Sometimes, IVF Is Not Enough
For cases of severe infertility in couples or individuals, in vitro fertilization (IVF) is regarded as an ideal path to parenthood. IVF falls under the assisted reproductive technology (ART) umbrella. These are techniques that handle sperm or eggs outside the body to help with pregnancy. With IVF, fertility teams create embryos using extracted eggs and sperm samples. One or more embryos are then surgically implanted into a woman’s uterus for pregnancy. While effective, with high success rates, IVF can fail and does have some limitations. Secondary to alternative ART strategies, fertility teams can identify and work around these challenges.
Why IVF needs an extra boost
ART strategies like IVF often require optimal conditions to be effective. When there are unique barriers, the success rates dip significantly. Certain circumstances necessitate targeted solutions to overcome these fertility obstacles. These reasons may not be revealed in initial attempts at IVF. For instance, some IVF patients have underlying genetic characteristics that make pregnancy and IVF difficult. Others have severe infertility challenges or may not respond to conventional IVF methods. There is also the overarching issue of advanced reproductive age, which severely affects IVF outcomes. Thanks to advancements in ART, discovering these issues can lead to targeted solutions. These solutions, like preimplantation genetic testing for aneuploidy (PGT-A), in vitro maturation (IVM), and intracytoplasmic sperm injection (ICSI), can improve IVF success rates.
A game-changer genetic test in PGT-A
Sometimes, an underlying chromosomal abnormality prevents a successful pregnancy, which is often only discovered via failed IVF cycles. PGT-A is a test done on all embryos before implantation to seek out aneuploidy, which is the presence of abnormal chromosomes. Embryos with aneuploidy are more likely to cause failed implantations and miscarriages. The test involves a biopsy of the embryos at the blastocyst stage, around day 5. The cells are taken through next-generation sequencing (NGS), which detects euploidy versus aneuploidy. The best embryos are then used for IVF, significantly improving survival and success rates.
Working around ovarian issues with IVM
IVM is often used as an alternative to IVF in cases where women need additional support during the process. With IVF, eggs are allowed to mature in a woman's ovaries before extraction to create embryos. IVM involves extracting immature eggs, which are then matured in a laboratory. Once the eggs mature, usually over 24-48 hours, the fertilization process continues. IVM is a helpful alternative ART for polycystic ovarian syndrome (PCOS) or ovarian hyperstimulation syndrome (OHSS) cases. Other cases include hormone medication sensitivities, cancer patients, or someone with a high follicle count.
With ICSI, a single sperm changes everything
IVF uses a sperm sample with extracted eggs to create embryos. Sperm samples often contain millions of sperm, making fertilization a straightforward process. With ICSI, a single sperm is carefully used to fertilize an egg. There are cases of male-factor infertility where embryo creation is not straightforward. Men with low sperm count or an absence of sperm in the ejaculate may struggle with IVF. Other cases include poor sperm motility, morphology, or repeated IVF failures. Men who had sperm surgically extracted can proceed with ICSI. Studies show that ICSI works well on frozen and fresh embryos.
Maximize the power of ART
IVF, while successful, can require additional support. These alternative strategies can help in the event of repeated IVF failure. PGT-A can identify genetic abnormalities that may be leading to unsuitable embryos. This test can be combined with IVM or ICSI to increase success rates. With each option comes some degree of risk. The fertility team will use all the alternative ART procedures available. Do not be deterred by failed IVF cycles. Trust that these strategies will serve to improve the success of IVF.