Top 55+ tips for getting pregnant through IVF
by Dr Mantas Dimitris, PhD│Last updated November 22, 2016.
As the number of infertile couples rises in all over the world, more and more couples visit fertility clinics in all over the world. The contribution of in vitro fertilization (IVF) and Assisted Reproductive Technology (ART) in the rapidly growing field of medical technologies and healthcare services is undoubtedly unique. If you experience fertility problems, considering an infertility treatment, here are the top 55+ tips you should know on how to increase your chances of a successful outcome.
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Basic IVF advices
According to the subfertility causes, there are a number of fertility treatment options and different IVF protocols developed for serving different needs. So finding out the exact cause of subfertility is critical and your physician should decide which treatment benefits you most.
2. Financial support
It’s well known that high stress levels are associated with a poor IVF outcome. The financial aspect of the treatment is usually another factor adding stress to an already emotionally and physically stressful procedure for couples. To minimize financial stress you can seek for fertility clinics offering financial planning assistance, making the treatment more affordable for you.
3. Should the male partner be evaluated for infertility as well?
Infertility is not primarily a woman’s problem, as it is mistakenly believed. It is estimated that infertility for about half of couples is due to a male factor, either alone or in addition to female issues. Thus, both partners should attend the initial consultation for IVF.
4. What about the age of the father?
Male fertility declines with age as well, research reveals. According to a recent study, every extra year of paternal age causes a 7% decrease in pregnancy chances. Data suggest that advanced paternal age is correlated to poor sperm quality. Collectively, both male and female partners’ age is critical for successful IVF.
Fertility and pre-conception checklist
Fertility specialists consider Anti-Müllerian Hormone (AMH) a reliable fertility blood test, through which they can assess a woman’s ovary function or dysfunction. Women’s ovarian reserve status should be taken into account in order to achieve pregnancy either naturally or following IVF treatments.
6. Have you checked your thyroid and reproductive hormone levels?
Thyroid is also an important gland for fertility and so T3, T4 and TSH levels should be checked. Thyroid dysfunction, if not treated properly, can cause sterility, miscarriage, birth defect complications and much more.
Assisted Reproductive Technology advices
The term IVF covers a wide range of assisted conception techniques used to treat infertile couples. Different Assisted Reproductive Techniques (ART) could be used accordingly to the infertility causes (ex.: age, male or female infertility, unexplained infertility, etc.). Intrauterine Insemination (IUI), Natural cycle (N/C), In Vitro Fertilization (IVF) or Intra-Cytoplasmic Sperm Injection (ICSI) are the most common methods used by fertility physicians worldwide.
8. Which stimulation protocol suits you better?
In order to get more follicles and oocytes which are recruited during a particular IVF cycle, fertility specialists use medical schemes (protocols) to ensure controlled ovarian stimulation. Most of the fertility drugs contain the same hormones that the body normally uses during a woman’s reproductive cycle. The right selection of stimulation protocol is just one of the critical factors for having good oocytes and embryos quality. The following schemes are the most commonly used in assisted reproduction clinics: Long agonist protocol, Short agonist protocol, Short antagonist protocol, Elonva (Corifollitropin alfa), Mini-IVF or Micro-IVF. Mild reactions to fertility drugs, Ovarian Hypestimulation Syndrome (OHSS) and rare allergic reactions (hot flushes, headaches, swelling, blocked nose) result in some discomfort but usually resolve quickly without complications. In any case ovarian stimulation should be carefully controlled by high experienced clinicians.
9. Is ovarian stimulation always the best option for successful IVF?
For maximizing chances of pregnancy for IVF, sufficient number of eggs is necessary. Naturally in women only one or some times two mature eggs are released for each ovulation cycle. For IVF, ovulation is stimulated by medication in order to harvest 8-15 eggs ideally. Unfortunately some woman have already tried to be stimulated with even the higher of fertility drugs dose and still produce one or two eggs. Others are not willing to take any kind of drugs because of their personal beliefs or they can’t because of their medical history. These cases are better to be treated without using drugs and just follow up their normal natural cycle ovulation.
10. Does timing of hCG administration and oocyte retrieval matter?
Oocyte collection is directly related to the hCG trigger. hCG (human chorionic gonadotropin) administration will promote egg maturation and release from the follicle between 36-40 hours after the final injection. The timing of the egg retrieval is critical and should be controlled very carefully from women and physicians. Any mistake in this specific step could compromise the whole IVF cycle, not only because it’s related with the eggs maturity but also in some cases if the ovulation happens before the right timing, the procedure could be canceled due to lack of egg collection.
11. Which drug is preferable for ovulation stimulation?
The choice of the drugs used for stimulation should be very carefully selected by the physician. Every patient reacts differently to the hormones and it’s crucial to design a systematic stimulation protocol in order to achieve the best ovarian response. Clomiphene is a drug commonly used for ovarian stimulation and the doctors know that it has fewer side effects than other drugs. So, clomiphene is a safer option for avoiding ovarian hyperstimulation syndrome (OHSS); a state that can affect both, the woman and IVF outcome. On the other hand, it’s not the best drug for getting the maximum number of oocytes. If clomiphene fertility drug does not work for you and your body does not respond to it, don’t worry, you can still have a successful IVF by using gonadotropins for ovulation induction quite effectively.
The answer could be based on the age and prognosis. Moreover, according to the local legislations, there are limits regarding the number of the embryos that could be transferred in a single cycle. At the age of 40, female fertility is seriously declined. So women aged 40 or more should consider two embryos transfer for better chances of successful IVF.
Research suggests that blastocyst embryo transfer may have higher success rates compared to early embryo transfer. This is probably due to the fact that till now, there is no any accurate method 100% to determine which two or three day old embryos, have the potential to develop into quality blastocysts leading to pregnancy outcome.
14. Egg and ovarian tissue freezing
Egg freezing is a fast developing process in which oocytes are collected, frozen and stored. The method for freezing eggs successfully is called vitrification and it’s an ultra-rapid technique with high survival rates. Later, when the woman wants to get pregnant, oocytes can be thawed, fertilized and finally transferred back into the uterus as embryos. Ovarian tissue freezing is an alternative strategy, apart from oocyte freezing. It offers women the chance to preserve their oocytes, so that they may have children in the future. Ovarian tissue will be transplanted back into the body and there are already pregnancies recorded in the literature.
Which women are suitable for oocyte or ovarian tissue freezing?
A. Those diagnosed with cancer and have not yet begun chemotherapy or radiotherapy.
B. Those undergoing IVF treatment who do not consider embryo freezing an option.
C. Those who would like to preserve their future ability to have children, either because they do not yet have a partner, or for other personal or medical reasons.
15. Egg donation
Egg donation is the process by which a woman (anonymous or non-anonymous) donates her oocytes for purposes of assisted reproduction to one or more recipients. The egg donor receives medication for ovarian stimulation, in order to stimulate the production of multiple follicles and finally collect the oocytes during oocyte retrieval. Egg donation is an effective way for successful fertilization following IVF for women with poor ovarian reserve. Egg donation is the best option for women over 40 for boosting their pregnancy chances since success rates with egg donation are high.
16. Surrogate mother
Gestational surrogacy is another ART option for women who are unable for medical reasons to carry a pregnancy. In such case the woman’s fertilized egg is transferred into the womb of another healthy woman who is not genetically related to the embryo. Surrogate mother transfers the rights and obligations of parentage to the intended parents after giving birth to the child.
17. Use of donor sperm
If you have not managed to achieve pregnancy through IVF using your partners own sperm then a sperm donor might be the answer. If your partner has no sperm or it’s a very poor quality, or even after multiple failure attempts because the poor quality sperm result to very low fertilization or poor embryos quality, healthy donor sperm can dramatically increase the success rates.
High Tech & Controversial Fertility Treatments
Time lapse imaging technique is a very useful screening tool for embryo selection that may boost IVF success rates. Unlike morphologic embryo selection, the time lapse technique allows monitoring without removing the embryo from its optimal conditions, providing extra information on embryo quality prior transfer. Thus, it enables fertility specialists to identify quality embryos with increased implantation chances.
19. Genetic Analysis (PGS / PGD, array-CGH and NGS) for higher implantation rates
Preimplantation Genetic Screening (PGS) is a test for detecting common chromosomal abnormalities of the embryos that could possibly lead to unsuccessful IVF. The same technique it is possible to be used for gender selection in cases that a couple suffering from sex-linked genetic disorder and they wish to have a healthy baby following IVF. Preimplantation Genetic Diagnosis (PGD) and Comparative Genomic Hybridization (array-CGH) are other options for embryo genetic testing, detecting specific genetic conditions and/or chromosomal abnormalities.
Currently, it has been reported that a new technique called Next Generation Sequencing (NGS) when used to perform genetic analysis delivers highly detailed and accurate results for improved selection of normal, in terms of chromosomes (euploid), embryos. These tests, enable IVF specialists to select genetically normal embryos to transfer, through the embryo biopsy or polar body biopsy technique.
20. PICSI for higher success rates
ICSI is a common ART technique during which the sperm is injected straight into the egg’s cytoplasm. It is a widely used method with high success rates. ICSI is preferable when there is poor sperm quality. PICSI is a modified ICSI method, more advanced since it allows the selection of only mature spermatozoa for fertilization. In other words PICSI technique could help fertility experts to choose the best spermatozoa not only based on their morphological criteria but also according to their DNA material.
21. IMSI (Intracytoplasmic Morphologically Selected Sperm Injection)
IMSI is a method of selecting spermatozoa according to their morphology, using high resolution microscopy (allows enlargement almost x 6000 times), compared to normal microscopy currently used.
IMSI allows the selection of good morphology spermatozoa, indicating good genetic quality. This selection is performed by experienced embryologists. After selection, spermatozoa are injected into the oocytes using the normal ICSI method.
22. In Vitro Maturation (IVM)
It has been observed, since the mid 20th century, that human oocytes can resume their final stages of maturation in vitro, in other words in the laboratory. The incidence of in vitro oocyte maturation along with their ability to be fertilized in vitro, set the basis to introduce a new technique in assisted reproduction technology, known as In Vitro Maturation (IVM). IVM is a very promising technique. In the near future, IVM may offer a therapeutic choice for women wishing to avoid hormone therapy or wishing to preserve their fertility, prior to treatment for malignant diseases that could adversely affect ovarian function.
23. Can PCOS women be treated?
Women with PCOS (Polycystic Ovary Syndrome) have a high risk for ovarian hyperstimulation syndrome when injected with hormonal drugs for ovulation induction. In these cases, the physician should use very low dose of gonadotropins. Another option is the IVM (in vitro maturation) technique. During this procedure immature eggs are harvested from PCOS women and put into petri dishes to mature in vitro. After their maturation are being fertilized and the embryos are transferred to the women following the usual IVF procedure.
24. Embryos energy status. Key for higher implantation rates?
Mitochondria are organelle, mainly involved of supplying energy to the cells. Mitochondrial DNA (mtDNA), is located inside mitochondria and would be considered as a new viability indicator. “MitoScore” and “MitoGrade“ are the two recent commercially available tests in which mtDNA can be used as biomarker indicating the energy status of an embryo. According to the scientists, up to one-third of implantations fail even after Preimplantation Genetic Diagnosis by transferring chromosomally normal embryos. Based on the findings, higher level of mtDNA in embryos are associated with less chances of initiating a clinical pregnancy. The mitochondrial DNA measurement can help IVF clinics to improve the efficiency and success rates of IVF by selecting between euploid embryos after genetic analysis.
25. Embryo squishing. A new viability test in ART technology?
A new method based on a rigidity assessment of the fertilized eggs can predict the embryo’s likelihood to reach a healthy blastocyst stage with 90% accuracy. The “embryo squishing” technique is really very simple and could help fertility specialists to make a successful embryo selection that would lead to pregnancy by transferring a single embryo.
Cytoplasmic transfer is a controversial ART method applying to women with dysfunctional mitochondria. Mitochondria are small organelles into the cytoplasm of the egg. This technique allows transfer of egg donors’ cytoplasm with functional mitochondria into the oocytes with the faulty ones. This method improves success rates since deficient mitochondria can cause implantation failure and poor embryo development.
27. Menopause can be reversed. True or False?
According to scientists menopause can be reversed and there is a way to rejuvenate post-menopausal ovaries. The new technique, called platelet-rich plasma (PRP), involves extracting blood from a patient and spinning it in a centrifuge to separate out growth factors and proteins that trigger the growth of tissue and blood vessels. The effectiveness of the PRP technique is unclear and the results should be verified by others in the scientific community. According to the team, when they injected PRP into the ovaries of around 30 menopausal women age 46 to 49, were able to retrieve and fertilize eggs from most of them. The new technique could help woman menopausal women to get pregnant with their own eggs instead of using donor oocytes.
Male fertility tests
28. Men are advised to check their semen for infectious diseases
Studies showed that men infected with human cytomegalovirus (HCMV) produce a decreased number of mature sperm cells impacting their fertility. The presence of the virus in semen and male reproductive tract could possibly suggest the development of a potentially dangerous fetal infection leading to miscarriage.
29. How to detect sperm chromosomal abnormalities?
A quite useful genetic test given in IVF clinics and genetics labs is the Fluorescent In Situ Hybridisation (FISH) analysis, which can be performed in semen samples. FISH analysis is an advanced technique, that can facilitate evaluation of sperm aneuploidy (more or less chromosomes than normal) by calculating the percentage of the spermatozoa with the right number of chromosomes in a given semen sample. High chromosomal aneuploidy in a given semen sample could be related with poor sperm quality, multiple failures attempts and lower pregnancies rates.
30. What to do in case of mild or poor semen parameters
In cases with mild or severe problems in the semen analysis (low concentration, low motility, high abnormal forms, etc) maybe you should consider medical or surgical intervention (TESA). A visit to a specialist could reveal the nature of the problem and in some cases there might be an easy resolution.
The most common causes include infections diseases, hydrocele, varicocele, unbalance hormone profiles, vitamin deficiencies or genetic abnormalities. According to the problem there are different approaches starting from antibiotics, surgical operations or food supplements. There are cases where no spermatozoa could be found in the semen sample (azoospermia) and these specific cases are more difficult to be treated. For these men invasive techniques could be performed like TESA – ICSI and if live spermatozoa are found these men should consider the freezing option for future use in fertility clinics.
Recurrent IVF failures
31. Genetic testing after multiple failure attempts
If you are trying to get pregnant without any success, maybe it’s time to consider genetic screening tests. These tests are used for detecting chromosomes abnormalities (aneupdoidies) or mutated genes, carried out by you or your partner. For a certain number of couples, genetic abnormalities could be the reason of infertility and in some cases could be also inherited to your baby causing serious genetic disorders. Most common genetic tests include karyotype analysis and cystic fibrosis screening for both partners as well as Y- microdeletions analysis for men.
32. Clotting disorders for repeated pregnancy loss
If you have experienced recurrent miscarriages there might be a genetic disorder underlying. Thrombophilias are conditions, which predispose an individual to form higher blood clots than usual. These clots could prevent the physiological blood circulation between the placenta vessels and embryo and as a consequence lead to poor IVF results or recurrent failures. Genetic tests are available in the market (e.g. testing mutations in MTHFR C677T, MTHFR A1298C, Factor V Leiden, etc) and could possibly reveal the cause so that you can be treated properly for a successful outcome.
33. Hysteroscopy / Laparoscopy for successful IVF?
For a successful IVF outcome a thorough investigation for pathological conditions that can affect pregnancy chances is necessary. Hysteroscopy is an endoscopic method that can detect intrauterine abnormalities related to low pregnancy and birth rates. Laparoscopy, on the other hand, can be used to check the uterus, fallopian tubes, ovaries, and internal pelvic area. These procedures could help your physician to diagnose the cause of infertility or repeated miscarriages.
34. Intralipid Infusion Therapy
Immune system faults is a common cause of female infertility but now according to a new study, a method called “intralipid infusion therapy” can actually increase success rates. Intralipid infusion therapy is based on a blend of soya oil, egg yolk and glycerine and is thought to protect the embryo/s cell membranes from the natural cell killers’ attacks. Women who have had implantation failures or early miscarriage/s could benefit from this method.
According to a new pilot study, findings from 85 women who had experienced at least 5 IVF attempts failed at the implantation stage, suggest that 20-25% of embryo transfers, happen sooner or later than the optimum time for successful implantation. A novel test, called ERA (Endometrial Receptivity Analysis) test, can improve successful implantation and promote a positive IVF outcome by pinpointing a woman’s optimum time (implantation window) for embryo transfer based on the individual results obtained.
Prior and post IVF – Embryo Transfer (IVF-ET) tips
36. Birth control pills?
Birth control pills at the start of an IVF cycle decrease odds of creating cysts that could affect the cycle’s initiation. Moreover it is very helpful for fertility doctors to control the timing of the cycle.
37. Can acupuncture make a difference?
Although it is not scientifically documented that acupuncture can boost natural conception chances, research indicates it may be beneficial for couples undergoing IVF. A few months of acupuncture prior your embryo transfer could promote a successful outcome.
38. Is there any medication for promoting successful embryo implantation?
Some fertility doctors recommend low dose corticosteroids like glucocorticoid, for enhancing embryo survival chances after embryo transfer by preventing an attack of the immune system to the transferred embryo/s. There are also some evidences using adherence compounds into the embryo transfer culture media like Hyaluronic Acid (HA), could increase the IVF success rates in terms of live birth.
Lifestyle, supplements and fertility
Women who are considering IVF / ICSI treatment should avoid too much coffee, experts recommend. A recent study showed that women who had 5 or more cups of coffee per day had 50% lower chances of achieving pregnancy and they were 40% less likely to sustain pregnancy and deliver a baby.
40. Good fats for successful IVF?
Research suggests that “good fats” could promote pregnancy by decreasing inflammation levels of the body. A recent study reported that consumption of monounsaturated fat-rich foods like olive oil and seeds helped women trying to get pregnant through IVF.
41. Can DHEA supplements improve success rates?
Research suggests that DHEA can enhance pregnancy chances by its potential to improve age-related medical conditions like menopause symptoms. Considering fertility is age related, DHEA may improve pregnancy chances – especially for women undertaking fertility treatments.
42. Aspirin for boosting fertility?
Doctors often recommend women starting IVF treatment to take baby aspirin. The reason is that scientific data indicate that aspirin can possibly promote blood supply to the uterus and therefore improving implantation rates. A current study has already reported increased pregnancy chances for women taking aspirin.
How Can I Use This Information for me?
Assisted Reproductive Technology (ART) is all about profound procedures that are a blessing to have available as infertility treatment options. However, IVF success is affected by many factors, as you can see by the information provided in this article, including age, weight, semen quality, reproductive history etc. We hope that you found our tips on how to optimize your IVF success rates quite informative but don’t forget that your doctor is the ultimate recourse to counsel on treatment options that are right for you.