- In This Feature
- The Acronyms
- Inducing Ovulation
- IVF (In Vitro Fertilization)
- The Fertility Guide: The ART Procedures
- Retrieving the Eggs
- GIFT (Gamete Intrafallopian Transfer)
- ZIFT (Zygote Intrafallopian Transfer)
- ICSI (Intracytoplasmic Sperm Injection)
- Cryopreservation of Eggs
- Decision-Making Guidance for Couples
- Summary and Perspective
Summary and Perspective
The decision whether or not to pursue one of the ART procedures is one that should only be reached after a couple has been provided with full information concerning the procedures. They should understand what treatments they must undergo, what monitoring and evaluation is involved, what procedures will be performed, what their costs will be, and what their chances of success are. In other words, be truly informed!
The decision as to which one of the ART procedures is best for a couple can be a difficult one. This decision must include consideration of the costs of the procedure, the invasiveness of the surgery involved, and the chances of success in the hands of your physician. Some consideration must also be given to how much, if any, of the procedure insurance will cover. It almost becomes a matter of balancing costs vs. benefits. If, for example, a particular center offers IVF for $5,000 with a 25 percent success rate and GIFT for $10,000 with a 30 percent success rate, then IVF may be the better choice at that particular center.
Another decision that couples must unfortunately face sometimes is whether or not to attempt a repeat procedure if the first one is unsuccessful. This decision can often be made much easier by discussing it with the physician. Following an ART procedure, the physician will have a great deal of information concerning the individual's response to the ovulation induction, egg development, sperm quality and fertilization, embryo quality, and perhaps even tubal quality. The physician can use this information to advise a couple if a repeat attempt is worthwhile. In general, unless there is some specific factor that would impel a physician to discourage a repeat attempt, there is good evidence that repeat attempts are worthwhile. Specific percentages must be obtained from your physician, but for virtually all of the ART procedures, there is data that the success rates justify repeating the procedure up to three times.
Finally, one of the most significant concerns over pursuing an ART procedure is the risk of multiple pregnancy. Everyone wants the procedure to work, and a singleton or twin pregnancy is wonderful. Triplet, and certainly quadruplet and quintuplet pregnancies, however, are not ideal. These higher-order multiple pregnancies certainly carry higher obstetrical risks, not to mention the demands they place on a couple after the children are born. This is a tricky issue. The more eggs returned to the woman's body in a GIFT procedure, the more zygotes returned in a ZIFT procedure, and the more embryos returned in an IVF procedure, the higher the chances that a conception will occur. But at the same time, the chances of a higher-order multiple pregnancy also increase significantly. These factors must be balanced when deciding the appropriate number to return. The age of the female is the most important factor in this consideration. It is not unusual to increase the number returned for women over the age of 35, and especially over 40.
The physician should be able to provide a couple with the data from their center concerning the number of eggs or embryos returned, the success rates, and the chances of multiple pregnancy. These numbers are tremendously program specific. Under age 35, we very rarely transfer more than two or three eggs at the time of a GIFT procedure, two or three zygotes at the time of a ZIFT procedure, and two or three embryos at the time of an IVF transfer.
To summarize, every couple must be comfortable with the procedure their physician has recommended, and this involves fully understanding how the procedure is done. Every couple must be comfortable with their chances of success, and this involves fully understanding the success rates of their center and their physician, and how the individual circumstances pertaining to any couple affect these success rates. And finally, a couple must be comfortable with the number of eggs or embryos that will be transferred, and this involves knowing how the number transferred affects their chances of success and their risk of multiple pregnancies. Get the information you need, talk it over with your physician and reach a decision as a team.
The ART procedures are hugely successful and have already helped tens of thousands of couples conceive. Success rates are improving rapidly, and many programs now report successful pregnancy rates of 40 percent or more per IVF procedure. With rates such as this for IVF, it becomes increasingly hard to justify more expensive and invasive procedures such as GIFT and ZIFT. And with success rates such as this, the treatment of impaired fertility has become more successful and more cost-effective than ever before.
With 40 percent of couples able to conceive as a result of a single IVF attempt, it is easy to see why IVF is assuming a much more preeminent role in fertility treatment. And it is easy to see why major surgical procedures, laparoscopies for mild endometriosis, and excessively prolonged treatment with, for example, clomiphene, have been relegated to the category of "the way it used to be done." The ART procedures have indeed revolutionized the contemporary treatment of impaired fertility, and with continued improvement in the success of these procedures, the revolution is not yet finished.