research has shown that IVF medications cause cancer. Thirty years of IVF have not demonstrated such a thing.
Using another person’s genetic material means donor sperm or eggs or a donor embryo is used. Foreign sperm has been used to a minor extent since the discovery of microfertilisation and is now exclusively used in men where sperm is absent after a biopsy. Using foreign genetic material in the form of foreign embryos or eggs is addressed to women unable to produce eggs (menopausal, early menopausal), women not producing good-quality genetic material, or women with no childbearing potential under certain conditions (mostly medically-induced or following surgery).
It is well-known that younger women have much higher pregnancy rates than older women. Moreover, we know that women after the age of 45 have only a slight chance of becoming pregnant and having a healthy child. This is due to age playing a major role in egg quality and number. There is no similar effect in men, but we do know that over time sperm becomes weaker. Therefore, age is a determinant of conception, either a natural or an IVF pregnancy.
More and more women and couples have grown a phobia of IVF drugs or consider there is no reason for multiple genetic material production and request that the single cell produced during the natural cycle is fertilised and that this embryo is implanted to have this IVF type. This is something that works, and it is rather inexpensive; however, it is not applicable in all cases. Natural cycle is proper for couples where the problem is the due to the male factor, i.e. the egg may not be fertilised from this specific sperm and microfertilisation is required or in couples where women are of advanced age and have become resistant to drugs, therefore whether or not they take drugs the final outcome will remain the same.
The question when a couple should stop attempting IVF is among the first questions addressed to the physician and most times it is very difficult to answer. We know that if a couple has attempted four times at a renowned IVF unit and there is response to treatment, pregnancy should be achieved at a rate of 80%. If this is not the case, then we should assess whether IVF is the proper treatment or whether something else is the matter. In any case, a couple should continue when the attempts show encouraging results, i.e. when medication is effective, when there is good-quality genetic material, when all other parameters have been tested, and when endometrial quality is good. When one of these is not the case, then other options should be provided, such as using foreign genetic material or even using a surrogate uterus.
IVF success rates vary between centres, countries, and depending on each couple’s problem. In general, we currently consider that the IVF success rate “per embryo transfer” is approximately 40%, however, there are cases where this rate may come up to 50% or 60%. This rate is shown in younger women having IVF and the problem is sperm-related, therefore, the solution is microfertilisation, or in women in egg donation programmes, where genetic material comes from younger women.
It is known that the only difference after IVF is the higher rate of multiple pregnancies. Since to this date more than one embryo is transferred, the twin rate in IVF reaching 30% is higher than the respective amount for natural conception coming up to 5%. Post-IVF pregnancy monitoring is exactly the same as for any other natural pregnancy. What usually makes a difference is that we are dealing with ages higher than those in natural conception.
IVF children do not have health problems different than those experienced by children born as a result of normal conception, except those due to multiple pregnancies, or premature labour. Several studies are currently ongoing about the likelihood of IVF children having their parents’ problems such as aspermia, oligospermia etc.
IVF is a process having a psychological impact on couples. There are decisions to be made, for example, whether or not foreign genetic material should be used as required. My personal opinion is that psychological support has a beneficial effect on couples that need it.
- Pre-implantation genetic diagnosis (PGD, PGS); Essentially this is the attempt to transfer healthy embryos following screening for known hereditary diseases.
- Vitrification, i.e. the new genetic material cryopreservation form ensuring much better conditions and much better post-abortion pregnancy rates since practically cells are not altered as was the case with the previous freezing method.
- In Vitro Maturation (IVM), this may be the future in IVF. It is applied in women with ovarian overstimulation, something we wish to avoid, in women who cannot take medication to induce multiple ovulations and women who had or are about to have cancer treatment in whom IVF medication would have an adverse impact. This is the collection of immature egg forms to be developed and grown in the oven followed by embryo transfer, just like in standard IVF, without using ovulation inducers.
- Assisted Hatching; In essence this is nothing more than providing assistance during which minor surgery to the foetus is performed to obtain a better implantation potential.
Previously, if someone did not have a good sperm the solution was to use donor sperm after a while. This is no longer the case, since in 99% of cases where the sperm is not good, there is the option of microfertilisation, which revolutionised IVF. In case where sperm is absent, then we may still use sperm found following testicular biopsy or epididymal sperm aspiration and microfertilisation.
The solution depends on the problem. If the problem lies in the fallopian tubes, such as blocked fallopian tubes or hydrosalpinges or any other problem, IVF is the answer. If the problem lies in the sperm, and the count or mobility is too low, microfertilisation is the answer. In cases of infertility of unknown causes, other parameters should be tested, but in a number of cases IVF is still the answer since probably the egg is not fertilised by this particular sperm.
Pre-implantation genetic diagnosis is screening prior to implantation, i.e. testing which may be performed on a foetus before it is implanted in the uterus. It is addressed to couples having a hereditary disease, in which case it is ensured that this disease is not passed on during embryo transfer.
Freezing genetic material is now feasible. We know that in an IVF attempt more than one eggs are produced and several embryos are transferred. In this case there is a higher production potential when there are extras. Such extras may be frozen and used later on without the couple being required to undergo further treatment. Moreover, they may be used in those cases where embryo transfer may not take place, for example in case of complications during IVF such as intra-abdominal bleeding or mostly ovarian overstimulation.
emBIO was established in 1997; it is the outcome of an effort by highly skilled people, experts in the field, who attempted and succeeded in creating the most modern IVF unit nationwide. emBIO has cutting-edge equipment, modern operating rooms, a high-standard microfertilisation laboratory, and highly-trained staff. Moreover, empathy is valued by us. Those who trust us find the warmth and compassion they need so that in combination with the best scientific expertise and individual monitoring, and personal effort, the best possible outcome is achieved both from infertility and human standpoints
