Step four. ivf and its types

Indications for an IVF cycle can be classified into the absolute ones when there are no doubts about the necessity of assisted reproductive technologies (ART), and the relative ones that can take up a lot of time, with the specialist trying to decide how to induce pregnancy.

The absolute indications include the following:
• A tubal factor (history of tubectomies, impermeable fallopian tubes);
• A marked male factor;
• Diminished ovarian reserve (assessment of AMH, antral follicles count)

Let us tell you about surrogacy right away. You should understand that the IVF programme, especially when involving a surrogate mother, is a cry of despair. This means that a woman has practically no chances of conceiving and giving birth naturally. It also means that a surrogate mother is not a free option for any couple or any woman. There are such factors as the surrogate mother's age, her important job, her fine figure, the suffering from toxicosis endured during the 1^st pregnancy, the indelible impression made by the maternity hospital...

As a solution to the infertility problem, surrogacy can only be discussed if:
• There are abnormalities or changes in the uterine cavity impeding the embryo implantation as well as the child's development;
• There are general contraindications for pregnancy (uncompensated diabetes mellitus, history of orthopaedic surgeries etc). In such a case, the medical conclusion is provided by the specialist treating the respective disease;
• The patient has a history of embryo transfers of excellent and good quality embryos that did not lead to implantation.

The seeming simplicity of these paragraphs harbours a very responsible decision of a fertility specialist or of our colleagues, and we give our conclusion about the necessity of surrogacy only after we have deliberated all the factors in the patient's medical history.

The same applies to the use of donor material: oocytes and sperm. Only when pregnancy with the patient's own cells is impossible or when its probability is as good as absent will we start this unpleasant discussion. Unfortunately, donor oocytes are a very popular option nowadays, due to a number of reasons. This will be discussed in the section called "Poor ovarian response to stimulation". You can trust us that fertility specialists will only offer this variant of IVF if we realize that the probability of pregnancy with the patient's own oocytes is much lower than that of complications developing in the course of stimulations or punctures, or when there is no chance at all... Cases like these are quite frequent as well...

The relative indications for IVF include:
- Age

After 38, the probability of natural conception as well as conception via an IVF cycle starts to decrease significantly with each passing year. This is why IVF is usually heavily advocated in case of older patients so that not to waste precious time.

The duration of infertility

The failure to conceive for more than 2 years after you have undergone a complete examination and have been given no reason for the non-occurrence of pregnancy is also an argument in favor of IVF. Insemination and controlled ovulation induction do not pay off in case of such patients.

Failed inseminations and ovulation inductions

Even if we have decided that it is not time for you yet to think about IVF and have suggested your trying to get pregnant without ART, if you have failed to do so in the course of 2-3-4 cycles, we will also have to consider switching to IVF. One-two years of inseminations and stimulations will not bring you any closer to the goal; instead, we will just lose time, money and nervous energy. Those who this treatment method is good for will get pregnant in the first three cycles. If you are not them, we will find another way!

Reconstructive surgery on the fallopian tubes, especially if repeatedly performed

If the surgeon had already had to restore the permeability of the fallopian tubes at least once and if after this manipulation you did not get pregnant within 6-12 months, there is no sense in waiting for the miracle, let alone in repeating the surgery. Fallopian tubes are nothing like water pipes, and their permeability is not the principle quality. A fallopian tube must have a live epithelium as well as a normal motility that helps a sperm cell reach the egg cell in the infundibulum of the uterine tube, whereafter the fertilized oocyte sets off back towards the uterus. Understanding whether a tube is capable of handling such a difficult task is impossible. Hence, we should act on a matter-of-fact basis:

Is the tube permeable? YES
Is conception unsuccessful? YES
Is the sperm fertile? — YES
Do you have ovulation? — YES
Hence, there is something wrong with the tube.
Hence, it is time you stopped worrying what is actually wrong with it.
Hence, IVF is our choice.

We did our best creating this section. We really want it to help you find the right as well as the shortest way to your child! The most frequent mistake is the initially wrong choice of infertility treatment. IVF is a tough treatment method and a serious test for a couple, but at the same time, it is the most effective type of therapy! Hence we have what (and who) to fight for!

This is educational material from the portal’s archive. It does not replace medical advice. Discuss tests, medicines and treatment decisions with your clinician.