Ever more Polish couples face the problem of infertility. A significant part of them considers or chooses in vitro fertilization. However, the success of in vitro fertilization depends on many factors – Krzysztof Łukaszuk PhD, MD, from the INVICTA Fertility Clinic explains what affects the successful outcome of the procedure and what the partners’ chances for having a child are.
What is the effectiveness of IVF? Does in vitro fertilization give a chance for pregnancy already at first attempt?
The success of in vitro fertilization depends primarily on individual characteristics and health condition of both partners. Usually, on the basis of test results and medical interview, we are able to predict what the chances for getting pregnant are with the application of this solution. Most often, in the case of partners facing the problem of infertility, two or three attempts at in vitro fertilization are necessary. Naturally, this is not a rule – often the first procedure brings results, but it happens sometimes that the Patients have to show more patience and perseverance in treatment.
What information does the doctor need in order to assess the chances for a successful procedure?
Most of all, a woman’s age is important, although also a man’s semen parameters change unfavorably over time. Therefore, in order to make diagnosis, tests have to be carried out in both patients. For female patients, we recommend the test determining the level of AMH – a hormone which indicates the level of ovarian reserve. This is a marker which allows to evaluate a woman’s fertility – how many egg cells she has and what their quality is. Further, gynecological examinations and hormonal tests allow to diagnose other potential problems related to the structure of reproductive organs or to the functioning of ovaries, pituitary, thyroid and adrenal glands. Men can carry out general semen analysis where basis parameters related to the ability to fertilize a woman are checked. Additionally – where there are indications – we recommend detailed semen analysis or sperm DNA fragmentation test. Based on their results, we can assess the percentage of normal sperm cells, their life functions, activation (that is, the ability to fertilize an egg cell) and the quality of the genetic material which could be passed on to future children. The sensitivity and accuracy of all tests is of key importance for the proper diagnosis.
What factors should be taken into account when diagnosis is being made?
During my first talk with the Patients, I always ask about the duration of infertility, meaning the time which has passed from the beginning of their attempts at having a child. We talk about infertility when a woman does not get pregnant for over a year despite regular (3-4 times a week) sexual intercourse without using contraceptives. I also verify the previous tests in order to make use of the already obtained data. Then the ultrasound exam is carried out, and if any doubt arises – hysteroscopy is performed. We also often carry out the tubal patency assessment. The important part are also genetic tests which in case of positive history often set the direction of further proceedings. Here, the reliability of tests is important; this is why INVICTA has its own full-profile genetic and molecular laboratory which is specialized so as to support the treatment of infertility. That is where the currently most important diagnostic testing takes place.
What more should the doctor know at this stage?
In case of diagnosis for infertility, the medical interview should also include questions concerning the number of miscarriages and of potential previous attempts at IVF. It is also important whether a woman already has children. These factors have influence on the success of treatment. The detailed questionnaire, the example of which can be found on the website of INVICTA, contains also questions concerning the family problems, overall health condition, etc. Sometimes small – seemingly unimportant – details put us on the trail of the key problem.
Is it only the patients’ health condition that is relevant for the efficacy of IVF?
No, far from it. A tremendous role in the medically assisted process of infertility treatment is played also by the embryology laboratory. It is on the quality of its work that the efficiency of the whole center depends on. And, also in this laboratory, the most important stages of the early development of future children take place. The conditions in which the embryos stay should differ significantly from typical laboratory conditions. It has been known for several years that the atmospheric air in which embryos are usually cultured is harmful for them. At INVICTA – as the first facility in Poland – embryos are cultured in a closed system where their contact with harmful atmospheric air is limited to a minimum. Other factors which impact the effect of treatment are clinical procedures which are optimized both during stimulation and in particular during and after embryo transfer. Already after the transfer, we check the hormone levels and verify the doses of medications so as to ensure that the patient’s hormonal condition is optimal for the reception of pregnancy.
And what is important in the case of embryos and their placement into a woman’s uterus?
The quality of embryos depends both on the personalized stimulation of the patient, the moment of its completion and the optimization of embryos for the patient. The procedure of transfer, that is placing embryos in the uterus, should be carried out as fast and as gently as possible.
One cannot skip over the issue of the number of transferred embryos…
Yes. The recommendations of the Polish Gynecological Society from 1997 currently in force are definitely obsolete. In the centers with high quality and, therefore, high effectiveness of IVF procedures, the number of embryos transferred should not be too high. In particular if we carry out preimplantation diagnosis which definitely reduces the rate of miscarriages, that is increases the rate of maintained pregnancies.
The Polish Gynecological Society recommends transferring 2 embryos in the case of women aged 35 and less, and 3 embryos if the patient is older. In our Clinic, we endeavor to transfer a maximum of 2 embryos in case of all patients. Multiple pregnancy (especially when more than 2 embryos are transferred) carries a high risk of miscarriages, and in particular of preterm births. Similarly, the rate of problems related to fetal development (causes unrelated to genetics) is definitely higher in case of multiple pregnancies.
Are there many couples, who, despite the necessity to make a few attempts, continue the treatment until they achieve a pregnancy?
It is hard to say, since patients – in case of no immediate effect – often change the centers in which they are treated. This is naturally also the factor which affects the effectiveness of IVF. It is more beneficial to act consistently under the supervision of a proven expert who has the knowledge of the particular case and medical situation of both partners. Another issue are the costs, which, in case of several attempts at in vitro fertilization program, can prove a serious barrier. For these reasons, INVICTA has been implementing the “In Vitro. Until Success” program for several years, under which only a one-time fee is charged, but there are as many attempts at IVF as needed for achieving a pregnancy. For many patients – in particular those with serious problems, or the older ones – this is the only option to become a mother.