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Office based IVF is
the best treatment for a number of fertility
problems. In cases of tubal disease or absent
fallopian tubes, or when there is extensive
scarring of the tubes and ovaries, IVF may allow a
woman to achieve a pregnancy. Another group are
women who have had surgical sterilizations, where
large sections of the fallopian tube have been
removed: their chances of a successful
microsurgical sterilization reversal may be low.
Office based IVF is also used effectively in women
with endometrioses, uterine fibroids and
unexplained infertility.
Different protocols
are now used in IVF for stimulating the ovaries to
produce multiple eggs. One approach is used for
patients with very sensitive ovaries, such as young
women or women with polycystic ovary disease (PCO).
A different regimen is called for in patients with
more resistant ovaries, such as women who are over
35 or 40 or who have not responded well to standard
fertility injections in the past.
Another variation
on the Office based IVF theme is natural cycle
IVF. Natural cycle IVF has the advantage of
being less expensive -- but it also has a lower
success rate. The key difference between this
program and regular IVF is that no fertility drugs
are used to stimulate the ovaries. In most cases,
only one egg is retrieved, so no extra embryos can
be frozen.
Gamete
intrafallopian transfer (GIFT) and zygote
intrafallopian transfer (ZIFT) were developed to
take advantage of the fallopian tube as nature's
incubator. In GIFT, the eggs and sperm are loaded
into a catheter and injected into the tubes, where
fertilization occurs naturally. GIFT is acceptable
to some religious groups that otherwise oppose IVF.
The disadvantage of GIFT and ZIFT is that they both
require an additional surgical procedure -- a
laparoscopy, in order for eggs and sperm (GIFT) or
early embryos (ZIFT) to be transferred back to the
tubes. In addition, with GIFT due to a relatively
non-precise selection of eggs, the chances of
pregnancy may be compromised and chance of high
order pregnancy increased.
Donor Egg
IVF
Donor egg IVF
allows women whose ovaries do not produce eggs to
bear children. The infertile woman becomes the
recipient of eggs donated by a friend, relative or
volunteer donor. The donor eggs are fertilized in
the lab with sperm from the husband of the
infertile couple. Resulting embryos are transferred
to the infertile woman's uterus.
Once experimental,
this treatment is now becoming a standard form of
care. It is recommended for women with premature
ovarian failure, for women with impaired ovarian
function, for carriers of a genetic disease, and
for women whose fertility is declining with age, or
who are past menopause.
There are also
couples who have had repeated failure at IVF. After
three or more cycles of IVF, a couple might want to
consider trying donor egg IVF, which has a higher
success rate. Success rates for donor egg IVF can
be two to three times higher than with regular IVF.
Much of this success is due to the use of young,
normally fertile donors. The disadvantages of donor
egg IVF are the higher cost and that the couple
will bear a child that is not genetically the
offspring of the woman who carries the
pregnancy.
There is a growing
movement to recommend donor egg IVF rather than
regular IVF as a first step to any patients over 42
years of age. Success rates nationally for regular
IVF for women over 40 are 7.2% per cycle. On the
other hand, the rates for women over 40 using donor
egg IVF are 31%. If a younger sister or relative is
willing to be the donor, this can be a very
attractive option for a couple.
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