“When to move on to IVF?” is amongst the most pressing questions on a fertility patient’s mind. Some patients who ask this question want to try IVF as soon as possible, while others prefer to use IVF only as a last resort. The truth is that the right time for IVF is different for each patient, ultimately, there is no right or wrong answer. Some patients will start with IVF as their first treatment, other patients will never try. As a multitude of variables determine the appropriate time for IVF, the job of the fertility physician is to help sort through the variables and guide the patient to make the best decision for their specific situation.
The following are some of the factors which deserve consideration as one contemplates IVF:
The age of the eggs is the single greatest factor in determining success with IVF. For those patients with eggs that are less than 30-35 years of age, they generally have the luxury of more time before moving on to IVF. Patients greater than 35 years of age should generally start sooner.
For patients with very severe male factor or tubal factor, IVF may be the only option available. At other times however, the diagnosis may not be that clear, and a couple may demonstrate “mild” male factor or only one blocked tube. In such instances, moving towards IVF more quickly is justified.
Traditionally, a couple undergoing fertility treatment would try 3 cycles of clomiphene citrate with intrauterine insemination, then 3 cycles of injectable gonadotropin medication with intrauterine insemination before moving on to IVF. Most physicians feel that this prolonged treatment course is not the most efficient approach to conception. None the less, if the infertility evaluation shows normal tubes, uterus and sperm, starting with a less aggressive treatment like clomid or injections plus IUI makes sense.
Length of infertility
Couples who have been trying to conceive for a year or more before seeing a fertility specialist should consider moving more quickly towards IVF. For couples who have been trying to conceive for less than 6 months, a more conservative approach is warranted.
Fertility is unique amongst medical specialties because the patient’s personal preference plays such a significant role in the decision making process. For example, in cardiology, there is not a great amount of emphasis placed upon what type of treatment a patient prefers to improve their cardiac function. In fertility, on the other hand, a patient’s preference is critically important. A doctor must respect the wishes of a couple as long as it is medically safe and reasonable. With this in mind, 2 different patients with who are exactly the same in terms of age, infertility evaluation, prior treatments and length of infertility may start IVF at very different times based on their personal preference.
If you have questions about IVF or any other fertility treatments. Feel free to contact us, we’d be happy to speak with you.