The extensive analysis of the couple’s medical problem, pretreatment evaluation and therapeutic choices of the couple are individualized, so that the first IVF attempt is most successful.
The most important prognostic factor is female age. The younger the female partner the higher the chances of success. Therefore, female age must be taken into notice seriously when the strategies for the treatment of infertility are being planned.
Certainly, it is NOT necessary. On the contrary, the couple returns immediately to their daily duties. There are no studies showing improved IVF success rates after rest at home and reduced daily activities.
Reproduction of the species and furthermore human reproduction is a significant event and is not affected by external factors. The human race has reproduced and continues to reproduce even under natural disasters, wars, hardships and distress. Daily anxiety and personal problems may psychologically exhaust the couple, but only if it affects the frequency of their sexual contacts does it contribute to their infertility.
A couple must visit a professional in infertility after one year of free sexual contacts with no result. At first, simple tests can be done such as a sperm analysis from the male partner/husband and a hormonal profile of the female partner to estimate ovarian reserve. Also, an extensive discussion about the physiology of the human reproduction must be done, without necessarily any interventions. It is important to discuss and define a time frame and the sequence for future interventions.
In only few cases we can find the definite reason for the couple’s infertility, as in most cases it is not possible, and furthermore we can hardly ever “correct” the problem. The process of human reproduction is complex and many factors are involved. In most cases, failure to conceive may due to a different factor each time. Common reasons such as oligospermia (low sperm count), athenozoospermia (low sperm motility), tubal factor, endometriosis, premature ovarian failure unfortunately cannot be “corrected”, but can be by-passed undergoing IVF. In other words we can ‘mimic’ natural reproduction by creating embryos, which are transferred into the uterus, hoping for implantation and pregnancy. If our result is unsuccessful, we critically analyze them and carefully repeat the attempt with few changes in the medical procedures.
Surplus embryos of good and medium quality can be cryopreserved for many years. The technology of cryopreservation has greatly improved allowing frozen-thawed embryos to have equal chances of success as ‘fresh’ embryos. Frozen embryo transfer is a simple procedure and can performed in a natural or artificial cycle, and adds to the overall success of the IVF attempt.
It is NOT necessary. A complete evaluation of the infertility problem, taking into consideration female age and the couples’ expectations, is needed to evaluate the potential of the couple to conceive naturally. A complete strategy is then planned with a defined time frame for interventions. Procedures such as expectant management, timed intercourse, controlled ovarian stimulation with intercourse or intrauterine insemination must be discussed and evaluated as potential treatments. IVF is a final choice. In the meantime, after anticipated pregnancy rates and time intervals are discussed and analytically explained, the couple and the doctor must clearly decide in common the interventions to be followed to be at the best interest for the certain couple.
Laparoscopy virtually does not improve IVF outcome but adds to the inconvenience of the couple with additional costs without offering significant benefits. Hysteroscopy is also not necessary, if the hysterosalpigogram (HSG), vaginal ultrasound and medical history are without findings. However, hysteroscopy become meaningful if there are previous failed IVF attempts.
Costly blood tests, such as immunological and thrombophilia tests are not necessary, as there is still no proof of an association of the corresponding diseases with IVF outcome. However, for certain heritable or de novo thrombophilia diseases and cases with individual and family history of deep venous thrombosis, these tests must be done.
Infertility treatments have begun since the seventies decade. Significant studies since then from all over the world have not shown a correlation between infertility treatments and a specific type of cancer in women. In other words, the frequency of diagnosis of cancer in infertile women is the same whether they undergo infertility treatment with IVF or not. It must be noted that every year millions of women undergo infertility treatments. It there was a definite correlation with cancer it would be made known.