We asked for your questions on IVF and you delivered! Dr. Elie Hobeika took on the top IVF questions in the answers below.
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What can be done for women with a diminished ovarian reserve?
A diminished ovarian reserve does not mean you will not have success, it means that you may require more treatment to achieve pregnancy. If a woman’s eggs are lower in number or quality, the goal is to develop as many follicles as possible to increase the number of eggs retrieved for IVF and in some instances improve quality. For women with low ovarian reserve, it may take two or three cycles to get the number of eggs needed to achieve pregnancy. Chances of becoming pregnant are largely dictated by age, but again, while more tries may be necessary, the odds of a good outcome are likely. If a cycle is not successful, we can adjust medical protocols based on a patient’s response in previous cycles, which can increase the number of eggs collected in the following cycle and increase chances of pregnancy after an embryo transfer. Do not hesitate to sit down with your provider after a failed IVF cycle and have a detailed conversation on how cycle parameters can be improved.
Are there guidelines for women over 40? How late is too late?
Unfortunately, the main determinant of a couple’s ability to conceive is the female partner’s age. After the age of 36 or 37, fertility starts declining. After age 40, it lowers further. That being said, a patient is evaluated by individual fertility potential, not age. If we are able to stimulate a good number of follicles on a woman’s ovaries at age 43 or 44 and create embryos with a normal number of chromosomes, we can proceed safely with transfer knowing that success is in the ballpark of 65-70%. While it is rarer, we have seen examples of this in our practice. When a patient is 40 or over, we make a careful assessment based upon individual reproductive potential, egg quality and chances of success, and a decision is jointly made between a physician and the couple.
What are success rates for women with endometriosis?
While women with endometriosis have a lower chance of pregnancy, we still don’t know the extent that the disease plays a role in that decrease. This will also vary from woman to woman as endometriosis cases can be more or less severe. We do know that endometriosis can significantly decrease the chances of success up to less than 50% compared to normal chances. There is hope: IVF offers the highest chance of a successful pregnancy for women with endometriosis. It may take more cycles, but adjusting treatment protocols can improve those chances.
What are the success rates for women with PCOS? What can be done to improve their chances of conception?
PCOS is one of the more common infertility diagnoses, often due to ovarian dysfunction such as a lack of ovulation. One thing women with PCOS can do to improve their chances of conceiving are lifestyle changes such as nutrition and diet, regular exercise and achieving a healthy weight.
What are the chances of twins? Are there ways to improve the chances of twins?
The number of embryos transferred will dictate the chances of having twins. The chances of having twins when one embryo decides to split, creating identical twins, is less than two percent. If you transfer multiple embryos, you may end up with triplets or quadruplets if the embryos split. Unfortunately, there are much higher morbidity rates for pregnancies with multiples. Twin or higher-order multiple pregnancies can present complications and risks for both babies and mother, so we always recommend pursuing a singleton pregnancy.
When does medication begin in an IVF cycle?
Medications to grow follicles in an IVF cycle are usually initiated when a period begins, starting on cycle day two or three. The earlier they start in your cycle, the better. Prior to starting medication, you’ll set up an appointment with your nurse to confirm that hormone levels are low and that there are no cysts present on the ovaries. Once you are cleared, medication will begin at the start of your monthly cycle. However, please note that your IVF regimen may include a preparation phase for the ovaries (aka priming phase), at that point medications may be started before a period begins.
When I’m taking IVF medication can I go about my day normally?
Yes, but it may take some getting used to it. Medications are self-administered and most of them are subcutaneous injections. They are typically taken once in the morning and/or evening. Some need to be refrigerated. While certain medications can be easily administered by an injectable pen, others consist of a powder and liquid form that need to be mixed prior to administration.
Medical contribution by Elie Hobeika, M.D.
Dr. Hobeika is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. He has studied with world leaders in PCOS and recurrent pregnancy loss and is fluent in English, French, and Arabic.
