From the Guidelines
Pursuing In Vitro Fertilization (IVF) for a couple having trouble conceiving can be a viable option, but it is crucial to carefully weigh the risks and benefits, considering the latest evidence from 2024, which suggests that the clinical context of IVF significantly affects decisions about types of preimplantation genetic testing (PGT) to pursue 1. The benefits of IVF include relatively high success rates, the ability to overcome various fertility barriers, and options for genetic testing of embryos to prevent hereditary diseases. However, IVF carries risks such as multiple pregnancy, ovarian hyperstimulation syndrome, procedure-related complications, and emotional and financial strain. Key considerations include:
- The success of IVF is most significantly affected by the age of the egg and the number of euploid embryos, which may limit embryo selection options 1.
- The clinical validity of PGT-P testing may be affected by many environmental factors related to IVF, and companies offering embryonic testing should report the accuracy of their genotyping procedure used to produce polygenic risk scores (PRS) 1.
- Medical professionals should make clear to those requesting PGT-P that it has not yet been shown to have clinical utility, and they may refuse to facilitate this testing based on this and the potential for harm in some clinical situations 1.
- Couples should consider their specific fertility diagnosis, age, financial resources, and emotional readiness before proceeding with IVF, and discuss their particular circumstances with a reproductive endocrinologist to determine if IVF is appropriate for their situation, taking into account the potential risks and benefits as outlined in the latest guidelines from 2024 1. It is also important to consider the cost-effectiveness of IVF compared to other fertility treatments, such as intrauterine insemination (IUI), and to weigh the potential benefits of single embryo transfer (SET) versus double embryo transfer (DET) in terms of reducing the risk of multiple pregnancy 1.
From the Research
Risks of Pursuing IVF
- Ovarian hyperstimulation syndrome and multiple pregnancies are the most serious risks associated with IVF, as reported by 2
- Other potential risks include increased levels of anxiety and depression, ovarian torsion, ectopic pregnancy, pre-eclampsia, placenta praevia, placental separation, and increased risk of cesarean section, as noted by 2
- The association between assisted conception and long-term risk of cancer is debatable, according to 2
Benefits of Pursuing IVF
- IVF can be an effective treatment for unexplained infertility, with an overall pregnancy rate per embryo transfer of 57% observed in one study, as reported by 3
- The use of intracytoplasmic sperm injection (ICSI) can result in a significantly better fertilization rate compared to conventional IVF, as found by 3
- IVF can provide a chance for women to become pregnant, even after multiple consecutive failing cycles, with a predictive model available to estimate the chances of live birth, as described by 4
- The pregnancy rate can vary depending on the number of transferred embryos, with a higher rate observed in triple-transfers, as reported by 5
Considerations for IVF Treatment
- The starting dose of gonadotrophins may not affect the outcome of IVF treatment for expected poor responders, as found by 6
- The antral follicle count can be used to predict the response to IVF treatment, with patients having a low count potentially not benefiting from a higher starting dose of gonadotrophins, as reported by 6
- The decision to pursue IVF treatment should take into account the potential risks and benefits, as well as the individual circumstances of the couple, including their age, infertility diagnosis, and previous treatment outcomes, as discussed by 3, 2, and 4